Üreter taşları tedavisinde pnömatik ve holmium lazer taş kırıcıların karşılaştırılması: retrospektif gözlemsel çalışma

Year 2022, Volume: 15 Issue: 4, 648 - 655, 01.10.2022

Tuncer Bahçeci Aykut Başer

https://doi.org/10.31362/patd.1055563

Abstract

Amaç: Üreter taşlarının endoskopik tedavisinde en sık kullanılan taş kırıcılar olan holmium lazer ve pnömatik taş kırıcıların tüm üreter seviyelerinde etkinlik ve komplikasyonlarını karşılaştırmak.
Gereç ve yöntem: Ocak 2018-2021 tarihleri arasında, tek cerrah tarafından üreterorenoskopik taş kırma uygulanan 510 hastanın verileri retrospektif olarak incelendi. Taş kırıcı cinsine göre lazer taş kırıcı (Grup 1) ve pnömatik taş kırıcı (Grup 2) olarak iki gruba ayrıldı. Taşın üreter içerisindeki lokalizasyonuna göre üreter proksimal, mid ve distal olmak üzere 3 bölüme ayrıldı. Demografik veriler, tam taşsızlık oranları, double-j (JJ) stent kullanımı, JJ stent çıkarılma süresi, anestezi yöntemi, operasyon süresi, hastanede kalış süresi ve komplikasyon oranları araştırıldı.
Bulgular: Hasta sayısı sırasıyla Grup 1’de 265, Grup 2’de 245 saptandı. Genel başarı oranı Grup 1'de %98,5, Grup 2’de %93,9 saptandı ve Grup 1’de istatiksel olarak daha başarılı bulundu (p=0,006). Proksimal üreter taşlarında başarı oranı Grup 1'de anlamlı olarak daha yüksek bulundu (%94,4’e karşı %68,9; p=0,001). Stent kullanılmadan sonlandırılan vaka sayısı Grup 1'de istatiksel olarak daha yüksek saptandı (%29,8’e karşı %17,6; p<0,001). Orta üreter ve distal üreter taşları, anestezi tipi, ameliyat süresi, hastanede kalış süresi, JJ stent çıkarma süresi ve komplikasyonlar açısından iki grup arasında fark bulunmadı.
Sonuç: Üreter taşları tedavisinde en sık tercih edilen yaklaşım üreterorenoskopik taş kırma yöntemidir. Taşın üreter içerisindeki lokalizasyonu ve taş kırıcının cinsi başarıyı etkilemektedir. Proksimal üreter taşları tedavisinde, yüksek etkinlik ve daha az üreteral stent ihityacı nedeniyle holmium lazer taş kırıcı tercih edilebilir.

Keywords

Holmium lazer, pnömatik taş kırıcı, üreter taşları

Supporting Institution

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Project Number

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Thanks

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Comparison the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for the treatment of ureteral stones: a retrospective observational study

Abstract

Purpose: To compare the efficacy and complications of holmium laser lithotripters and pneumatic lithotripters, the two most commonly used lithotripters in the endoscopic treatment of ureteral stones, at all ureteral levels.
Material and method: Retrospective data on 510 patients who had ureterorenoscopic lithotripsy performed by a single surgeon between January 2018 and 2021 were studied. Patients were divided into two groups: those who received a holmium laser lithotripter and those who received a pneumatic lithotripter. Demographic information, stone-free rates, double-j (JJ) stent usage, JJ stent removal time, type of anesthesia, operation time, hospital stay, and complication rates were all examined.
Results: The patient numbers in the holmium laser and pneumatic groups were 265 and 245, respectively. The overall success rate in group 1 was found to be significantly higher than in group 2 (98.5 percent vs 93.9 percent; p=0.006). Group 1 had a significantly higher success rate in proximal ureteral stones (94.4 percent vs 68.9 percent; p=0.001). Patients in group 1 had a significantly higher rate of not using any ureteral stent (29.8 percent vs 17.6 percent; p<0.001). There was no difference between the two groups in terms of mid-ureter and distal ureter stones, anesthesia type, operation time, hospital stay, JJ stent removal time, and complications.
Conclusion: For ureteral stones, ureterorenoscopic lithotripsy is the chosen therapeutic approach. The location of the stone in the ureter as well as the type of lithotripters used can have an impact on the outcome. Because of its great efficiency and lack of need for ureteral stents, holmium laser lithotripsy may be preferred for the treatment of proximal ureteral stones.

Keywords

Holmium laser, pneumatic lithotripsy, ureteral stones

Project Number

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