ÜRETERAL GİRİŞ KILIFI KULLANILMADAN GERÇEKLEŞTİRİLEN RETROGRAD İNTRARENAL CERRAHİ SONUÇLARIMIZ

Öz

Kliniğimizde böbrek taşı nedeniyle üreteral giriş kılıf kullanılmadan retrograd intrarenal cerahi RİRC yapılan 39 olgunun sonuçlarını sunmak. Temmuz 2013 ile Haziran 2014 tarihleri arasında Bozyaka Eğitim ve Araştırma Hastanesi Üroloji kliniğinde böbrek taşına yönelik RİRC uygulanırken üreteral giriş kılıfı kullanılmayan 39 26 erkek, 13 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 negatif olunca ameliyata alındı. Olguların 13’ü kadın, 26’sı erkek, yaş ortalaması 48.6 yıl idi.Ortalama taş boyutu 14.1 mm idi. Bütün işlemler üreteral giriş kılıfı kullanılmadan gerçekleştirildi. Ortalama operasyon süresi 73.1 30132 dk, fluoroskopi süresi ise 6.9 sn idi. Bütün hastalar ameliyat sonrası 1. günde taburcu edildi. Olguların 1. ay kontrollerinde 33 inde %84,6 taşsızlık sağlanırken, 5 tanesinde %12.8 rezidü taş, 1 tanesinde de %2.5 klinik önemsiz taş saptandı. Takiplerde 4 %10,2 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. Üreteral giriş kılıfı kullanılmadan yapılan RİRC işleminde başarı oranları değişmezken komplikasyon oranları belirgin olarak düşmektedir

Anahtar Kelimeler

• böbrek taşı,fleksible üreteroskop,retrograd intrarenal cerrahi

RETROGRADE INTRARENAL SURGERY OUTCOMES WITHOUT USING AN ACCESS SHEAT

Abstract

To present the outcome of 39 cases who had undergone retrograde intrarenal surgery RIRS without using an access sheath for renal stones in our clinic. The data of 39 patients who underwent RİRS wıthout using an access sheath 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 13 female and 26 male patients with a mean age of 48.6 years range 2381 .Mean stone size was 14.1 mm. Access sheaths were not used in all cases during the RIRS. Mean operative, and fluoroscopy times were 73.1 minutes, and 6.9 seconds, respectively. All patients were discharged at postoperative 1st day . At 1st month follow-up stone-free rate was achieved in 33 84,6% patients. Clinically insignificant residual stone fragments were detected in 1 2.5% , and residual stones in 5 12.8% . During follow-up period, non-complicated urinary tract infection developed in 4 10,2 % 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. RIRS without access sheat is a safe procedure with lower complication rates and similar success rates

Keywords

• renal stone,flexible ureteroscope,retrograde intrarenal surgery

Kaynakça

1. ) Chow GK, Patterson DE, Blute ML JW. Ureteroscopy: effect of technology and technique on clinical practice. J Urol 2003;170(1):99–102.
2. ) Wendt-Nordahl G, Mut T, Krombach P et al Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011;39(3):185–8.
3. ) Breda A, Ogunyemi O, Leppert JT et al. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2 0 0 9 ; 55 (5): 1190–6.
4. ) Preminger GM Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 2006;34(2):108–11.
5. ) Srisubat A, Potisat S, Lojanapiwat B, et al Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev: CD0070446,2009
6. ) Takayasu H, Aso Y. Recent development for pyeloureteroscopy: guide tube method for its insertion into the ureter. J Urol 1974;112(2):176-8.
7. ) Newman RC, Hunter PT, Hawkins IF, Finlayson B. The ureteral access system: a rewiev of the immediate results in 43 cases. J Urol 1987;137 (3):380-3.
8. ) Newman RC, Hunter PT, Hawkins IF, Finlayson B. A general ureteral dilator- sheathing system. Urology 1985;25(3):287-8.

9. ) Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol 2007;21(2):119– 23.
10. ) Auge BK, Pietrow PK, Lallas CD et al. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004;18(1):33–6.
11. ) L’Esperance JO, Ekeruo WO, Scales CD Jr et al Effect of ureteral access sheath on stone- free rates in patients undergoing ureteroscopic management of renal calculi. Urology 2005;66(2): 252–5.
12. ) Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001;165(3):789–93.
13. ) Traxer O, Thomas A () Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013;189(2): 580–4.
14. ) Pietrow PK, Auge BK, Delvechio FC, Silverstein AD, Weizer AZ, Albala DM, et al. Techniques to maximize flexible ureteroscope longevity. Urology 2002;60(5):784-8.
15. ) Stoller ML, Wolf JS Jr, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. J Urol 1992;147(5):1238-42.
16. ) Çakıroğlu B, Çaşkurlu T,Başarısız SWL yapılan böbrek alt kaliks taşlarında flexible URS ve Holmium Lazer etkinliği. Yeni Üroloji Dergisi 2012;7(2):20-5.
17. ) Akpınar H, Tüfek İ,Atuğ F, Sevinç C, Kural AR.Alt kaliks taşlarının tedavisinde retrograde intrarenal cerrahi.Türk Üroloji Dergisi 2009;35(2):108-12.
18. ) Sofer M, Watterson JD, Wollin TA et al Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 2002;167(1):3–4.
19. ) Monga M, Bhayani S, Landman J, Conradie M, Sundaram CP, Clayman RV, Ureteral access for upper urinary tract disease: the access sheath. J Endourol 2001;15(8):831-4.
20. ) Wu NZ, Auge BK, Preminger GM. Simplified ureteral stent placement wıth the assistance of a ureteral access sheath. J Urol 2001;166(1):206-8.
21. ) Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001;165(3):789-93.
22. ) 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(6):313-20.
23. ) Geavlete P, Seyed Aghamiri SA, Multescu R. Retrograde flexible ureteroscopic approach for pyelocaliceal calculi. J Urol 2006;3(1):15-9.
24. ) Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ. Indwelling ureteral stents: Evaluation of symptoms, quality of life and utility. J Urol 2003;169(3):1065-9.
25. ) Lee C, Kuskowisky M, Premoli J, Skemp N, Monga M. Randomized evaluation of Ureteral stents using validated symptom questionnaire. J Endourol 2005;19 (8):990-3.
26. ) Ronald A, Rubenstein RA, Zhao LC, Loeb S, Shore DM, Nadler RB. Presenting improves ureteroscopic stone-free rates. J Endourol 2007;21(11):1277-80.
27. ) Vanlangendonck R, Landman J. Ureteral access strategies: pro-access sheath. Urol Clin North Am 2004;31(1):71–81.
28. ) Abrahams HM, Stoller ML. The argument against the routine use of ureteral access sheaths. Urol Clin North Am 2004;31(1):83–7.
29. ) Lallas CD, Auge BK, Raj GV et al. Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol 2002; 16(8):583–90.
30. ) Delvecchio FC, Auge BK, Brizuela RM et al. Assessment of stricture formation with the ureteral access sheath. Urology 2003;61(3):518–22. 31) Characterization
31. ureteropyeloscopy with ureteral access sheaths. Urology 2003;61(4):713–8. intrapelvic pressure
32. during 32) Mona M, Dretler SP, Landman J, Slaton JW, Conradie MC, Clayman RV. Maximizing ureteroscope deflection. ‘’play it straight’’ Urology 2002;60(5):902- 5.