Retrograt intrarenal cerrahi geriatrik erkek hastalarda böbrek taşı tedavisinde etkin ve güvenilir bir seçenek midir?

Yıl 2021, Cilt 31, Sayı 4, 396 - 401, 15.12.2021

Ali Furkan BATUR Mustafa GÜLMEN Kadir BÖCÜ Emre ALTINTAŞ Murat GÜL Mehmet KAYNAR Özcan KILIÇ Serdar GÖKTAŞ

https://doi.org/10.54005/geneltip.972227

Öz

Amaç Bu çalışmada böbrek taşı tedavisi için kliniğimizde retrograt intrarenal cerrahi(RİRC) uygulanılan geriatrik yaş grubu erkek hastaların etkinlik ve güvenlik sonuçlarının, daha genç yaş hasta grubu ile karşılaştırılarak sunulması amaçlanmıştır. Gereç ve Yöntem Kliniğimizde böbrek taşı nedeniyle RİRC uygulanmış olan, 40 yaş üzeri erkek hastaların verileri retrospektif olarak değerlendirildi. Hastalar yaşlarına göre iki gruba ayrıldı: 40-64 yaş (Grup 1) ve 65 yaş ve üzeri (Grup 2). Komorbidite değerlendirilmesi için anestezi risk skoru (ASA) ve modifiye Charlson komorbidite indeksi (MCKİ) kullanıldı. Hastanenin kayıt sisteminden ve hastaların dosyalarından genel bilgiler, komplikasyon bilgileri, renal anormallik varlığı, taşın bulunduğu böbrek ve lokalizasyonu, taşın dansitesi, taşın boyutu, taş sayısı verileri ve postoperatif taş temizlenme verileri elde edildi. Bulgular Çalışmaya 233 tanesi Grup 1 (40-64 yaş) ve 61 tanesi Grup 2 (65 yaş ve üstü) olmak üzere toplam 294 hasta alınmıştır. ASA ve MCKİ skorları bakımından Grup 2’de yer alan hastaların skorları Grup 1’e göre istatistiksel olarak anlamlı olarak daha yüksek olarak bulunmuştur (sırasıyla p=.000, p=.000). Gruplar arasında taş dansitesi, taş boyutu, taş hacmi, operasyon süresi, hastanede yatış süreleri ve postoperatif taşsızlık oranları bakımından fark bulunmamıştır. Grup 1’de toplam 25 (%10.7) hastada ve Grup 2’de toplam 10 (%16.4) hastada komplikasyon geliştiği tespit edilmiştir ve gruplar arasında genel komplikasyon oranları açısından istatistiki fark bulunmamıştır (p=.265). Sonuç Dünya nüfusunun giderek yaşlanması ile beraber bu hasta grubunun hastalıklarının da en uygun tedavi metodlarıyla tedavi edilmesinin önemi artmıştır. Çalışmamızda RİRC yöntemi ile böbrek taşı tedavisi yaşlı hasta grubunda da güvenli ve etkili olarak çıkmıştır.

Anahtar Kelimeler

Böbrek taşı, Geriatrik hasta, Komorbidite, Komplikasyon, Retrograt intrarenal cerrahi

Is retrograde intrarenal surgery an effective and safe option in the treatment of kidney stones in geriatric male patients?

Öz

Objective In this study, it was aimed to present the efficacy and safety results of geriatric male patients who underwent retrograde intrarenal surgery (RIRC) in our clinic for the treatment of kidney stones, by comparing them with the younger age group. Material and Methods The data of male patients over 40 years of age who underwent RIRC for kidney stones in our clinic were evaluated retrospectively. The patients were divided into two groups according to their age: 40-64 years (Group 1) and 65 years and older (Group 2). The data on the comorbidity status of the patients were compiled from their files. American Society of Anesthesiologists score(ASA) and modified Charlson comorbidity index(MCCI) were used for comorbidity assessment. General information, complication information, presence of renal abnormality, kidney and location of the stone, density of the stone, size of the stone, number of stones and postoperative stone clearance data were obtained from the hospital's registry system and the files of the patients. Results A total of 294 patients were included in the study, of which 233 were in Group 1 (40-64 years old) and 61 in Group 2 (65 years and older). In terms of ASA and MCKI scores, the scores of the patients in Group 2 were found to be statistically significantly higher than Group 1 (p=.000, p=.000, respectively). There was no difference between the groups in terms of preoperative DJ catheter set, presence of renal abnormalities and non-functioning kidneys. There was no difference between the groups in terms of stone density, stone size, stone volume, operation time, hospital stay, and postoperative stone-free rates. Complications were detected in 25 (10.7%) patients in Group 1 and in 10 (16.4%) patients in Group 2, and there was no statistical difference between the groups in terms of overall complication rates (p=.265). Conclusion With the aging of the world population, the importance of treating the diseases of this patient group with the most appropriate treatment methods has increased. In our study, kidney stone treatment with the RIRC method was found to be safe and effective in the elderly patient group.

Anahtar Kelimeler

Comorbidity, Complication, Geriatric patient, Kidney stone

Kaynakça

• Referans 1. Tzelves L, Mourmouris P, Skolarikos A.Comparison of current guidelines on medical management of stone disease. Arch Esp Urol 2021 ;74:171-82.
• Referans 2. Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol 2011;185:1304–11.
• Referans 3. Kim CH, Chung DY, Rha KH, Lee JY, Lee SH. Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2020;57:26-31.
• Referans 4. Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016;69:475–482.
• Referans 5. Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int 2014;92:164–168.
• Referans 6. Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol 2013;31:1605-10.
• Referans 7. Long Q, Guo J, Xu Z, et al. Experience of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones. Urol Int 2013;90:384-8.
• Referans 8. Sun X, Xia S, Lu J, Liu H, Han B, Li W. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol 2008;22:913-7.
• Referans 9. Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 2016;196:1153-60.
• Referans 10. Aykac A, Baran O. Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups. Int Urol Nephrol 2020;52:2229-36.
• Referans 11. Gökce Mİ, Akpinar Ç, Obaid K, Süer E, Gülpinar Ö, Bedük Y. Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population. Int Braz J Urol 2021;47:64-70.
• Referans 12. Gokcen K, Dundar G, Bagcioglu M, Karagoz MA, Gokce G, Sarica K. Safety and Efficacy of RIRS in Geriatric Patients: A Comparative Evaluation on an Age Based Manner. Urol J 2020;17:129-33.
• Referans 13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
• Referans 14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
• Referans 15. Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults--present status and future implications. Lancet 2015;385:563-75.
• Referans 16. Giusti G, Proietti S, Cindolo L, et al. Is retrograde intrarenal surgery a viable treatment option for renal stones in patients with solitary kidney? World J Urol 2015;33:309-14.
• Referans 17. Prattley S, Voss J, Cheung S, Geraghty R, Jones P, Somani BK. Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature. Int Braz J Urol 2018;44:750-757.
• Referans 18. Berardinelli F, De Francesco P, Marchioni M, et al. RIRS in the elderly: Is it feasible and safe? Int J Surg 2017;42:147-151.