Üreteroskopide Üreteral Balon Komplikasyonları

Öz

Amaç: Endoskopik üreter taşı tedavisinde kullanılan üreteral balon komplikasyonları araştırıldı. Materyal ve Metot: 2015–2018 yılları arasında bu konuda deneyimli tek cerrah tarafından üreteral balon dilatasyonu yapılan ve operasyon sonrası en az 1 yıl takibi olan hastalar retrospektif olarak çalışmaya dahil edildi. Operasyon anında gelişen komplikasyonlar modifiye Satava komplikasyon sınıflamasına göre, sonrasında olanlar Clavien sınıflamasına göre belirlendi. Postoparatif takiplerde rezidü taş boyutu <4 mm olan hastalar başarılı tedavi olarak değerlendirildi. Bulgular: Çalışmaya 54 hasta dahil edildi. Taşlar 16 (%29,6) hastada böbrek içinde 38 (%70,4) hastada üreterde saptandı. Çalışmada kullanılan üreteroskop çapları 8,5–11,5 fr., üreteral access sheath çapları 10–12 fr. olarak belirlendi. 34 (%62,9) hastada üreteroskop, 20 (%37,1) hastada üreteral access sheath geçmediği için balon dilatasyon yapıldı. Çalışmada 47 (%87,03) hastada başarılı tedavi sağlandı. Balon dilatasyona bağlı 5 (%9,2) hastada intraoperatif komplikasyon gelişti. 1 (%1,85) hastada perforasyon, 1 (%1,85) hastada lost access ve sonrasında üreteral darlık ve 3 (%5,55) hastada mukozal yaralanma görüldü. Postoperatif 6 (%11,1) hastada genel komplikasyonlar (ateş, hematüri, taşyolu ve geç dönem üreteral darlık) görüldü. Sonuç: Üreteral balon komplikasyonlarını cerrahın deneyimi azaltmamaktadır. Bu konuda iyi standardize edilmiş deneyimli cerrahların daha çok çalışmalarına ihtiyaç vardır.

Anahtar Kelimeler

• üriner taşlar
• dilatasyon
• üreteroscopy; komplikasyon

Ureteral Balloon Complications in Ureteroscopy

Öz

Aim: Complications of ureteral balloon used in the endoscopic treatment of ureteral stones were investigated. Material and Method: This retrospective study evaluated patients who underwent ureteral balloon dilatation by a single surgeon between 2015 and 2018 and followed up for at least one year. Intraoperative complications were determined according to the modified Satava complication classification, while postoperative complications were determined according to the Clavien classification. In the postoperative follow-up, patients with a residual stone size of less than 4 mm were considered successful treatment. Results: A total of 54 patients were included in this investigation. Stones were detected in the kidney in 16 (29.6%) patients and the ureter in 38 (70.4%) patients. The ureteroscope diameters used in those operations were 8.5–11.5 fr., and the ureteral access sheath diameters were 10–12 fr. Balloon dilatation was performed in 20 (37.1%) patients because the ureteral access sheath could not be passed and in 34 (62.9%) patients because the ureteroscopy could not be passed. Successful treatment was achieved in 47 (87.03%) patients. Due to balloon dilatation, intraoperative complications developed in 5 (9.2%) patients. Perforation was observed in 1 (1.85%) patient, lost access and subsequent ureteral stricture in 1 (1.85%) patient, and mucosal injury in 3 (5.55%) cases. General complications (fever, hematuria, calculus, and late ureteral stricture) were reported in 6 (11.1%) patients. Conclusion: The surgeon’s experience does not reduce ureteral balloon complications. There is a need for more studies by experienced surgeons who are well standardized on this subject.

Anahtar Kelimeler

• urolithiasis
• dilatation
• ureteroscopy; complication

Kaynakça

1. 1. Türk C (Chair), Skolarikos A (Vice-chair), Neisius A, Petrik A, Seitz A, Thomas A. Guidelines on urolithiasis. Eur Assoc Urol/ 2019;69:1–88.
2. 2. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association, Endourological Society Guideline, PART I. J Urol. 2016;196:1153–60.
3. 3. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association, Endourological Society Guideline, PART II. J Urol. 2016;196:1161–69.
4. 4. Ahmed M, Pedro RN, Kieley S, Akornor JW, Durfee WK, Monga M. Systematic evaluation of ureteral occlusion devices: insertion, deployment, stone migration, and extraction. Urology. 2009;73(5):976–980.
5. 5. Cetti RJ, Biers S, Keoghane SR. The difficult ureter: what is the incidens of pre-stending, Ann Re Coll Surg Engl. 2011;93:31–3.
6. 6. Sahabana W, Teleb M, Dawot T. Safety and efficacy of using the stone cone, entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones. Arb J Urol. 2015;13:73–9.
7. 7. Kuntz NJ, Neisius A, Tsivian M, Ghaffar M, Patel N, Ferrandino MN, et al. Balloon dilation of the ureter: A contemporary review of outcomes and complications. J Urol. 2015;194(2):413–17.
8. 8. Stoller ML, Wolf JS Jr, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: An outcome assessment. J Urol. 1992;147(5):1238–42.

9. 9. Huffman JL, Bagley DH. Balloon dilation of the ureter for ureteroscopy. J Urol. 1988;140(5):954–56.
10. 10. Castro PE, Osther PJ, Jinga V, Razvi H, StravodimosKG, Parikh K, et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. Eur Urol. 2014;66:102–9.
11. 11. Ambani SN, Faerber GJ, Roberts WW, Hollingsworth JM, Wolf JS Jr. Ureteral stents for impassable ureteroscopy. J Endourol. 2013;27(5):549–53.