Erişkin Böbrek Taşı Hastalarında Daha Minimal İnvazif Perkütan Nefrolitotomi

Year 2021, Volume: 18 Issue: 2, 221 - 224, 27.08.2021

Bülent Katı , Adem Tunçekin , İbrahim Halil Albayrak , Muhammed Nur Karadeniz , Halil Çiftçi

https://doi.org/10.35440/hutfd.930444

Abstract

Amaç: Perkütan nefrolitotomi (PNL) ameliyatı 2 cm’den büyük böbrek taşları için önerilen minimal invazif bir cerrahi işlemdir. Yıllar içinde pediatrik böbrek taşları için geliştirilen minyatürize nefroskoplar artan bir hızla cerrahide mini PNL tanımını alarak uygulanmıştır. Bu çalışmada erişkin hastalara uyguladığımız mPNL operasyonlarının başarı ve sonuçlarını değerlendirdik.
Materyal ve Metod: Ocak 2018-Haziran 2020 tarihleri arası hastanemizde 18 yaş üstü erişkin böbrek taşlarına pron pozisyonda uyguladığımız mPNL (20-24f), 42 hasta pre op ve post op özellikleri ile beraber retrospektif olarak değerlendirildi. Hasta özellikleri, operasyon sonrası taşsızlık durumu ve post op komplikasyonlar belirlenerek çalışmaya eklendi.
Bulgular: Hastaların yaş ortalaması 33,64±6.8 yıldı. Hastaların 18’inde (%42.8) en az grade 1 hidronefroz mevcuttu. Ortalama taş boyutu 300±26 mm2’di. Üç (%7.1) hastada “staghorn” tipi taş mevcuttu. Ortalama operasyon zamanı 52±18 dk’di. Operasyon sonrası taşsızlık oranı 33 (%78,5) hastada mevcuttu. Post op toplam 3 (%7.1) hastaya ek kan desteği sağlandı. Tüpsüz PNL uygulanmadı. Nefrostomi çıkarılması sonrası akıtma nedeniyle 4 (%9.5) hastaya ve post operatif piyelonefrit tablosu gelişen bir hastaya JJ stent takıldı. Ortalama nefrostomi kalış zamanı 2,5±0,6 gündü.
Sonuç: mPNL özellikle pre-post operatif komplikasyonların daha az ve düzeltilebilir olması nedeniyle kanama riski veya operasyon için ko-morbiditesi olan erişkin hastalarda akut obstruksiyonu açmak amaçlı ilk seçeneklerden olabileceğini önermekteyiz.

Anahtar kelimeler: PNL, Mini PNL, Böbrek Taşı, Komplikasyon

Keywords

PNL, Mini PNL, Böbrek Taşı, Komplikasyon

Supporting Institution

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Teşekkürler

More Minimally Invasive Percutaneous Nephrolithotomy in Adult Patients with Kidney Stones

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure recommended to remove kidney stones larger than 2 cm. Miniaturized nephroscopes developed over the years to treat pediatric kidney stones have been increasingly used in surgeries referred to as mini PCNL (mPCNL). This study will evaluate the success rates and results of mPCNL operations performed on adult patients.
Materials and Methods: The study will examine mPCNL (20-24f) performed in the prone position on adults over 18 years old with kidney stones between January 2018 and June 2020. Further, the pre-operative (pre-op) and post-operative (post-op) features of 42 patients were retrospectively evaluated. The patients’ features, including post-op stone-free status and complications, were determined and included in the research.
Results: The mean age of the patients was 33.64 ± 6.8 years, and 18 (42.8%) of them had at least grade 1 hydronephrosis. The average stone size was 300 ± 26 mm². Three (7.1%) patients had a "staghorn" type stone. The mean operation time was 52 ± 18 minutes and post-op stone-free rate was present in 33 (78.5%) patients. Additionally, post-op blood transfusions were provided to three (7.1%) patients. Tubeless PCNL was not applied to any patients. After the removal of the nephrostomy tubes, double-J stents were placed in four (9.5%) patients for drainage and in another due to postoperative pyelonephritis. The average length of time a nephrostomy tube was used on patients was 2.5 ± 0.6 days.
Conclusions: mPCNL should be one of the first options for resolving ureteral obstructions in adult patients with a high risk of bleeding or co-morbidities from the operation. Thus, it is a more reliable option that can be used to reduce the risk of complications.


Key Words: PCNL, Mini PCNL, Kidney Stones, Complications

Keywords

PCNL, Mini PCNL, Kidney Stone, Complications

References

• 1- D'Arcy FT, Lawrentschuk N, Manecksha RP, Webb DR. Renal track creation for percutaneous nephrolithotomy: the history and relevance of single stage dilation. Can J Urol. 2015 Oct;22(5):7978-83.
• 2- Webb DRTH. Intraluminal surgery of the uper tract. Dial Paed Urol first edition, USA 1995;18: 2–4
• 3- Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M, et al. Miniperc? No, thank you! Eur Urol. 2007 Mar;51(3):810-4.
• 4- Salah MA, Tóth C, Khan AM, Holman E. Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country. World J Urol. 2004 Oct;22(4):277-80.
• 5- Samad L, Aquil S, Zaidi Z. Paediatric percutaneous nephrolithotomy: setting new frontiers. BJU Int. 2006 Feb;97(2):359-63.
• 6- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13.
• 7- Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review. Curr Urol Rep. 2018 Mar 7;19(4):27.
• 8- Schoenthaler M, Wilhelm K, Hein S, Adams F, Schlager D, Wetterauer U, et al. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20mm.World J Urol. 2015;33(10):1601–5.
• 9- Jones P, Bennett G, Aboumarzouk OM, Griffin S, Somani BK. Role of Minimally Invasive Percutaneous Nephrolithotomy Techniques-Micro and Ultra-Mini PCNL (<15F) in the Pediatric Population: A Systematic Review. J Endourol. 2017 Sep;31(9):816-824.
• 10- Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S, Vyas J, Jagtap J et al. Current role of microperc in the management of small renal calculi. Indian J Urol. 2013 Jul;29(3):214-8.
• 11- Thapa BB, Niranjan V. Mini PCNL Over Standard PCNL: What Makes it Better? Surg J (N Y). 2020 Feb 12;6(1):e19-e23.
• 12- Ganesamoni R, Sabnis RB, Mishra S, Parekh N, Ganpule A, Vyas JB et al. Prospective randomized controlled trial comparing laser lithotripsy with pneumatic lithotripsy in miniperc for renal calculi. J Endourol. 2013 Dec;27(12):1444-9.
• 13- Kati B, Buyukfirat E, Pelit ES, Yagmur I, Demir M, Albayrak IH, Ciftci H. Percutaneous Nephrolithotomy with Different Temperature Irrigation and Effects on Surgical Complications and Anesthesiology Applications. J Endourol. 2018 Nov;32(11):1050-1053.
• 14- Lahme S. Miniaturisation of PCNL. Urolithiasis. 2018 Feb;46(1):99-106.
• 15- Sebaey A, Khalil MM, Soliman T, Mohey A, Elshaer W, Kandil W et al. Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial. Arab J Urol. 2016 Mar;14(1):18-23.