Böbrek taşı tedavisinde fleksibl üreterorenoskopi ile lazer litotripsi sonrası enfektif komplikasyonları etkileyen faktörler

Yıl 2021, Cilt: 13 Sayı: 2, 61 - 69, 31.07.2021

Feyzullah Çelik , Şaban Demirdöğen , Şenol Adanur

Öz

Amaç: Böbrek taşlarının tedavisinde holmium lazer ile fleksibl üreterorenoskopi (f-URS) prosedürü sonrası enfeksiyöz komplikasyonları etkileyen faktörleri değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Ocak 2015 – Ekim 2019 tarihleri ​​arasında kliniğimizde böbrek taşı nedeniyle holmiyum lazer ile f-URS uygulanan 482 hastanın cinsiyet, yaş, komorbidite, son altı ayda endoskopik taş cerrahi öyküsü, idrar analizi ve idrar kültürü sonuçları, kan testi sonuçları, operasyon süresi, rezidüel taşlar ve taş boyutu verileri retrospektif olarak incelendi. Tüm hastalara standart bir f-URS prosedürü uygulandı. Ameliyat sonrası ateşle birlikte üriner trakt enfeksiyonu, Sistemik İnflamatuar Cevap Sendromu (SIRS) ve sepsis gibi postoperatif görülen enfeksiyöz komplikasyonlar kaydedildi.
Bulgular: Hastaların ortalama yaşı 52±15 yıl ve preoperatif serum kreatinin seviyeleri 0,94±0,34 mg/dL idi. f-URS prosedürü uygulanan 22 hasta soliter böbrekli idi. Preoperatif pozitif idrar kültürü olan hasta sayısı 62(%12,9) idi ve 253 hastada preoperatif Double J (DJ) stent olduğu tespit edildi. Ortalama taş dansitesi 1010±393 Hounsfield Unit (HU) bulundu. Operasyon esnasında 473(%98,1) hastada üreteral acces sheat kullanıldı. Ortalama operasyon süresinin 56±19 dk idi. İlk seansta taşsızlık oranı %80,7 olarak bulundu. f-URS sonrası enfeksiyöz komplikasyon insidansı %10 (n = 48) idi. 21 hastada (%4,4) ateşle birlikte üriner trakt enfeksiyonu, 11 hastada (%2,2) SIRS, 16 hastada (%3,4) ise ürosepsis görüldü. Tek değişkenli analiz sonucu; ameliyat süresi, serum kreatinin yüksekliği, preoperatif pozitif idrar kültürü, son altı ay içinde endoskopik taş tedavisi öyküsü, preoperatif DJ stent varlığı, taş boyutunun artışı ve rezidüel taş varlığı postoperatif komplikasyon ile ilişkili bulundu(p<0.05). Çok değişkenli regresyon analizi ile yapılan değerlendirmede, operasyon süresi, preoperatif pozitif idrar kültürü ve son altı ay içerisinde endoskopik taş tedavisi öyküsünün f-URS sonrası enfeksiyöz komplikasyonlar için prediktif faktörler olduğu tespit edildi.
Sonuç: Böbrek taşlarının fleksibl URS ile holmium lazer litotripsi tedavisinde; ameliyat süresinin, preoperatif pozitif idrar kültürünün ve son altı ay içerisinde endoskopik taş tedavisi öyküsünün bağımsız olarak f-URS prosedürünü takiben enfeksiyöz komplikasyonların gelişimi ile ilişkili bulundu.

Anahtar Kelimeler

Böbrek taşları, flexibl ureterorenoskopi, enfektif komplikasyonlar, risk faktörleri

Factors affecting infective complications after laser lithotripsy with flexible ureterorenoscopy in kidney stone treatment

Öz

Objective: We aimed to evaluate the factors affecting infectious complications after flexible ureterorenoscopy (f-URS) procedure with holmium laser in the treatment of kidney stones.
Material and Methods: 482 patients who underwent f-URS with holmium laser between January 2015 - October 2019 were analyzed retrospectively in terms of gender, age, comorbidity, history of endoscopic surgery in the last six months, urine analysis and urine culture, blood test, operation time, residual stones and stone size. All patients underwent a standard f-URS procedure. Postoperative infectious complications such as postoperative fever with urinary tract Infections, Systemic Inflammatory Response Syndrome (SIRS) and sepsis were evaluated.
Results: The mean age of the patients was 52±15 years and pre-oerative creatine levels were 0.94±0.34 mg/dL. Twenty-two patients undergoing the f-URS procedure had solitary kidneys. The number of patients with preoperative positive urine culture was 62 (12.9%) and 253 patients had a preoperative Double J (DJ) stent. The mean stone density was found 1010 ± 393 Hounsfield Unit (HU). Urethral access sheat was used in 473 patients during the operation. It was determined that the mean operation time was 56 ± 19 minutes. In the first session, the stone-free rate was found 80.7%. The incidence of infectious complications after f-URS was 10% (n = 48) of these patients (4.4%), SIRS in 11 (2.2%), and sepsis in 16 (3.4%). Univariate analysis result revealed that surgery time, high creatinine levels, preoperative positive urine culture, endoscopic stone treatment history in the last six months, presence of preoperative DJ stent, increase in stone size and residual stone were associated with postoperative complications (p <0.05). In the evaluation made with multivariate regression analysis, the duration of operation, preop positive urine culture and endoscopic stone treatment history in the last six months were found to be predictive factors for infectious complications after f-URS.
Conclusion: We observed that the duration of surgery, preoperative positive urine culture, and the history of endoscopic stone therapy in the last 6 months were independently associated with the development of infectious complications following the f-URS procedure. 

Anahtar Kelimeler

idney stones, flexible ureterorenoscopy, infective complications, risk factors

Kaynakça

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