Standart Perkütan Nefrolitotomi ve Tüpsüz Perkütan Nefrolitotomi Sonuçlarının Karşılaştırılması: Prospektif Randomize Çift Kör Çalışma

Abstract

Amaç: Standart PNL ve tüpsüz PNL yapılan hasta gruplarının güvenlik, etkinlik ve hasta konforu açısından karşılaştırılmalarını amaçladık.

Gereç ve Yöntemler: PNL endikasyonu alan 78 hasta çalışmaya alındı. Standart PNL yapılan 38 hasta Grup I ve tüpsüz PNL prosedürü uygulanan 40 hasta Grup II olarak randomize edildi. Çalışma prospektif randomize çift kör çalışma olarak dizayn edildi. Operasyon sonunda aktif kanaması olan ve multipl akses kullanılan hastalar çalışma dışı bırakıldı. Ameliyat sonrası ağrı ve komplikasyonların değerlendirilmesinde sırasıyla VAS (visual analogue scale) ve modifiye Clavien sınıflaması kullanıldı.

Bulgular: Yaş, cinsiyet, taş boyutu, taşların böbrekteki lokalizasyonları, taraf gibi demografik verilerde iki hasta grubu arasında istatistiksel fark yoktu (P>0,05). Yine perioperatif verilerde; operasyon süresi, skopi süresi, taşsızlık oranları, peroperatif kreatin ve hemoglobin değişimi, kan transfüzyonu, VAS 2-VAS 3 ağrı skorları, analjezik gereksinimi, ateş ve ek cerrahi gerektiren komplikasyonlarda iki grup arasında istatistiksel fark bulunmadı (P>0,05). VAS 1 skoru ve hastanede kalış süreleri açısından her iki grup karşılaştırıldığında, her iki parametre tüpsüz PNL grubunda istatistiksel olarak anlamlı düşük bulundu (P=0,003).

Sonuç: Tüpsüz PNL operasyonu, erken postoperatif dönemde daha az ağrı ve kısa hastanede kalış süresi gibi avantajları ve standart PNL operasyonuna göre anlamlı olmayacak derecede düşük komplikasyon oranları ile deneyimli cerrahlar tarafından etkin ve güvenle uygulanabilecek endoürolojik bir yöntemdir.    

Keywords

• Böbrek taşları,Perkütan nefrolitotomi,Standart PNL,Tüpsüz PNL,Ağrı,Hastanede kalış süresi

A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study

Abstract

Aim: We aimed to compare patient groups who underwent either a standard percutaneous nephrolithotomy (PNL) or tubeless PNL for safety, effectiveness and patient comfort.

Material and Methods: 78 patients were included in the study. Patients who underwent the standard PNL (n=38) or tubeless PNL (n=40) were randomized into Groups 1 and 2, respectively. This study was designed as a prospective, randomized, double-blind investigation. Patients who had active bleeding at the end of the operation and those with multiple access tracts were excluded from the study. To evaluate postoperative pain and complications, a visual analogue scale (VAS) and a modified Clavien classification were used, respectively.

Results: A statistically significant difference was not found between the two patient groups for demographic data (age and gender), or for size, laterality, and intrarenal location of the stone(s) (p>0.05). Perioperative data, including operative and fluoroscopy times and stone‑free rates, perioperative changes in creatinine and haemoglobin values, blood transfusion, VAS 2 to 3 pain scores, analgesic requirements, fever and complications requiring additional surgical treatment were not statistically different between groups (p>0.05). A VAS 1 pain score and hospital stays were significantly decreased in the tubeless PNL group (p=0.003).

Conclusions: Tubeless PNL surgery is an effective and safe endourological procedure that can be performed by experienced surgeons. Its advantages over standard PNL include less pain during the early postoperative period, shorter hospital stays but the rates of complications are not significantly lower.

Keywords

• Renal stones,Percutaneous nephrolithotomy,Standard PNL,Tubeless PNL,Pain,hospitalization time

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