Öz
Objective: The developments in the endourological treatments of urinary system stone diseases led to the discussions about the first choice treatment methods. We have evaluated the results of extracorporeal shock wave treatments being applied in our clinics for the lower pole stones which has the most of the those discussions. Methods: The records of 271 stone patients who were applied ESWL according to CT results between January 2013 and July 2013 to our clinics were examined. In the controls after the procedure, who could not be evaluated with the non-contrast computerized tomography (CT) and ESWL treatment not completed, were excluded from the study. 52 patients with lower pole stone in total were divided into two according to the success of the ESWL treatment. ESWL success or unsuccessful groups, the size of the stone, density of the stone and the distance between the stone and skin was recorded by examining the abdominal non-contrast computed tomography (CT) of the patient. Results: Of all, 28 of the patients in the study (54%) were male and 24 of them (46%) were female. The average age was 46±12.3 (21-73) years. Among the 52 patients included in the study after ESWL treatment, the stones of the 24 patients (46.2%) were successfully treated. ESWL treatment was unsuccessful in total 28 patients (53.8%). The average size of the stone was 9.8 mm (6-17 mm), the distance between the stone and the skin was 93 mm in average (50-140). The stone density was measured as 845 HU (353-1600). Conclusion: The ESWL treatment is still a noninvasive and successful method for the lower pole kidney stones. While the ESWL success is being determined, the imaging method chosen is important, the use of abdominal CT provides accurate evaluation. The higher success rates of minimal invasive surgery methods is promising and might change the treatment methods in the future. Key words: Kidney stone, lower pole stone, ESWL, success
Anahtar Kelimeler
Kaynakça
- Türk C (chairman), Knoll T (vice-chairman), Petrik A, Sarica
- K, Straub M, Seitz C. Guidelines on Urolithiasis. EAU
- Guidelines. 2012
- Chaussy CG, Brendel W, Schmidt E. Extracorporeally induced
- detruction of kidney stones by shock waves. Lancet
- :2:1265-1268.
- Ozturk U, Sener N. C, Goktug H. N. G, et al. Comparison of
- percutaneous nephrolithotomy, shock wave lithotripsy, and
- retrograde intrarenal surgery for lower pole renal calculi
- -20 mm. Urol Int 2013: 91, 345-349.
- Knoll T, Buchholz N, Nordahl GW. Extracorporeal shockwave
- lithotripsy vs. percutaneous nephrolithotomy vs. flexible
- ureterorenoscopy for lower-pole stones. Arab J Urol
- :336-340.
- İnci K, Şahin A, İslamoglu E, et al. Prospective long-term
- follow up of patients with asymptomatic lower pole caliceal
- stones. J Urol 2007;177:2189-92.
- Connors BA, Evan AP, Blomgren PM, et al. Extracorporeal
- shock wave lithotripsy at 60 shock waves/min reduces renal
- injury in a porcine model. BJU Int 2009;104:1004-1008.
- Pishchalnlkov YA, Mcateer JA, WilIams JC, et al. Why
- Stones Break Better at Slow Shockwave RatesThan at Fast
- Rates: In Vitro Study with a Research Electrohydraulic
- Lithotripter. J Endourol 2006:20; 537-541.
- Davarcı M, Rifaioğlu M, Yalçınkaya F R, İnci M. Üriner sistem
- taşlarında iki senelik şok dalgası ile taş kırma tedavisi
- sonuçları. Dicle Tıp Derg 2012;39:377-380.
- Weld KJ, Montiglio C, Morris MS, et al. Shock wave lithotripsy
- success according to the patient and computed tomography
- stone characteristics. Urology 2008:4:91.
- Kose E, Oğuz F, Beytur A. The effect of the diameter of the
- lower calyx infundibulum on the success of ESWL. İnönü
- University Health Sciences Journal 2013:1:43-45.
- Turna B, Ekren F, Nazlı O, et al. Comparative results of
- shockwave lithotripsy for renal calculi in upper, middle and
- lower calices. J Endourol 2007:21:951-956.
- Danuser H, Müller R, Descoeuders B, et al. Extracorporeal
- shock wave lithotripsy of lower calyx calculi: how much is
- treatment outcome influenced by the anatomy of the collecting
- system? Eur Urol 2007:52:539-546.
- Pearle MS, Lingeman JE, Leveillee R, et al. Prospective,
- randomized trial comparing shock wave lithotripsy and
- ureteroscopy for lower pole caliceal calculi 1 cm or less. J
- Urol. 2005;173:2005-2009.
- Deem S, DeFade B, Modak A, et al. Percutaneous nephrolithotomy
- versus extracorporeal shock wave lithotripsy for
- moderate sized kidney stones. Urology 2011:78;739-743.
- Sankhwar SN, Singh BP, Prakash J, Goel A. Extra corporeal
- shock wave lithotripsy versus retrograde intra renal surgery
- for 1-2 cm lower calyceal calculi: A prospective case control
- study. J Urol 2013;189:750-751
- Salem A, Saad I, Abdelhakim M, et al. Laser Lithotripsy
- versus ESWL for Lower Calyceal renal stones. J Urol
- :189;751
- Tepeler A, Armagan A, Sancaktutar AA, et al. The role of
- microperc in the treatment of symptomatic lower pole renal
- calculi. J Endourol 2013;27:13-18.
- Lingeman JE, Siegel Yİ, Steele B, et al. Management of
- lower pole nephrolithiazis: A critical analysis. J Urol
- ;151:663-667,
- Knoll T, Musial A, Trojan L, et al. Measurement of renal
- anatomy for prediction of lower-pole caliceal stone clearance:
- reproducibility of different parameters. J Endourol
- ;17:447-451.
Öz
Amaç: Üriner sistem taş hastalığının endoürolojik tedavisinde ki gelişmeler birincil seçenek tedavi yöntemleriyle ilgili tartışmalara yol açmıştır. Bu çalışmamızda, böbrek alt pol taşı olan hastalara kliniğimizde uygulanan Ekstrakorporeal Şok dalga litotripsi (ESWL) tedavisinin sonuçları incelenmiştir.Yöntemler: Ocak- Temmuz 2013 tarihleri arasında kontrastsız bilgisayarlı tomografi (BT) sonucuyla teşhis edilip kliniğimizde ESWL uygulanan 271 böbrek taşı hastasının kayıtları retrospektif olarak incelendi. Tedavi öncesi ya da sonrası izlemlerde kontrastsız BT filmleri olmayan ve ESWL tedavisi tamamlanmayan hastalar çalışma dışı bırakılmıştır. 52 hasta, ESWL başarısına göre iki gruba ayrılmıştır. ESWL başarısı, taşın büyüklüğü, taşın yoğunluğu ve taşın cilde olan uzaklığı; kontrastsız BT kayıtlarının incelenmesi ile sağlanmıştır.Bulgular: Çalışmamız, 28 (%54) erkek ve 24 (%46) bayan hastadan oluşmaktadır. Ortalama yaş 46±12,3 (2173) idi. ESWL tedavisi alan ve çalışmaya dahil edilen 52 hastanın 24’ü (%46,2) tedaviden fayda görmüştür, 28’i (%53,8) tedaviden fayda görmemiştir. Ortalama taş boyutu 9.8 mm (6-17 mm), ortalama taş-cilt mesafesi 93 mm idi, ortalama taş yoğunluğu 845 HU idi. Tartışma: ESWL tedavisi böbrek alt pol taşlarında hala non-invaziv ve başarılı bir yöntemdir. ESWL başarısı değerlendirilirken seçilen görüntüleme yöntemi önemlidir ve abdominal BT’nin kullanımı doğru değerlendirme sağlar. Minimal invaziv tedavi yöntemlerinin yüksek başarı oranları umut vericidir ve gelecekteki tedavi yöntemlerinin değişimine neden olabilir
Anahtar Kelimeler
Kaynakça
- Türk C (chairman), Knoll T (vice-chairman), Petrik A, Sarica
- K, Straub M, Seitz C. Guidelines on Urolithiasis. EAU
- Guidelines. 2012
- Chaussy CG, Brendel W, Schmidt E. Extracorporeally induced
- detruction of kidney stones by shock waves. Lancet
- :2:1265-1268.
- Ozturk U, Sener N. C, Goktug H. N. G, et al. Comparison of
- percutaneous nephrolithotomy, shock wave lithotripsy, and
- retrograde intrarenal surgery for lower pole renal calculi
- -20 mm. Urol Int 2013: 91, 345-349.
- Knoll T, Buchholz N, Nordahl GW. Extracorporeal shockwave
- lithotripsy vs. percutaneous nephrolithotomy vs. flexible
- ureterorenoscopy for lower-pole stones. Arab J Urol
- :336-340.
- İnci K, Şahin A, İslamoglu E, et al. Prospective long-term
- follow up of patients with asymptomatic lower pole caliceal
- stones. J Urol 2007;177:2189-92.
- Connors BA, Evan AP, Blomgren PM, et al. Extracorporeal
- shock wave lithotripsy at 60 shock waves/min reduces renal
- injury in a porcine model. BJU Int 2009;104:1004-1008.
- Pishchalnlkov YA, Mcateer JA, WilIams JC, et al. Why
- Stones Break Better at Slow Shockwave RatesThan at Fast
- Rates: In Vitro Study with a Research Electrohydraulic
- Lithotripter. J Endourol 2006:20; 537-541.
- Davarcı M, Rifaioğlu M, Yalçınkaya F R, İnci M. Üriner sistem
- taşlarında iki senelik şok dalgası ile taş kırma tedavisi
- sonuçları. Dicle Tıp Derg 2012;39:377-380.
- Weld KJ, Montiglio C, Morris MS, et al. Shock wave lithotripsy
- success according to the patient and computed tomography
- stone characteristics. Urology 2008:4:91.
- Kose E, Oğuz F, Beytur A. The effect of the diameter of the
- lower calyx infundibulum on the success of ESWL. İnönü
- University Health Sciences Journal 2013:1:43-45.
- Turna B, Ekren F, Nazlı O, et al. Comparative results of
- shockwave lithotripsy for renal calculi in upper, middle and
- lower calices. J Endourol 2007:21:951-956.
- Danuser H, Müller R, Descoeuders B, et al. Extracorporeal
- shock wave lithotripsy of lower calyx calculi: how much is
- treatment outcome influenced by the anatomy of the collecting
- system? Eur Urol 2007:52:539-546.
- Pearle MS, Lingeman JE, Leveillee R, et al. Prospective,
- randomized trial comparing shock wave lithotripsy and
- ureteroscopy for lower pole caliceal calculi 1 cm or less. J
- Urol. 2005;173:2005-2009.
- Deem S, DeFade B, Modak A, et al. Percutaneous nephrolithotomy
- versus extracorporeal shock wave lithotripsy for
- moderate sized kidney stones. Urology 2011:78;739-743.
- Sankhwar SN, Singh BP, Prakash J, Goel A. Extra corporeal
- shock wave lithotripsy versus retrograde intra renal surgery
- for 1-2 cm lower calyceal calculi: A prospective case control
- study. J Urol 2013;189:750-751
- Salem A, Saad I, Abdelhakim M, et al. Laser Lithotripsy
- versus ESWL for Lower Calyceal renal stones. J Urol
- :189;751
- Tepeler A, Armagan A, Sancaktutar AA, et al. The role of
- microperc in the treatment of symptomatic lower pole renal
- calculi. J Endourol 2013;27:13-18.
- Lingeman JE, Siegel Yİ, Steele B, et al. Management of
- lower pole nephrolithiazis: A critical analysis. J Urol
- ;151:663-667,
- Knoll T, Musial A, Trojan L, et al. Measurement of renal
- anatomy for prediction of lower-pole caliceal stone clearance:
- reproducibility of different parameters. J Endourol
- ;17:447-451.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Mayıs 2015 |
| Gönderilme Tarihi | 9 Mayıs 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 42 Sayı: 1 |