Taşa Bağlı Akut Üst Üriner Obstrüksiyonlarda Cerrahi Dekompresyon Olarak Ne Seçmeli? JJ Kateter ve Perkütan Nefrostominin Karşılaştırılması

Year 2025, Volume: 20 Issue: 1, 40 - 46, 27.02.2025

Ali Ayrancı , Faruk Özgör

https://doi.org/10.33719/nju1615392

Abstract

Giriş: Taşa bağlı akut üst üriner obstrüksiyon bazı durumlarda konservatif kalınabilse de perkütan nefrostomi kateter (PNC) veya retrograd üreteral stent (RUS) ile cerrahi dekompresyon yapılarak tedavi edilmektedir. Bu iki tedavinin başarı ve komplikasyon açısından birbirine üstünlüğünü gösteren yeterli veri bulunmamaktadır. Biz bu çalışmada iki tedavi yaklaşımını başarı ve komplikasyon açısından karşılaştırmayı amaçladık.
Materyal-metod: Ocak 2017 ile Ocak 2022 arasında, üçüncü basamak sağlık kuruluşunda üreter taşları nedeniyle acil JJ stenti ve acil nefrostomi kateteri takılan hastalar retrospektif olarak incelendi. Üreter taşı dışındaki nedenlerle müdahale edilen hastalar, gebe hastalar, 18 yaş altı hastalar, koagülopatisi olan hastalar ve kronik böbrek yetmezliği olan hastalar çalışmadan hariç tutuldu. JJ stent grubunda 112 hasta ve nefrostomi grubunda 19 hasta olmak üzere toplam 131 hasta çalışmaya dahil edildi.
Bulgular: 12. saat tedavi sonrası karşılaştırmada jj stent grubunda istatistiksel olarak daha yüksek kreatinin düzeyleri bulundu (p=0,042). Tedavi sonrası 48. saatte kreatinin değerlerinde gruplar arasında fark yoktu (p=0,579). JJ stent grubunda intraoperatif komplikasyon oranı %14,3 iken nefrostomi grubunda %10,5 idi. Gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p=0,660). Postoperatif komplikasyonlar ağrı, ateş, sepsis ve hematüri olarak sınıflandırıldı. Postoperatif komplikasyon oranları gruplar arasında istatistiksel olarak benzerdi (p=0,490).
Sonuç: Acil cerrahi dekompresyon gerekliliğinde perkütan nefrostomi ya da retrograd üreteral stent takılması hastalığın yönetiminde benzer oranda etkin ve güvenilir şekilde uygulanabilir tedavilerdir. Komplikasyonlar açısından her iki tedavi yaklaşımı arasında anlamlı fark yoktur.

Keywords

Üriner obstrüksiyon, akut obstrüksiyon, renal kolik, nefrostomi, JJ kateter, üreter taşı, hidronefroz

Which Surgical Decompression Method to Choose for Acute Upper Urinary Obstruction Due to Stones? A Comparison of JJ Stenting and Percutaneous Nephrostomy

Abstract

Objective: Acute upper urinary tract obstruction due to stones is treated with surgical decompression with percutaneous nephrostomy catheter (PNC) or retrograde ureteral stent (RUS). There is not enough data to show the superiority of these two treatments. In this study, we aimed to compare the two treatment approaches in terms of success and complications.
Material and Methods: Between January 2017 and January 2022, patients who underwent emergency JJ stent and emergency nephrostomy catheter insertion due to ureteral stones in a tertiary healthcare institution were retrospectively analyzed. Patients who underwent intervention for reasons other than ureteral stones, pregnant patients, patients under 18 years of age, patients with coagulopathy and patients with chronic renal failure were excluded. A total of 131 patients, including 112 patients in the JJ stent group and 19 patients in the nephrostomy group were included in the study.
Results: Statistically higher creatinine levels were found in the JJ stent group in the 12th hour post-treatment comparison (p=0.042). There was no difference between the groups in creatinine values at the 48th hour after treatment (p=0.579). The intraoperative complication rate was 14.3% in the JJ stent group, compared to 10.5% for the nephrostomy group. There was no statistically significant difference between the groups (p=0.660). Postoperative complication rates were statistically similar between the groups (p=0.490).
Conclusion: In cases where urgent surgical decompression is required, PNC or RUS placement are equally effective and reliable treatments for the management of the disease. There is no significant difference between the two treatment approaches in terms of complications.

Keywords

urinary obstruction, acute obstruction, renal colic, nephrostomy, jj catheter, ureter stone, hydronephrosis

Ethical Statement

Haseki Training and Research Hospital Clinical Research Ethics Committee Date: 08.06.2022 Decision No: 112-2022.

Supporting Institution

The authors declared that this study received no financial support.

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