Preoperatif ve İntraoperatif Klinik Bulguların Üreter Taşı Endoskopik Tedavi Başarısına Etkisi

Öz

Amaç: Üreter taşı nedeniyle üreterorenoskopi (URS) yapılan hastaların klinik verileri ile taşsızlık oranları arasındaki ilişkiyi retrospektif olarak araştırmayı amaçladık. Yöntemler: Çalışmamız kliniğimizde üreter taşı tanısıyla URS yapılan 83 hastanın verilerinin retrospektif analizinden oluşturuldu. Preoperatif ve intraoperatif klinik veriler kaydedildi. Operasyondan 2 hafta sonrasında 4 milimetreden büyük fragmanın saptanmaması başarı olarak kabul edildi. Klinik veriler ile taşsızlık oranı arasındaki ilişki uygun istatistik yöntemlerle değerlendirildi. Bulgular: Ortalama yaş 50.48±14,41 ve erkek/kadın oranı 2 olarak bulundu. Toplam taşsızlık oranı %83,2 idi. Komplikasyon olarak 7 hastada postoperatif ateş, 2 hastada üreteral perforasyon gelişti. Yaş, cinsiyet, taraf, taş sayısı, çapı, hacmi, en geniş yüzey alanı, ortalama Hounsfield ünitesi, üreteral balon dilatasyon kullanımı, litotriptör cinsi (pnömotik, pnömotik + lazer, lazer) açısından başarılı ve başarısız hastalar arasında anlamlı farklılık saptanmazken, preoperatif hidronefroz derecesi (düşük dereceli: %95,2 vs yüksek dereceli: %69,4, p=0,006), taş lokasyonu (distal üreter: %92,9 vs proksimal üreter: %72,5, p=0,014) ve operasyon süresi (başarılı: 60,0 (45,0-60,0) dak. vs başarısız: 85,0 (60,0-97,5) dak. p=0,048) açısından taşsızlık oranında farklılık olduğu bulundu. Ayrıca antiretropulsif Stone cone kullanımında başarı %91,7, kullanılmayanlarda %81,4 olarak saptandı (p=0,347). Sonuç: Başarı oranını artırmak ve ek prosedür gereksinimini azaltmak için özellikle hidronefrotik proksimal üreter taşlarında antiretropulsif aletlerin veya fleksible URS kullanımının tercih edilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

• Üreterorenoskopi, üreter taşı, endoskopik taş tedavi başarısI

The Effect of Preoperative and Intraoperative Clinical Findings on Success of Endoscopic Management of Ureteral Stone

Öz

Objective: We investigated the relationship between clinical data of patients who underwent ureterorenoscopy (URS) due to ureteral stone and stone free rates retro­spectively. Methods: Clinical data of 83 patients who underwent URS in our clinic were retrospectively analyzed. Pre­operative and intraoperative clinical parameters were recorded. Success was defined as not to detect > 4mm stone fragments 2 weeks after the operation. Appropriate statistical analysis were done for evaluating relationship between stone free rate and clinical data. Results: Mean age was 50.48±14.41 and male to female ratio was 2. Overall stone free rate was 83.2%. Postop­erative fever, ureteral perforation were detected in 7 and 2 patients, respectively. There were no differences between success and failure groups in terms of age, sex, opera­tion side, stone number, diameter, size, surface area, mean Hounsfield unit, usage of balloon dilatation. How­ever with respect to preoperative grade of hydronephrosis (low grade: 95.2% vs high grade: 69.4%, p=0.006), stone location (distal ureter: 92.9% vs proximal ureter: 72.5%, p=0.014) and operation time (success: 60.0 (45.0-60.0) min. vs failure: 85.0 (60.0-97.5) min. p=0.048) we found statistically significant differences between the study groups. In addition stone free rate was 91.7% with anti-retropulsion device Stone cone, whereas it was 81.4% without any ureteral occlusion (p=0.347). Conclusion: We assume that anti-retropulsion devices or flexible URS should be prefered especially in patients with hydronephrotic proximal ureteral stone for higher stone free rate with lower auxiliary procedure.

Anahtar Kelimeler

• Ureterorenoscopy, ureteral stone, endoscopic stone management success

Kaynakça

1. 1. J Fasihuddin Q, Hasan AT. Ureteroscopy (URS): an effective interventional and diagnostic modality. Pak Med Assoc 2002;52:510-512.
2. 2. Watson GM, Landers B, Nauth Misir R, et al. Development in ureteroscopes, techniques and accessories associated with laser lithotripsy. World J Urol1993;11:19.
3. 3. Wu CF, Shee JJ, Lin WY, et al. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium: YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 2004;172:1899-1902.
4. 4. Hamano S, Nomura H, Kinsui H, et al. Experience with ureteral stone management in 1,082 patients using semirigid ureteroscopes. Urol Int 2000;65:106-111.
5. 5. Elashry OM, Elgamasy AK, Sabaa MA, et al. Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int 2008;102:1010-1017.
6. 6. Delvecchio FC, Preminger GM. Management of residual stones. Urol Clin N Am 2000;27:347-354.
7. 7. Sun L, Peng FL. Simultaneous saline irrigation during retrograde rigid ureteroscopic lasertripsy for the prevention of proximal calculus migration.Can Urol Assoc J 2013;7:E65- 68.
8. 8. Yuksel OH, Akan S, Urkmez A, et al. Efficacy and safety of semirigid ureteroscopy combined with holmium: YAG laser in the treatment of upper urinary tract calculi: Is it a good alternative treatment option of flexible ureteroscopy for developing countries? J Pak Med Assoc 2015;65:1193- 1196.

9. 9. Cabrera FJ, Preminger GM, Lipkin ME. Antiretropulsion devices. Curr Opin Urol 2014;24:173-178.
10. 10. Ahmed M, Pedro RN, Kieley S, et al. Systematic evaluation of ureteral occlusion devices: insertion, deployment, stone migration, and extraction. Urology 2009;73:976–980.
11. 11. Farahat YA, Elbahnasy AE, Elashry OM. A randomized prospective controlled study for assessment of different ureteral occlusion devices in prevention ofstone migration during pneumatic lithotripsy. Urology 2011;77:30–35.
12. 12. Dretler SP. Ureteroscopy for proximal ureteral calculi: prevention of stone migration. J Endourol 2000;14:565–567.
13. 13. Ursiny M, Eisner BH. Cost-effectiveness of antiretropulsion devices for ureteroscopic lithotripsy. J Urol 2013;189:1762–1766.
14. 14. Georgescu D, Mulţescu R, Geavlete B, Geavlete P. Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management. Chirurgia (Bucur) 2014 May-Jun;109:369-374.
15. 15. Librenjak D, Šitum M, Gugić D, et al. Ureterorenoscopic treatment of ureteral stones--influence of operator’s experience and skill on the procedure outcome. Croat Med J 2011;52:55-60.
16. 16. Moufid K, Abbaka N, Touiti D, et al. Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position. Urol Ann 2013;5:140-146.
17. 17. Elsheemy MS, Maher A, Mursi K, et al. Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success.World J Urol 2014;32:985-990.
18. 18. Süer E, Gülpinar Ö, Özcan C, et al. Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm. Korean J Urol 2015;56:138-142.
19. 19. Rifaioğlu MM, Demirbas O, Davarcı M. The importance of hydronephrosis in percutaneous nephrolithotomy operation. Dicle Med J 2013;40:441-445.