Evaluation of The Effectiveness and Postoperative Urinary Tract Infection Development in RIRS Treatment Performed Without The Use of A Ureteral ‘Access Sheath’

Yıl 2025, Cilt: 15 Sayı: 3, 240 - 248, 15.09.2025

Haşmet Sarıcı , Osman Gercek , Berkay Eren , Recep Uzun , M. Ali Ulucak

Öz

Aim: This study aims to evaluate the effects of stone location and size, the presence of a preoperative DJ stent, and preoperative positive urine culture on early postoperative infection in patients undergoing RIRS without the use of an access sheath due to kidney stones. Additionally, we aim to compare the effects of stone location, size, and Hounsfield Unit (HU) value on stone-free rates.
Materials and Methods: This retrospective study was conducted on 326 patients who underwent RIRS + Laser Lithotripsy without the use of an access sheath, followed by DJ-stent placement, between January 2021 and March 2024. Postoperative infection, the need for re-RIRS, and stone-free status at 4 weeks postoperatively were analyzed.
Results: When comparing patients with and without postoperative infections, there was no statistically significant difference between the groups in terms of age, gender, stone volume, stone location or operation time (p=0.968, p=0.346, p=0.318, p=0.151, p=0.621, respectively). Preoperative DJ stent placement was significantly higher in the infection group (35.2% vs. non-infection group, p=0.002). Residual stones were also significantly more common in the infection group (p<0.001), with a higher incidence of lower pole and multiple stones (p=0.016).
Conclusion: Routine use of a ureteral access sheath is not always necessary for RIRS in kidney stone treatment. Success and stone-free rates are related to stone size, location, and HU value. Additionally, no ureteral injuries were observed, and the operation time was shorter without an access sheath.

Anahtar Kelimeler

Ureteral 'Access Sheat' , RIRS , Urinary Tract Infection , Residual Stone Presence

Etik Beyan

Bu çalışmayı gerçekleştirmek için yönergelere uygun olarak kurumumuzun Etik Komitesi tarafından 07/06/2024 tarih ve 2024/174 sayılı etik onayı verildi

ÜRETERAL ACCESS SHEATH KULLANILMADAN UYGULANAN RIRC TEDAVİSİNDE ETKİNLİK VE POSTOPERATİF ÜRİNER SİSTEM ENFEKSİYONU GELİŞİMİNİN DEĞERLENDİRİLMESİ

Öz

Amaç: Biz bu çalışmamızda böbrek taşları nedeni ile ‘Access Sheath’ kullanılmadan Retrograd İntrarenal
Cerrahi (RIRC) uyguladığımız hastalarda, taşın böbrekteki yerleşim yeri ile taşın boyutu, preoperatif Double
J Stent (DJS) varlığı ve preoperatif pozitif idrar kültürü varlığının postoperatif erken dönem enfeksiyon gelişimine etkisini ve taşın böbrekteki yerleşim yeri ile taşın boyutu ve Hounsfield Unit (HU) değerinin taşsızlık
oranlarına etkisini karşılaştırmayı amaçladık.
Gereç ve Yöntemler: Bu retrospektif çalışma Ocak 2021 – Mart 2024 tarihleri arasında böbrek taşı nedeni
ile ‘Access Sheath’ kullanılmadan RIRC + Laser Litotripsi uyguladığımız ve DJ Stent yerleştirilen 326 hasta
üzerinde yapılmıştır. Hastaların Re-Do Retrograd Intrarenal Cerrahi (Re-RIRC) gereksinimi, postoperatif erken
dönem enfeksiyon gelişimi ve postoperatif 4. Haftada renal taşsızlık durumları incelenmiştir.
Bulgular: Bu çalışmada postoperatif enfeksiyon gelişen ve gelişmeyen hastalar iki farklı grup olarak incelendiğinde; gruplar arasında, yaş, cinsiyet, taş hacmi, taş lokalizasyonu ve operasyon süresi açısından istatistiksel anlamlı fark saptanmadı (sırasıyla; p=0,968, p=0,346, p=0,318, p=0,151, 0,621). Postoperatif enfeksiyon
gelişen grupta 19 (%35,2) hastada preoperatif DJS takıldığı izlendi ve bu oran enfeksiyon gelişmeyen gruba
göre anlamlı olarak yüksekti (p=0,002). Ayrıca postoperatif enfeksiyon gelişen grupta, gelişmeyen gruba
göre anlamlı derecede yüksek rezidü taş varlığı saptandı (p<0,001). Rezidü taş saptanan grupta alt pol ve
multipl taş varlığının diğer gruba göre anlamlı olarak yüksek olduğu görüldü (p=0,016).
Sonuç: Böbrek taşlarının RIRC ile tedavisinde rutin olarak Üreteral ‘Access Sheath’ kullanımı her zaman
gerekli değildir. Üreteral ‘Access Sheath’ kullanılmadan uygulanan cerrahilerin başarısı, taşsızlık oranları, taşın HU değeri ve taş hacmi ile ilişkilidir. Ayrıca ‘Access Sheath’ kullanılarak yapılan cerrahilerde görülen üreteral yaralanmalar uyguladığımız hiçbir cerrahide görülmemiştir ve operasyon süresi daha kısadır.

Anahtar Kelimeler

Üreteral ‘Access Sheat’ , RIRC , Üriner Sistem Enfeksiyonu , Rezidüel Taş Varlığı

Etik Beyan

Bu çalışmayı gerçekleştirmek için yönergelere uygun olarak kurumumuzun Etik Komitesi tarafından 07/06/2024 tarih ve 2024/174 sayılı etik onayı verildi

Destekleyen Kurum

Yoktur

Kaynakça

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