Okul Öncesi Çocuklarda Farklı Kılıf Büyüklüğünde yapılan Mini-Perkütan Nefrolitotomi Sonuçlarının Karşılaştırması

Öz

Amaç: Bu çalımada , bebeklerde ve okul öncesi yaş gruplarındaki çocuklarda mini perkütan nefrolitotomi (Mini-PCNL) uygulanan başarı oranını ve komplikasyonları, kompleks böbrek taşları için iki farklı boyutta traktlarla karşılaştırdık. Materyal ve Metot: Ocak 2002 ile Haziran 2018 tarihleri arasında mini PCNL uygulanan 7 yaşından küçük 260 pediatrik hastanın kayıtları geriye dönük olarak araştırıldı. Karmaşık böbrek taşı hastalığı olan yüz kırk dokuz okul öncesi çocuk ve bebek (66 kız ve 83 erkek) dahil edildi. Çalışmada toplam 158 mini-PCNL gerçekleştirildi ve iki farklı gruba ayrıldı (14Fr grubu, n = 104 [% 69.8]; 20Fr grubu, n = 45 [% 30.2]). Bulgular: Ortalama hasta yaşı 14Fr ve 20Fr gruplarında sırasıyla 3.5 ± 2.0 ve 5.2 ± 2.2 yıl idi (p = 0.158). Hemoglobin düşüşünde (0.73 gr / dL'ye karşı 1.0 gr / dL, p = <0.041), kan transfüzyon hızında (% 3.6'ya karşı 16.7, p = 0.013), floroskopi süresi (4,29 dk. - 5,42 dk., p = <0,001), dakikada ortalama parçalanmış taş boyutu (4,29 mm2 / dk - 5,43 mm2 / dk, p = 0,016), ameliyat süresi (65,2 - 74,1 dk, p = 0.040), kateter çıkarılma süresi (2.58 güne karşı 2.89 gün, p = <0.001) ve hastanede kalış sürelerinde (3.78 güne karşı 4.67 gün, p = 0.010) 20Fr grubuna göre 14Fr grubu daha avantajlıydı. Bununla birlikte, cinsiyette, taşın lateralitesi, yeri, yükü ve opaklığı, hidronefroz varlığı, önceki taş tedavisi sayısı, acsess girişler, kaliksler, taş temizleme oranı, diversiyon tipleri, komplikasyonlar ve taşsızlık oranları açısından istatistiksel bir farklılık gözlenmedi. Sonuçlar: Bu çalışma, 14Fr ile 20Fr kılıfla yapılan mini-PCNL prosedürünün hemoglobin düşüşü, kan transfüzyon hızı, kateter çıkarma süresi ve hastanede kalış süresinin önemli ölçüde azaltılması ile ilgili önemli avantajlı olduğunu göstermiştir. Taşsızlık oranları ve komplikasyonlar her iki grupta benzerdi.

Anahtar Kelimeler

• Nefrolitotomi
• Çocuk
• Endouroloji

Comparison of Different Sheath-sized Mini-Percutaneous Nephrolithotomy in Preschool-aged Children

Öz

Aim: We compared success rate and complications in infants and preschool-aged children who had undergone mini-percutaneous nephrolithotomy (Mini-PCNL) with two different sizes of tracts for complex renal calculi. Materials and Methods: Two thousand sixty pediatric patients younger than 7 years old who had undergone mini-PCNL between January 2002 and June 2018 were evaluated retrospectively. One hundred forty-nine preschool-aged children and infants (66 girls and 83 boys) with complex kidney stone disease were included. A total of 158 mini-PCNL were performed in the study. These were classified into two groups (the 14Fr group, n=104 [69.8%]; the 20Fr group, n=45 [30.2%]). Results: The mean age of the patients was 3.5±2.0 year-old and 5.2±2.2 year-old in the 14Fr and 20Fr groups, respectively (p=0.158). There was an superiority of 14Fr group over 20Fr group in terms of significant reduction of hemoglobin difference (0.73 gr/dL vs. 1.0 gr/dL, p=<0.041), blood transfusion rate (3.6% vs. 16.7, p=0.013), fluoroscopy time (4.29 min. vs 5.42 min., p=<0.001), mean fragmented stone size per minute (4.29 mm2/min vs 5.43 mm2/min, p=0.016), operative time (65.2 vs 74.1 min, p=0.040 ), catheter removal time (2.58 days vs. 2.89 days, p<0.001) and hospitalization (3.78 days vs. 4.67 days, p=0.010), respectively. However, no significant differences were observed regarding gender, laterality, location, burden, and the opacity of the stone, presence of hydronephrosis, number of previous stone treatments, accesses achieved, calyces accessed, stone clearance rate, diversion types, complications, and stone-free rates between the groups. Conclusions: This study expressed that the mini-PCNL performed by 14Fr was superior over that by 20Fr sheath regarding the significant reduction of hemoglobin drop, blood transfusion rate, catheter removal time, and duration of hospitalization. The stone-free rates and the other parameters were comparable in both groups.

Anahtar Kelimeler

• nephrolithotomy
• children
• endourology

Kaynakça

1. Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, Sultan S and Mehdi H. Management of pediatric urolithiasis in Pakistan: experience with 1,440 children. J Urol 2003; 169: 634-637.
2. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC and Rule AD. Temporal trends in incidence of kidney stones among children: a 25-year population based study. J Urol 2012; 188: 247-252.
3. Woodside JR, Stevens GF, Stark GL, Borden TA and Ball WS. Percutaneous stone removal in children. J Urol 1985; 134: 1166-1167.
4. Kapoor R, Solanki F, Singhania P, Andankar M and Pathak HR. Safety and efficacy of percutaneous nephrolithotomy in the pediatric population. J Endourol 2008; 22: 637-640.
5. Jackman SV, Hedican SP, Peters CA and Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 1998; 52: 697-701.
6. Ozden E, Sahin A, Tan B, Dogan HS, Eren MT and Tekgul S. Percutaneous renal surgery in children with complex stones. J Pediatr Urol 2008; 4: 295-298. Dindo D, Demartines N and 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: 205-213.
7. Mor Y, Elmasry YE, Kellett MJ and Duffy PG. The role of percutaneous nephrolithotomy in the management of pediatric renal calculi. J Urol 1997; 158: 1319-1321. Helal M, Black T, Lockhart J and Figueroa TE. The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithotomy. J Endourol 1997; 11: 171-172.
8. Sabnis RB, Ganesamoni R and Sarpal R. Miniperc: what is its current status? Curr Opin Urol 2012; 22: 129-133. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2. http://uroweb.org/guidelines/compilations-of-all-guidelines/.

9. Zanetti SP, Talso M, Palmisano F, Longo F, Gallioli A, Fontana M, De Lorenzis E, Sampogna G, Boeri L, Albo G, Trinchieri A and Montanari E. Comparison among the available stone treatment techniques from the first European Association of Urology Section of Urolithiasis (EULIS) Survey: Do we have a Queen? PLoS One 2018; 13: e0205159.
10. Wright AE, Somani BK and Rukin NJ. Proposition for new terminologies in PCNL: what does ‘ultra-mini-micro’ actually mean? Urolithiasis 2014; 42: 539-540. Bilen CY, Kocak B, Kitirci G, Ozkaya O and Sarikaya S. Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol 2007; 177: 1867-1871.
11. Guven S, Istanbulluoglu O, Ozturk A, Ozturk B, Piskin M, Cicek T, Kilinc M, Ozkardes H and Arslan M. Percutaneous nephrolithotomy is highly efficient and safe in infants and children under 3 years of age. Urol Int 2010; 85: 455-460.
12. Unsal A, Resorlu B, Kara C, Bozkurt OF and Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010; 76: 247-252.
13. Mahmud M and Zaidi Z. Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre. BJU Int 2004; 94: 1352-1354. Aron M, Yadav R, Goel R, Hemal AK and Gupta NP. Percutaneous nephrolithotomy for complete staghorn calculi in preschool children. J Endourol 2005; 19: 968-972.
14. Manohar T, Ganpule AP, Shrivastav P and Desai M. Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol 2006; 20: 547-551.
15. Webb DR and Fitzpatrick JM. Percutaneous nephrolithotripsy: a functional and morphological study. J Urol 1985; 134: 587-591.
16. Clayman RV, Surya V, Hunter D, Castaneda-Zuniga WR, Miller RP, Coleman C, Amplatz K and Lange PH. Renal vascular complications associated with the percutaneous removal of renal calculi. J Urol 1984; 132: 228-230.
17. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R and Desai M. Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011; 108: 896-899; discussion 899-900.
18. Cheng F, Yu W, Zhang X, Yang S, Xia Y and Ruan Y. Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol 2010; 24: 1579-1582. Desai M. Endoscopic management of stones in children. Curr Opin Urol 2005; 15: 107-112.
19. Ozden E, Mercimek MN, Yakupoglu YK, Ozkaya O and Sarikaya S. Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children. J Urol 2011; 185: 264-268.