PRİMER İNCE BAĞIRSAK TÜMÖRLERİ: ÇEYREK YÜZYILLIK KLİNİKOPATOLOJİK DENEYİM

Öz

Kliniğimizde böbrek taşı nedeniyle retrograd intrarenal cerahi RİRC uygulanan ilk 41 olgunun sonuçlarını sunmak. Temmuz 2013 ile Haziran 2014 tarihleri arasında Bozyaka Eğitim ve Araştırma Hastanesi Üroloji kliniğinde böbrek taşına yönelik RİRC uygulanan 41 27 erkek, 14 kadın hastanın verileri prospektif olarak kaydedildi. Tüm hastalar ameliyat öncesi ayrıntılı bir hikaye, rutin labarotuvar testleri ve idrar kültürü ile değerlendirildi. İdrar kültüründe üreme olan hastalar antibiyotik tedavisi sonrası kültürler temiz olunca ameliyata alındı. Olguların 14’ü kadın, 27’si erkek, yaş ortalaması 48.6 yıl idi. Ortalama taş boyutu 14.1 mm idi. İşlemlerin 2 % 4.8 tanesinde üreteral giriş kılıfı kullanılırken, kalan 39 % 95.2 hastada işlem kılıfsız uygulandı. Ortalama operasyon süresi 73.1 dk, floroskopi süresi ise 6.9 sn idi. Bütün hastalar ameliyat sonrası 1. günde taburcu edildi. Olguların 1. ay kontrollerinde 35 inde %85.3 taşsızlık sağlanırken, 5 tanesinde %12.1 rezidü taş, 1 tanesinde de %2.4 klinik önemsiz taş saptandı. Takiplerde 4 hasta antibiyotiklerle kontrol altına alınan üriner enfeksiyon saptandı, hiçbir hastada sepsis gelişmedi. İki cm altındaki böbrek taşlarının tedavisinde RİRC işlemi güvenle uygulanabilen, taşsızlık, kısa hastanede kalış süresi ve düşük komplikasyon oranıyla günümüzde tercih sebebi olan minimal invaziv yöntemdir

Anahtar Kelimeler

• böbrek taşı,fleksible üreteroskop,retrograd intrarenal cerrahi

PRIMARY SMALL INTESTINE TUMORS: A QUARTER CENTURY OF CILINICOPATHOLOGICAL EXPERIENCE

Öz

To present the outcome of first 41 cases who had undergone retrograde intrarenal surgery RIRS for renal stones in our clinic. The data of 41 patients who underwent RİRC for renal stones in our clinic between July 2013 and June 2014 were noted prospectively. All patients were evaluated with a detailed medical history, routine labarotory tests and urine culture preoperatively. If the urine culture was positive, antibiotic therapy was given and the operation was postponed until a negative culture was achieved. Study population consisted of 14 female and 27 male patients with a mean age of 48.6 years . Mean stone size was 14.1 mm. Access sheaths were used in 2 4.8 % cases, while in 39 95.2 % cases the procedure was applied without using an access sheath. Mean operative, and fluoroscopy times were 73.1 minutes, and 6.9 seconds, respectively. All patients were discharged at postoperative day 1. At 1st month follow-up stone-free rate was achieved in 35 85.3% patients. Clinically insignificant residual stone fragments were detected in 1 2.4% , and residual stones in 5 12.1% . During follow-up period, non-complicated urinary tract infection developed in 4 patients . But none of the patients had developed sepsis.RIRS is a safe and effective minimally invasive method for the treatment of renal stones less than 2 cm with high stone-free rates, low complication rate and short hospitalization time

Anahtar Kelimeler

• renal stone,flexible ureteroscope,retrograde intrarenal surgery

Kaynakça

1. ) Zheng W, Beiko DT, Segura JW, et al. Urinary calculi in aviation pilots: what is the best therapeutic approach? J Urol ;168:1341–3.
2. ) Türk C, Knoll T, Petrik A, et al, & Seitz, C. Guidelines on Urolithiasis. 2012.
3. ) Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology 1995;45:372-6.
4. ) Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009; :1190-6.
5. ) Unsal A, Resorlu B, Kara C, et al. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010;76:247-52.
6. ) Kara C, Resorlu B, Bayindir M, Unsal A. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology 2010;76:289-93.
7. ) Johnson DE, Cromeens DM, Price RE. Use of the holmium:YAG laser in urology. Lasers Surg Med 1992;12:353–63.
8. ) Sayer J, Johnson DE, Price RE, Cromeens DM. Ureteral lithotripsy with the holmium:YAG laser. Laser Med 1993;11: –5.

9. ) Wong MY. Flexible ureteroscopy is the ideal choice to manage a 1.5 cm diameter lower pole stone. J Endourol 2008; :1845-6.
10. ) Fuchs GJ, Fuchs AM. Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment. Der Urologe Ausg A 1990;29:313-20.
11. ) Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urology 1998;159:1139-43.
12. ) Gould DL. Holmium:YAG laser and its use in the treatment of urolithiasis: our first 160 cases. J Endourol 1998;12:23-6.
13. ) Reşorlu B, Ünsal A. Böbrek Taşlarının Tedavisinde Retrograd İntrarenal Cerrahi (RIRC) Turk Urol Sem 2011;2: 64-7.
14. ) Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol 2007;21:119-23.
15. ) Abrahams HM, Stoller ML. The argument against the routine use of ureteral access sheaths. Urol Clin North Am 2004;31:83-7.
16. ) Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001; :789-93.
17. ) Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 2005;173:2005-9.
18. ) Reşorlu M, Ağladıoğlu K, Özyuvalı E ve ark. Retrograd intrarenal cerrahi sonrası hastaların takibinde direkt üriner sistem grafisi ile birlikte ultrasonografinin etkinliği. Dicle Tıp Dergisi 2012;39:387
19. ) Auge BK, Dahm P, Wu NZ, Preminger GM. Ureteroscopic management of lower- pole renal calculi: technique of calculus displacement. J Endourol 2001;15:835-8.
20. ) Watterson JD, Girvan AR, Cook AJ, et al. Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urology 2002;168:442-5.
21. ) Harmon WJ, Sershon PD, Blute ML, et al. Ureteroscopy: current practice and long-term complications. J Urology 1997; :28-32.