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RIRS’ta tam taşsızlık için prediktif faktörler; güncel bir retrospektif analiz

Yıl 2020, Cilt: 12 Sayı: 3, 210 - 216, 31.12.2020

Öz

Amaç: Üriner sistem taş hastalığı ülkemizde sık görülen ve cerrahi nedeni olan bir hastalıktır. Günümüzde taş hastalığı için Retrograd intrarenal cerrahi (RIRS) en önde gelen minimal invaziv tedavi seçeneklerinden birisidir. Bu çalışmada böbrek taşı nedeniyle RIRS cerrahisi yaptığımız hastalarda başarı ve komplikasyonları etkileyen faktörleri belirlemeyi amaçladık.

Gereç ve Yntemler: Haziran 2019-Temmuz 2020 tarihleri arasında böbrek taşı tanısı konulan ve RIRS operasyonu yapılan toplam 106 hasta çalışmaya dahil edilmiştir. Hastaların demografik, radyolojik ve cerrahi ilişkili verileri hasta kayıtlarından retrospektif olarak incelenmiştir. Veriler SPSS programı yardımıyla analiz edilerek yorumlanmıştır.

Bulgular: Yaş, cinsiyet, ek hastalık varlığı, Beden Kitle indeksi (BKİ) gibi demografik veriler açısından grupların birbirine benzediği görülmüştür. (Tablo 1)
Taş lokalizasyonlarını değerlendirdiğimizde ise RIRS başarısının sağlandığı Grup 1’de üst polde, RIRS başarısızlığı olan Grup 2’de ise alt polde daha fazla taş olduğu izlendi. (p=0,027) Çalışmamızdaki hastaların ortalama taş boyutu 12,7 mm olup, Grup 1’de 12.02, Grup 2’de 18,3 mm olarak tespit edilmiştir.(p=0,004)
Hastaların alt pol infindübulopelvik açıları BT görüntülerinden ölçüldüğünde Grup 1’de 55,8°, Grup 2’de 48,2° olarak ölçüldü. Grup 1’in istatistiksel anlamlı olarak daha yüksek olduğu belirlendi (p=0,02).
Ortalama operasyon süresi, taş dansitesi, floroskopi süresi ve preoperatif serum kreatinin seviyeleri arasında istatistiksel anlamlı farklılık saptanmadı.

Sonuç: Çalışmamızda RIRS başarısını etkileyen faktörler taş lokalizasyonu, taş boyutu ve alt pol infindibulopelvik açı olarak bulunmuştur. Uygun hastalarda kullanıldığında düşük komplikasyon oranları ve yüksek taşsızlık oranları elde edilebilmektedir. Böbreğe ulaşım açısından anatomik problemi olmayan daha küçük boyutta ve daha az sayıda böbrek taşı olan hastalarda etkin olarak kullanılabilen bir yöntem olarak seçilebilmektedir.

Kaynakça

  • Referans 1. Türk, C., et al., EAU guidelines on interventional treatment for urolithiasis. European urology, 2016. 69(3): p. 475-482.
  • Referans 2. Hyams, E.S., et al., A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. The Journal of urology, 2015. 193(1): p. 165-169.
  • Referans 3. Resorlu, B., et al., Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology, 2012. 80(3): p. 519-523.
  • Referans 4. Hussain, M., et al., Redefining the limits of flexible ureterorenoscopy. Journal of endourology, 2011. 25(1): p. 45-49.
  • Referans 5. Perlmutter, A.E., et al., Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008. 71(2): p. 214-217.
  • Referans 6. Eken, A. and B. Soyupak, Retrospective analysis of retrograd intrarenal surgery results and factors affecting success rate.
  • Referans 7. Abd El Hamed, A.M., et al., Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2–3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?”. Turkish journal of urology, 2017. 43(2): p. 158.
  • Referans 8. Ito, H., et al., Development and internal validation of a nomogram for predicting stone‐free status after flexible ureteroscopy for renal stones. BJU international, 2015. 115(3): p. 446-451.
  • Referans 9. Berquet, G., et al., The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World journal of urology, 2014. 32(1): p. 229-232.
  • Referans 10. Geraghty, R.M., H. Ishii, and B.K. Somani, Outcomes of flexible ureteroscopy and laser fragmentation for treatment of large renal stones with and without the use of ureteral access sheaths: results from a university hospital with a review of literature. Scandinavian Journal of Urology, 2016. 50(3): p. 216-219.
  • Referans 11. Resorlu, B., et al., The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology, 2012. 79(1): p. 61-66.
  • Referans 12. Skolarikos, A., et al., Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. The Journal of urology, 2015. 194(1): p. 137-143.
  • Referans 13. Resorlu, B., et al., A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the “resorlu-unsal stone score”. Urology, 2012. 80(3): p. 512-518.
  • Referans 14. Goldberg, H., et al., The “old” 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World Journal of Urology, 2017. 35(12): p. 1947-1954.
  • Referans 15. Elbir, F., et al., Flexible ureterorenoscopy results: Analysis of 279 cases. Turkish journal of urology, 2015. 41(3): p. 113.
  • Referans 16. Jacquemet, B., et al., Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations. Journal of endourology, 2014. 28(10): p. 1183-1187.
  • Referans 17. Martin, F., et al., Impact of lower pole calculi in patients undergoing retrograde intrarenal surgery. Journal of Endourology, 2014. 28(2): p. 141-145.
  • Referans 18. Mahajan, P., et al., Is stenting required before retrograde intrarenal surgery with access sheath. Indian Journal of Urology: IJU: Journal of the Urological Society of India, 2009. 25(3): p. 326.
  • Referans 19. Alkan, E., et al., Retrograde intrarenal surgery in patients who previously underwent open renal stone surgery. Minimally invasive surgery, 2015. 2015.
  • Referans 20. Traxer, O. and A. Thomas, Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. The Journal of urology, 2013. 189(2): p. 580-584.
  • Referans 21. Schoenthaler, M., et al., The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World journal of urology, 2014. 32(4): p. 1033-1040.
  • Referans 22. Pan, J., et al., RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis, 2013. 41(1): p. 73-78.
  • Referans 23. Bozkurt, O.F., et al., Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. Journal of endourology, 2011. 25(7): p. 1131-1135.

Predictive factors for achieving stone-free in RIRS; a current retrospective analysis

Yıl 2020, Cilt: 12 Sayı: 3, 210 - 216, 31.12.2020

Öz

Objective: Urinary system stone disease is a common disease in our country. Retrograde intrarenal surgery (RIRS) is currently one of the leading minimally invasive treatment options for stone disease. In this study, we aimed to determine the factors affecting success and complications in patients undergoing RIRS surgery for kidney stones.

Material and Methods: A total of 106 patients who were diagnosed with kidney stones and underwent RIRS operation between June 2019 and July 2020 were included in the study. Demographic, radiological, and surgical data of the patients were analyzed retrospectively from the hospital archive. The data were analyzed and interpreted with the SPSS program.

Results: It was observed that the groups were similar in terms of demographic data such as age, gender, presence of comorbidities, Body Mass Index (BMI). (Table 1)
When we evaluated the stone localizations, it was observed that there were more stones in the upper pole in Group 1, where RIRS success was achieved, and in the lower pole in Group 2 with RIRS failure. (p = 0.027) The average stone size of the patients in our study was 12.7 mm, and it was found as 12.02 mm in Group 1 and 18.3 mm in Group 2. (p = 0.004)
When the lower pole infundibulopelvic angles of the patients were measured from CT images, it was measured as 55.8 ° in Group 1 and 48.2 ° in Group 2. It was determined that group 1 was statistically significantly higher (p = 0.02).
There was no statistically significant difference between the mean operation time, stone density, fluoroscopy time, and preoperative serum creatinine levels.

Conclusion: In our study, the factors affecting the success of RIRS were stone location, stone size, and lower pole infundibulopelvic angle. Low complication rates and high stone-free rates can be obtained when used in appropriate patients. It can be chosen as a method that can be used effectively in patients with smaller sizes and fewer kidney stones, who do not have anatomical problems in terms of access to the kidney.

Kaynakça

  • Referans 1. Türk, C., et al., EAU guidelines on interventional treatment for urolithiasis. European urology, 2016. 69(3): p. 475-482.
  • Referans 2. Hyams, E.S., et al., A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. The Journal of urology, 2015. 193(1): p. 165-169.
  • Referans 3. Resorlu, B., et al., Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology, 2012. 80(3): p. 519-523.
  • Referans 4. Hussain, M., et al., Redefining the limits of flexible ureterorenoscopy. Journal of endourology, 2011. 25(1): p. 45-49.
  • Referans 5. Perlmutter, A.E., et al., Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008. 71(2): p. 214-217.
  • Referans 6. Eken, A. and B. Soyupak, Retrospective analysis of retrograd intrarenal surgery results and factors affecting success rate.
  • Referans 7. Abd El Hamed, A.M., et al., Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2–3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?”. Turkish journal of urology, 2017. 43(2): p. 158.
  • Referans 8. Ito, H., et al., Development and internal validation of a nomogram for predicting stone‐free status after flexible ureteroscopy for renal stones. BJU international, 2015. 115(3): p. 446-451.
  • Referans 9. Berquet, G., et al., The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World journal of urology, 2014. 32(1): p. 229-232.
  • Referans 10. Geraghty, R.M., H. Ishii, and B.K. Somani, Outcomes of flexible ureteroscopy and laser fragmentation for treatment of large renal stones with and without the use of ureteral access sheaths: results from a university hospital with a review of literature. Scandinavian Journal of Urology, 2016. 50(3): p. 216-219.
  • Referans 11. Resorlu, B., et al., The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology, 2012. 79(1): p. 61-66.
  • Referans 12. Skolarikos, A., et al., Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. The Journal of urology, 2015. 194(1): p. 137-143.
  • Referans 13. Resorlu, B., et al., A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the “resorlu-unsal stone score”. Urology, 2012. 80(3): p. 512-518.
  • Referans 14. Goldberg, H., et al., The “old” 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World Journal of Urology, 2017. 35(12): p. 1947-1954.
  • Referans 15. Elbir, F., et al., Flexible ureterorenoscopy results: Analysis of 279 cases. Turkish journal of urology, 2015. 41(3): p. 113.
  • Referans 16. Jacquemet, B., et al., Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations. Journal of endourology, 2014. 28(10): p. 1183-1187.
  • Referans 17. Martin, F., et al., Impact of lower pole calculi in patients undergoing retrograde intrarenal surgery. Journal of Endourology, 2014. 28(2): p. 141-145.
  • Referans 18. Mahajan, P., et al., Is stenting required before retrograde intrarenal surgery with access sheath. Indian Journal of Urology: IJU: Journal of the Urological Society of India, 2009. 25(3): p. 326.
  • Referans 19. Alkan, E., et al., Retrograde intrarenal surgery in patients who previously underwent open renal stone surgery. Minimally invasive surgery, 2015. 2015.
  • Referans 20. Traxer, O. and A. Thomas, Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. The Journal of urology, 2013. 189(2): p. 580-584.
  • Referans 21. Schoenthaler, M., et al., The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World journal of urology, 2014. 32(4): p. 1033-1040.
  • Referans 22. Pan, J., et al., RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis, 2013. 41(1): p. 73-78.
  • Referans 23. Bozkurt, O.F., et al., Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. Journal of endourology, 2011. 25(7): p. 1131-1135.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Üroloji
Bölüm Araştırma Makaleleri
Yazarlar

Gökhan Ecer 0000-0002-2805-8664

Mehmet Giray Sönmez 0000-0003-4615-7348

Mehmet Balasar 0000-0003-4041-9669

Arif Aydın 0000-0001-8691-090X

Ahmet Öztürk Bu kişi benim 0000-0002-8491-3346

Yayımlanma Tarihi 31 Aralık 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 12 Sayı: 3

Kaynak Göster

Vancouver Ecer G, Sönmez MG, Balasar M, Aydın A, Öztürk A. Predictive factors for achieving stone-free in RIRS; a current retrospective analysis. Endourol Bull. 2020;12(3):210-6.