Üreteral Stentlerin Postoperatif Ağrı Üzerine Etkisi

Yıl 2021, Cilt: 26 Sayı: 1, 54 - 59, 30.01.2021

Mustafa Bilal Hamarat Fatih Üstün Serkan Özcan Murat Bagcıoglu Mehmet Kutlu Demirkol Bekir Turgut

https://doi.org/10.21673/anadoluklin.778906

Öz

Amaç: Çalışmamızda Double J (DJ) üreteral stentlerin endoskopik üreter taş tedavisi sonrası postoperatif ağrı üzerine olan etkisini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Prospektif randomize çalışmamızda tek taraflı üreter taşı nedeniyle başarılı bir şekilde opera edilen ve DJ üreteral stent yerleştirilen 63 hasta çalışmaya dahil edildi. Hastalar yaşlarına göre 40 yaş üzeri ve 40 yaş altı olmak üzere iki alt grupta değerlendirildi. Bu alt gruplar da preoperatif çift kör olarak 4.8 fr ve 6 fr üreteral DJ stent yerleştirilen gruplar olarak randomize edildi. Hastaların preoperative (preop), postoperative (po) 3. ve 7. gün ve stent çekildikten 1 hafta sonraki ağrı ve diğer şikayetleri kaydedildi. Hastaların ağrı düzeyleri Sayısal Ağrı Skalası(SAS) kullanılarak belirlendi.

Bulgular: 40 yaş altı Grup 1’de (4.8 fr) preop SAS skoru 9,17±0,2 iken, Grup 2’de (6 fr) 9,79±0,15 (p=0,099) saptandı. Bu gruplarda po 3. gün SAS skoru sırasıyla 2,50±0,73, 7,36±0,45 (p<0.05), po 7. gün sırasıyla 1,92±0,53, 2,57±0,48 (p=0,428) saptandı. DJ katater çekildikten 1 hafta sonra SAS skorları sırasıyla 0,08±0,08, 0,57±0,23 (p=0,087) idi. 40 yaş üstü her iki grupta da belirtilen zamanlarda bakılan SAS skorları arasında anlamlı bir fark bulunamadı. Ortalama taş boyutu ve operasyon süreleri açısından gruplar arasında anlamlı bir fark saptanmadı.

Sonuç: Özellikle 40 yaş altı genç hastalarda endoskopik üreter taş tedavisinde 4.8 Fr DJ katater kullanımının hastanın po erken dönemdeki ağrı kontrolü için daha etkili olduğu bulunmuştur. Ayrıca üreteral stentlerin kullanılmasının gerekliliği ve optimal stentlerin hangi özelliklere sahip olması gerektiği ile ilgili daha fazla çalışmaya ihtiyaç duyulmaktadır.

Anahtar Kelimeler

üreter stenti, üreter taşı, üreterorenoskopi

The Effect of Ureteral Stents on Postoperative Pain

Öz

Aim: We aimed to assess the postoperative pain after endoscopic ureter stone treatment according to the diameter of double J ureteral stents.

Materials and Methods: Our prospective randomized study included 63 patients with successful operation for unilateral ureter stone and DJ ureteral stent inserted. Patients were divided into 2 subgroups as aged under 40 years and over 40 years. These subgroups were randomized into 4.8 Fr and 6 Fr ureteral DJ stent groups preoperatively in double-blind manner. Patients had pain and other complaints recorded preoperative (preop), postoperative (po) 3rd, 7th days and 1 week after stent removal. Patient pain levels were determined using the numerical pain scale (NPS).

Results: For patients under 40 years of age, Group 1 had preop NPS score of 9.17±0.32, while in Group 2 this was 9.79±0.15 (p=0.099), on po 3rd day NPS scores were 2.50±0.73 and 7.36±0.45 (p<0.05), on po 7th day scores were 1.92±0.53 and 2.57±0.48 (p=0.428), and 1 week after DJ catheter removal scores were 0.08±0.08, 0.57±0.23 (p=0.087), respectively. In both groups over 40 years of age, there were no significant differences in the NPS scores at these times. There were no significant differences identified between the groups for stone size and operation duration.

Conclusions: We think the use of 4.8 Fr DJ catheters after endoscopic ureter stone treatment is more appropriate for pain control in the early po period, especially for young patients under 40 years of age. Additionally, we believe there is a need for more studies related to the necessity for use of ureteral stents and the features that optimal stents should have.

Anahtar Kelimeler

ureteral stent, ureter stone, ureterorenoscopy

Kaynakça

• Finney RP. Experience with new double J ureteral catheter stent. J Urol. 1978;120(6):678-81.
• Lingeman JE, Preminger GM, Goldfischer ER, Krambeck AE, Team CS. Assessing the impact of ureteral stent design on patient comfort. J Urol. 2009;181(6):2581-7.
• Damiano R, Autorino R, De Sio M, Cantiello F, Quarto G, Perdonà S, et al. Does the size of ureteral stent impact urinary symptoms and quality of life? A prospective randomized study. Eur Urol. 2005;48(4):673-8.
• Auge BK, Sarvis JA, L'Esperance JO, Preminger GM. Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists. J Endourol. 2007;21(11):1287-92.
• Öztekin Ü, Caniklioğlu M, Sercan S, Gürel A, Selmi V, Işıkay L, et al. Impact of preoperative stent on retrograde intrarenal surgery outcomes. KÜ Tıp Fak Derg. 2020;22(1):89-95.
• Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, D’Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int. 2002;69(2):136-40.
• Miyaoka R, Monga M. Ureteral stent discomfort: Etiology and management. Indian J Urol. 2009;25(4):455-60.
• Jeong H, Kwak C, Lee SE. Ureteric stenting after ureteroscopy for ureteric stones: a prospective randomized study assessing symptoms and complications. BJU international. 2004;93(7):1032-4.
• Joshi H, Newns N, Stainthorpe A, MacDonagh R, Keeley F, Timoney A. Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol. 2003;169(3):1060-4.
• Johnson C. Measuring pain. Visual analog scale versus numeric pain scale: what is the difference? J Chiropr Med. 2005;4(1):43.
• Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69(3):468-74.
• Muslumanoglu AY, Fuglsig S, Frattini A, Labate G, Nadler RB, Martov A, et al. Risks and benefits of postoperative double-J stent placement after ureteroscopy: results from the clinical research office of endourological society ureteroscopy global study. J Endourol. 2017;31(5):446-51.
• Canepa G, Conzi G, Capponi G, Campodonico F, Maffezzini M. Short-time ureteral catheterization after operative ureteroscopic lithotripsy: an alternative to stent versus no stent evaluated in a retrospective study. Arch Ital Urol Androl. 2009;81(1):43-5.
• Damiano R, Autorino R, Esposito C, Cantiello F, Sacco R, de Sio M, et al. Stent positioning after ureteroscopy for urinary calculi: the question is still open. Eur Urol. 2004;46(3):381-7; discussion 7-8.
• Bach P, Reicherz A, Teichman J, Dahlkamp L, von Landenberg N, Palisaar R-J, et al. Short-term external ureter stenting shows significant benefit in comparison to routine double-J stent placement after ureterorenoscopic stone extraction: A prospective randomized trial – the Fast track stent study (FaST). Int J Urol. 2018;25(8):717-22.
• Sercan S, Selmi V, Caniklioğlu M, Öztekin Ü, Gürtan E, Işıkay L. Yozgat Bozok Üniversitesi 2-4 Cm Böbrek taşları tedavisinde retrograd intrarenal cerrahi deneyimimiz. Yozgat Bozok University retrograde intrarenal surgery experience for treatment of 2-4 cm kidney stones. Bozok Tıp Derg.2020;10(1):150-53.
• Cubuk A, Yanaral F, Ozgor F, Savun M, Ozdemir H, Erbin A, et al. Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial. Kaohsiung J Med Sci.2018;34(12):695-9.
• Candela JV, Bellman GC. Ureteral stents: impact of diameter and composition on patient symptoms. J Endourol. 1997;11(1):45-7.
• Keun PH, Hyun PS, Gon KH, Soo LY, Sangrak B. The impact of ureteral stent type on patient symptoms as determined by the ureteral stent symptom questionnaire: a prospective, randomized, controlled study. J Endourol. 2015;29(3):367-71.
• Neeraj Agarwal AG, S S Yadav, Shivam, Priyadarshi RDS. Comparatıve analysıs of effıcacy of different calibre of dj stent in relation to urinary tract symptoms. Ind J Res. 2018;7(3):3.