Perkütan Nefrolitotomide Renal Dilatasyon Yöntemlerinin Sonuç ve Komplikasyonlar Üzerine Etkisi

Öz

Giriş/Amaç:Perkütan nefrolitotomide kullanılan iki farklı renal dilatasyon yönteminin taşsızlık oranları ve komplikasyonlar üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntemler:Haziran 2013-Aralık 2018 tarihleri arasında iki ayrı merkezde, renal pelvis ve kaliks taşları nedeni ile perkütan nefrolitotomi uygulanan hastaların verileri retrospektif olarak değerlendirildi. Tüm hastaların, komorbid hastalıkları, geçirilmiş taş cerrahisi öyküleri, yaş gibi demografik özelliklerinin yanı sıra taş tarafı, taş sayısı ve taş yükü, Hounsfield Unit değeri ve hidronefroz derecesi kaydedildi. Hastalar, kullanılan dilatasyon yöntemine göre balon dilatasyon (Grup 1), amplatz seri dilatasyon (Grup 2) ve kombine (Grup 3) olmak üzere 3 gruba ayrıldı. Operasyon süreleri, postoperatif hemoglobin düşüşü, transfüzyon gereksinimi, taşsızlık oranı, hastanede kalış ve nefrostomi alınma süreleri ile komplikasyon oranları gruplar arasında karşılaştırıldı. Bulgular:Gruplar arasında ortalama operasyon süreleri (p=0,185), taşsızlık oranları (p=0,313) ve komplikasyonlar (p=0,053) açısından istatistiki anlamlı fark izlenmedi. Postoperatif hemoglobin ve hematokrit düşüşü en fazla grup 3 hastalarda gözlendi. Grup 1 ve grup 2 hastalar arasında ise anlamlı fark yoktu (p=0,373). Benzer şekilde grup 1 hastalarda, grup 2’ye göre daha fazla transfüzyon ihtiyacı saptansa da anlamlı fark izlenmedi (p=0,787). Hastanede kalış ve nefrostomi alınma süresi ise grup 1’de anlamlı derecede daha kısa saptandı (p<0,05). Sonuç:Amplatz seri dilatatörler, komplikasyon ve taşsızlık oranları bakımından balon dilatatörlere benzer sonuçlar sunmaktadır.

Anahtar Kelimeler

• Perkütan nefrolitotomi
• Balon dilatatör
• Amplatz Seri Dilatatör
• Perkütan renal giriş
• Komplikasyon

Efficacy of Renal Dilatation Methods on Results and Complications in Percutaneous Nephrolithotomy

Abstract

Objective:We aimed to compare the effects of two different renal dilatation methods used in percutaneous nephrolithotomy on stone-free rates and complications. Methods:In two centers between June 2013 and December 2018, the data of patients who underwent percutaneous nephrolithotomy for renal pelvis and calyceal stones were retrospectively evaluated. Stone side, stone number and stone burden, Hounsfield Unit value and degree of hydronephrosis were recorded as well as demographic characteristics of all patients such as comorbid diseases, history of previous stone surgery, age. The patients were divided into 3 groups according to the dilatation method used: balloon dilatation (Group 1), amplatz serial dilatation (Group 2) and combined (Group 3). Operation times, postoperative hemoglobin decrease, transfusion requirement, stone-free rate, hospital stay, time of nephrostomy and complication rates were compared between the groups. Results:There was no difference between the groups in terms of mean operation times (p=0,185), stone-free rates (p=0,313) and complications (p=0,053). Postoperative hemoglobin and hematocrit decrease was mostly observed in group 3 patients. There was no significant difference between group 1 and group 2 patients (p = 0.373). Similarly, although the transfusion requirement was higher in group 1 patients compared to group 2, no significant difference was observed (p=0,787). The duration of hospital stay and nephrostomy removal time were significantly shorter in group 1 (p<0,005). Conclusion:Amplatz series dilators offer similar results to balloon dilators in terms of complication and stone-free rates.

Keywords

• Percutaneous nephrolithotomy
• Balloon dilator
• Amplatz serial dilator
• Percutaneous renal Access
• Complication.

Kaynakça

1. 1- Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Adv Urol. 2018; Article ID 3068365.
2. 2- Romero V, MD, Akpinar H, MD, Assimos DG. Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors. Rev Urol. 2010; 12(2-3): e86–e96.
3. 3- Moe O. W. Kidney stones: pathophysiology and medical management. The Lancet. 2006;367(9507):333–344.
4. 4- Knoll T. Epidemiology, Pathogenesis, and Pathophysiology of Urolithiasis. Eur. Urol. Suppl. 2010; 9(12): 802-806.
5. 5- Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976; 10(3):257-259.
6. 6- Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K. EAU Guidelines on Urolithiasis, 2018. https://uroweb.org/guideline/urolithiasis/
7. 7- Michel MS, Trojan L, Rassweilwe JS. Complications in percutaneous nephrolithotomy. Eur Urol. 2007; 51:899-906.
8. 8- Ko R, Soucy F, Denstedt JD, Razvi H. Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks. BJU Int. 2008;101(5):535-539.

9. 9- Yamaguchi A, Skolarikos A, Buchholz NP, Chomon GB, Grasso P, Saba P, Nakada S, De La Rosette J, Clinical Research Office Of The Endourological Society Percutaneous Nephrolithotomy Study Group. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol. 2011; 25:933–9.
10. 10- Fernbach SK, Maizels M, Conway JJ: Ultrasound grading of hydronephrosis: Introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993; 23: 478–480.
11. 11- Lee WJ, Smith AD, Cubelli V, Vemace FM. Percutaneous nephrolithotomy: analysis of 500 consecutive cases. Urol Radiol. 1986; 8:61-66.
12. 12- Watterson JD, Soon S, Jana K. Access Related Complications During Percutaneous Nephrolithotomy: Urology Versus Radiology at a Single Academic Institution. J Urol. 2006; 176:142-145.
13. 13- De la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A, CROES PNL Study Group. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011; 25:11–17.
14. 14- Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007;334:468–472.
15. 15- Skolarikos A, De La Rosette J. Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol. 2008; 18:229–234.
16. 16- Kallidonis P, Panagopoulos V, Kyriazis I, Liatsikos E. Complications of percutaneous nephrolithotomy: Classification, management and prevention. Curr Opin Urol. 2016; 26:88-94.
17. 17- Srivastava A, Singh S, Dhayal IR, Rai P. A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy. World J Urol. 2017; 35: 803-807.
18. 18- Wu Y, Xun Y, Lu Y, Hu H, Qin B, Wang S. Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta‑analysis. Exp Ther Med. 2020;19: 2661-2671.
19. 19- Frattini A, Barbieri A, Salsi P, Sebastio N, Ferretti S, Bergamaschi E, Cortellini P. One shot: A novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol. 2001; 15: 919‑923.
20. 20- Ucar M, Kisa E, Celik F, Yucel C, Suelozgen T, Ilbey YO, Kilic N. Can single-step dilatation technique in pediatric percutaneous nephrolithotomy be an effectice alternative to stepwise dilatation? J Surg Med. 2019; 3(8):583-587.
21. 21- Joel AB, Rubenstein JN, Hsieh MH, Chi T, Meng MV, Stoller ML. Failed Percutaneous Balloon Dilation For Renal Access: Incidence And Risk Factors. Urology. 2005; 66: 29-32.
22. 22- Wezel F, Mamoulakis C, Rioja J, Michel MS, De la Rosette J, Alken P. Two Contemporary Series of Percutaneous Tract Dilation for Percutaneous Nephrolithotomy. J Endourol. 2009; 23(10): 1655-1661.
23. 23- Gonen M, Istanbulluoglu OM, Cicek T, Ozturk B, Ozkardes H. Balloon Dilatation versus Amplatz Dilatation for Nephrostomy Tract Dilatation. J Endourol. 2008; 22(5): 901-904.
24. 24- Reddy SVK, Shaik AB. Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi. Int Braz J Urol. 2016; 42(2):262-269.
25. 25- Hu H, Lu Y, Cui L, Zhang J, Zhao Z, Qin B, Wang Y, Wang Q, Wang S. Impact of previous open renal surgery on the outcomes of subsequent percutaneous nephrolithotomy: a meta-analysis. BMJ Open 2016; 6:e010627.
26. 26- Margel D, Lifshitz DA, Kugel V, Dorfmann D, Lask D, Livne PM. Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy. J Endourol. 2005; 19:1161-1164.
27. 27- Ozgor F, Kucuktopcu O, Sarılar O, Toptas M, Simsek A, Gurbuz ZG, Akbulut MF, Muslumanoglu AY, Binbay M. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy. Urolithiasis. 2015; 43(6):541-547.
28. 28- El-Shazly M, Salem S, Allam A, Hathout B. Balloon dilator versus telescopic metal dilators for tract dilatation during percutaneous nephrolithotomy for staghorn stones and calyceal Stones. Arab J Urol.2015; 13:80-83.
29. 29- Kumar V, Keeley FX. Percutaneous Nephrolithotomy: Why Do We Use Rigid Dilators? J Endourol. 2008; 22 (9): 1877–1879.
30. 30- Alyami F, Norman RW. Is an overnight stay after percutaneous nephrolithotomy safe? Arab J Urol. 2012; 10(4): 367–371.