Okul Çağı Öncesi Çocuklarda Perkütan Nefrolitotomi Sonuçları: Tek Merkez Deneyimi

Abstract

Amaç: Böbrek taşı yetişkinlerde olduğu gibi çocukluk döneminde de önemli bir ürolojik problemdir. Bunlara genetik ve metabolik hastalıklar da eşlik etmekte ve ülkemizdeki taş hastalarının yaklaşık %20’si çocuk yaş grubundadır. Bu çalışmada; kliniğimizde 6 yaş ve altı okul öncesi çocuklarda uygulanan perkütan nefrolitotomi (PNL) sonuçlarımızı sunmayı amaçladık.Gereç ve Yöntemler: Mart 2012 ile Haziran 2016 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Hastanesinde böbrek taşları 1.5 cm’den büyük veya ESWL’ye dirençli taşı olan, 0-6 yaş arası (okul öncesi) 54 çocuk hasta uygun tetkikler ile değerlendirildikten sonra genel anestezi uygulanarak mini-PNL uygulandı. Hastalara, önce supin pozisyonda sistoskopi eşliğinde üreter kateteri takıldı ve üretral foley katetere tespit edildi, daha sonra prone 17 fr nefroskopla giriş sağlandı. İşlem sonrası gerektiği düşünülen hastalara renal kılıf içerisinden nefrostomi kateteri yerleştirildi. PNL sonrası 4 mm’den küçük taşlar, klinik önemsiz taş rezidüleri olarak kabul edildi.Bulgular: Toplamda PNL operasyonu yapılan 54 hastanın yaş ortalaması 3.16±0.8 yıldı ve bu hastaların 25’ine sol PNL, 29’una sağ PNL uygulandı. Üç hastada bilateral böbrek taşı vardı. Eş seanslı uygulama olmadı. Dokuz hastanın (%16.6) daha önce ESWL hikayesi mevcuttu. Ortalama taş boyutu 370±45 mm2’di. Ortalama operasyon zamanı 55±21 dk’dı. Operasyon sonrası taşsızlık sıklığı 45(%83.3) hastada mevcuttu. Post op 2 (%3.7) hastada serbest sıvı ve ileus tablosu gelişti. Post op toplam 6 (%11.1) hastaya kan transfüzyonu yapıldı. Bunlara ek JJ stent takılarak stabil hale geldi. Tüpsüz PNL uygulanmadı. Nefrostomi çıkarılması sonrası akıtma nedeniyle 4 (%7.4) hastaya JJ stent takıldı. Ortalama nefrostomi kalış zamanı 3.1±0.9 gündü.Sonuç: PNL her yaşta olduğu gibi 2’cm den büyük böbrek taşları ve ESWL’ye dirençli taşların tedavisinde, okul öncesi çocuklarda da başarısı yüksek minimal invaziv bir yöntemdir.

Keywords

• Böbrek taşı, Okul-öncesi, PNL

The Results of Percutaneous Nephrolithotomy in Pre-School Age Children: Single Center Experience

Abstract

Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery.Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine.PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16± 0.8. 25 left-sided and 29 right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was 370±45 mm2 , while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days. Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens. Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure

Keywords

• Kidney stone, Pre-school, PCNL

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