Üst Üreter Taşlarında Tedavi Yöntemlerinin Karşılaştırılması Ve Başarı Üzerine Etkili Faktörler

Year 2020, , 57 - 64, 16.03.2020

Hüseyin Aydemir , Osman Köse Salih Budak Deniz Gül

https://doi.org/10.31832/smj.623052

Abstract

Amaç: Üst üreter taşlarının
tedavisinde beden dışı şok dalga (ESWL) 
ve üreteroskopi (URS ) uygulamalarının etkinliğini ve başarı üzerine
etkili olabilecek faktörleri değerlendirmek.

Yöntemler: Üst üreter taşı tanısı ile
tedavi edilen 233 hastanın verileri retrospektif olarak değerlendirildi. ESWL
uygulanan hastalar Grup 1, URS yapılan hastalar ise Grup 2 olarak ayrıldı. Tüm
hastalar kontrastsız  abdominal bilgisayarlı
tomografi ile değerlendirildi. Hastaların yaş ve cinsiyetleri, vücut kitle
indeksi, taş boyutu, ortalama taş dansitesi, cilt-taş mesafesi gibi faktörler
kayıt edilerek tedavi başarısı üzerine etkileri değerlendirildi.

Bulgular: Hastaların yaş ortalaması 47,4
yıl idi. Ortalama taş boyutu 119,7 mm³ idi ve ortalama taş dansitesi
690,5 Hounsfield Ünitesi idi. Grup 1’de   %55,2 taşsızlık tespit edildi. Grup 2’de ise
bu oran %74,1 idi.  Kadın cinsiyet, taş
boyutu ve cilt taş mesafesi ESWL başarısı için prediktif faktörlerdi.  URS için herhangi bir prediktif faktör tespit
edilmedi. Taş cilt mesafesi 10 cm’den uzun olanların kısa
olanlara göre başarısız olma riski 13 kat daha fazlaydı (p<0.001). URS
yapılan grupta ise herhangi bir parametrenin istatistiksel olarak başarıyı
etkilemediği görülmüştür.

Sonuç: Bu çalışma, üst üreter taşı olan hastalarda
URS’nin ESWL’ye kıyasla daha yüksek taşsızlık oranına sahip olduğunu
göstermiştir.  URS daha fazla hastanede
kalma süresi ve daha fazla cerrahi enstrüman gerektirmektedir.  ESWL uygulanan hastalarda ise ikincil tedavi
ihtiyacı daha fazladır

Keywords

Extrakorporeal şok dalga litotripsi, Üreter taşı, Üreteroskopi

Comparison Of Treatment Methods In Upper Uretheral Stones And Factors Affecting Treatment Success

Abstract

Aim:
To evaluate the
efficacy of extracorporeal shock wave (ESWL) and ureteroscopy (URS) in the
treatment of upper ureteral stones and the factors that may affect the success.

Methods:
The data of 233
patients treated with the diagnosis of upper ureteral stones were analyzed
retrospectively. Patients divided two groups according to ESWL (Group 1) and
URS (Group 2) treatment. All patients were evaluated by non-contrast abdominal
computed tomography. The factors such as age and sex, body mass index, stone
size, mean stone density, skin-stone distance were recorded and their effects
on treatment success were evaluated.

Results:
The mean age of
the patients was 47.4 years and the mean body mass index was 25.9 kg/m².The
mean stone size was 119.7 mm³ and the mean stone density was 690.5
Hounsfield Units. 76.4% of the patients had hydronephrosis. Stone-free status
was detected in 55.2% patients in the group 1, while it is 74.1% in the group 2.
Female gender, stone size and skin distance were predictive factors for ESWL
success. No predictive factor was detected for URS. The risk of failure was 13
times higher than those with shorter stone skin lengths greater than 10 cm (p
<0.001). In addition, when the stone volume increased by 1 unit, the risk of
failure increased by 1-fold (p = 0.009). In the URS group, it was observed that
any parameter did not affect statistical success.

Conclusion:
This study
showed that URS had a higher stone-free rate compared to ESWL in patients with
upper ureteral stones. URS requires more hospital stay and more surgical
instruments.  Otherwise, the need for
secondary treatment is higher in patients undergo ESWL.

Keywords

Extracorporeal shock wave lithotripsy, Ureteral calculi, Ureteroscopy

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