Prone Perkütan Nefrolitotomi

Yıl 2020, Cilt: 12 Sayı: 1, 35 - 44, 30.01.2020

Yusuf Özlülerden Ömer Tuncay

Öz

Perkütan nefrolitotomi (PNL) 2 cm üzerindeki böbrek taşlarında, çoklu böbrek taşlarında ve staghorn tipi böbrek

taşlarında tercih edilen ilk tedavi yöntemidir. PNL’ de standart hasta pozisyonu prone (yüzükoyun) pozisyondur. Prone

pozisyonu, geniş bir alan sağlayarak hem böbreğe girişte; hem de böbreğe girdikten sonra çalışma sırasında avantaj

sağlamaktadır.

Bu derlemenin amacı güncel literatürler eşliğinde prone PNL’ yi yeniden gözden geçirmektir.

Prone PNL ve supin PNL güncel çalışmalar incelendiğinde benzer taşsızlık oranları, benzer organ yaralanması, idrar

kaçağı ve genel komplikasyon oranları görülmektedir. Prone PNL özellikle obez hastalarda, ağrı palyasyonunun önemli

olduğu spinal anestezi planlanan hastalarda, çoklu giriş gerektiren hastalarda, eş zamanlı bilateral PNL yapılması

planlanan hastalarda güvenliği, etkinliği ve daha düşük komplikasyon oranlarıyla daha ön plana çıkmaktadır.

Her ne kadar supin PNL için literatür sayısında artışla beraber bazı avantajları nedeniyle tercih edilmesi hususunda

desteklenme çabaları günümüzde yoğunlaşsada prone PNL den hala daha güvenli başarılı olduğu kanıtlanamamıştır.

Prone PNL; kolay akses ve dilatasyon sağlaması, daha geniş operatif alana sahip olması, çoklu girişler için daha konforlu

olması, obez hatta morbit obez hastalarda dahi güvenli olması ve akses kolaylığı sağlaması ve atnalı böbrekler gibi

anomalili böbreklerde de daha güvenli olması nedeniyle birçok ürolog tarafınca en çok tercih edilen yöntemdir. Ayrıca

yıllar içinde edinilen tecrübe ve uygulanma oranı ile ön plana çıkmaktadır. Prone PNL de yeni akses kolaylığı sağlayan

tekniklerin tanımlanması ve kombine Retrograd intrarenal cerrahi kullanımının sağlanması yöntemin hala gelişime

açık olduğunu göstermektedir. Bu nedenle prone PNL eski bir yöntem olarak görünmesine rağmen eskimeyen bir

yöntem olduğu akılda tutulmalıdır.

Anahtar Kelimeler

perkütan nefrolitotomi, prone, supin, böbrek, taş hastalığı

Prone Percutaneous Nephrolitotomy

Öz

Percutaneous nephrolithotomy (PNL) is the first treatment method of choice for kidney stones over 2 cm, multiple

kidney stones and staghorn type kidney stones. The standard patient position in PNL is prone position. Prone position

provides a wide area both at the entrance to the kidney and it also provides an advantage during the operation after

entering the kidney.

The aim of this review is to evaluate the prone PNL with new literature.

When Prone PNL and supine PNL current studies are examined, both had similar stone-free rates, similar organ

injuries, urine leakage and general complication rates. Prone PNL is more prominent with its safety, efficacy and lower

complication rates, especially in obese patients, patients with spinal anesthesia where pain palliation is important,

patients requiring multiple accesses and patients scheduled for simultaneous bilateral PNL. Although the number

of studies for supine PNL is increasing due to some advantages, it is not proved that safe and more successful than

prone PNL. Prone PNL is the most preferred by many urologists because it provides easy access and dilatation collage,

provides a wider operative area, is more comfortable for multiple entrances, is safe in obese or morbid obese patients,and is easier to access and is safer in anomaly kidneys such as horseshoe kidneys. It also comes to the forefront with the experience and implementation rate gained over the years. In Prone PNL, the identification of techniques that provide new accessories and the use of combined RIRS show that the method is still open to development. Therefore, it should be kept in mind that although prone PNL seems to be an old method, it is an obsolete method.

Anahtar Kelimeler

Percutaneous nephrolithotomy, prone, supine, kidney, stone disease

Kaynakça

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