Üst üriner sistem taşlarında taş büyüklüğüne göre fleksibl üreterorenoskopinin etkinliği

Abstract

renal cerrahi RIRS uygulanan 280 olgunun sonuçları taş boyutlarına göre retrospektif olarak değerlendirildi. Gereç ve Yöntem: Eylül 2014 ve Şubat 2016 tarihleri arasında üst üriner sistem taş hastalığı olan 280 hastada fleksibl üreterorenoskopi ile taş kırma işlemi yapıldı. Görüş altında taş veya taşlar 3 mm’den küçük hale gelinceye kadar kırıldı. Üç mm’den büyük taşlar klinik anlamlı rezidü parçalar olarak kabul edildi. Bulgular: Fleksibl üreterorenoskopi ile taş tedavisi 197 erkek, 83 kadın toplam 280 hastaya uygulandı. Hastaların yaş ortalaması 45.8 yıl ve ortalama taş boyutu 16,9 mm 7 - 40 mm idi. Ortalama işlem süresi 47.6 dk 30 - 90 dk idi. İkizyüz oniki hastaya %75.7 işlem sonrası double J stent takılırken, işlem süresinin çok kısa sürdüğü, rezidüel taşı kalmayan ve üreter hasarı gelişmeyen 68 hastaya %24.2 double J stent takılmadı. Üreteral kılıf 256 hastada ilk seansta yerleştirildi, 17 hastada ise 3 haftalık double j stent sonrası yerleştirilebildi. 229 %81.7 hastada tek seansta tüm taşlar kırılmış iken 51 %18.2 hastada rezidü taşlar nedeniyle ikincil işlem gerekti. Fleksibl üreterorenoskopi esnasında ciddi kanama meydana gelmedi. Bir hastada üreteral hasar gelişmesi ve double J stent takılamaması nedeniyle açık cerrahiye dönüldü. Sonuç: Üst üriner sistem taş hastalığında fleksibl URS yüksek taşsızlık ve düşük morbidite oranları ile güvenilir ve etkin bir cerrahi yöntemdir.

Keywords

• ürolithiasis,retrograd intrarenal cerrahi,fleksible ureterorenoskopi

Efficacy of flexible ureterorenoscopy in the upper urinary tract stones according to stone size

Abstract

Aim: The results of retrograde intrarenal surgery in 280 cases according to stone size were retrospectively evaluated. Material and Methods: Between September 2014 and February 2016, flexible ureterorenoscopy was performed in 280 cases with upper urinary tract stone disease. Stone or stones were fragmented until smaller than 3 mm under vision. Larger than 3 mm stones were accepted as the clinical significance residual stones. Results: Stone treatment with flexible ureterorenoscopy was performed in 197 male and 83 female patients. Median age was 45.8 years and median stone size was 16.9 mm 7- 40mm . Median operation time was 47.6 min 30-90 min . Double J stent was placed in 212 patient 75.7% after the operation while 68 patients 24.2% who has a very short operation time, without residual stone and ureteral damage was not placed. Ureteral access sheath was inserted at first procedure in 256 patient, 17 patient was inserted after the 3 week double J stent period. 229 81.7% patient stones were fragmented at first procedure but 51 18.2% patient had seconder procedure for residual stones. Severe bleeding did not occur during flexible ureterorenoscopy. In one patient developed ureteral injury inserting double J stent was unsuccesfully and was converted to open surgery. Conclusion: Flexible ureterorenoscopy is effective and reliable surgical procedure with high stone free rates and low morbidity in upper urinary system stone treatment.

Keywords

• urolithiasis,retrograde intrarenal surgery,flexible ureterorenoscopy

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