30 mm’den Küçük Renal Pelvis Taşlarının Üreteroskopik Tedavisi

Yıl 2017, Cilt: 12 Sayı: 1, 11 - 16, 29.03.2017

Tayfun Şahinkanat , Hasan Çetin Ekerbiçer

https://doi.org/10.17517/ksutfd.302093

Öz

Amaç: Bu çalışmanın amacı retrospektif olarak
renal pelvis taş tedavisinde semirigid üreterorenoskopi sonuçlarımızı ve
modifiye Clavien sınıflamasına göre komplikasyonlarımızı değerlendirmek ve
literatür eşliğinde tartışmaktır.

Gereç ve Yöntemler:30 mm’den küçük
renal pelvis taşı nedeniyle 2014-2015 yılları arasında semirigid
üreterorenoskopi uygulanan 23 hastanın tıbbi kayıtları geriye dönük olarak
değerlendirildi.

Hastalar yaş,
cinsiyet, taş boyutu, daha önce vücut dışı ses dalga tedavisi ve ürteral
kateter kullanımı, taşsızlık ve komplikasyon açısından incelendi. Taş kırma
işlemi için Holmium-Yag lazer ve/veya pneumotik lithotripsi kullanıldı.
Hastalar postoperatif birinci ayda kontrastsız batın tomografisi ile
değerlendirildi. Klinik başarı taşsızlık veya asemptomatik klinik önemsiz
reziduel fragmanlar (<4 mm) olarak tanımlandı.  Komplikasyonlar modifiye Clavien
sınıflamasına göre sınıflandırıldı.

Bulgular: Çalışma grubu yaş ortalaması 39.78 ± 19.48
yıl (3-76 yıl) olan 11 kadın ve 12 erkek hastadan oluştu. Ortalama taş boyutu
19.6 ± 5.76 mm (7-30 mm) idi. İlk semirigid üreterorenoskopik lithotripsi
sonrası taşsızlık yüzdesi % 78.3 idi. Taş boyutu, cinsiyet ve hidronefroz
derecesinin başarı oranı üzerine anlamlı etkisi olmadığı görüldü (p>0.05).
Clavien sınıflamasına göre bir hastada derece 1, iki hastada derece 2 olmak
üzere toplam üç hastada minör komplikasyonlar oluştu. Derece 3,4,5 komplikasyonlar
hiçbir hastada izlenmedi.

Sonuç: Semirigid üreterorenoskopik lithotripsi
30 mm’den küçük renal pelvis taş tedavisinde etkili ve güvenli bir yöntemdir.
Bu bulguların doğrulanması için ileriye dönük randomize kontrollü çalışmalara
ihtiyaç vardır.

 

Anahtar Kelimeler

Semirigid üreterorenoskopi, renal pelvis taşı

Ureteroscopic Management of Renal Pelvic Stones Less Than 30 mm

Öz

Objective: The aim of this study was to assess the
our outcomes of semirigid ureterorenoscopy for management of renal pelvic stones
and determine complications according to the modify Clavien classification
retrospectively and discuss with literature.

Material and Methods: Medical
records of 23 patients who underwent semirigid ureteroscopy due to renal pelvic
stones sized < 30 mm between 2014 and 2015 were retrospectively evaluated.

Patients were
investigated with regard to age, gender, stone size, history of previous
shockwave lithotripsy and ureteral catheterization, stone clearance and
complications. Holmium-Yag laser and/or pneumatic lithotripsy was used for
lithotripsy. Patients assessed using non-contrast computed tomography at one
month, postoperatively. Clinical success was defined as stone-free status or
asymptomatic insignificant residual fragments (<4 mm). Complications were
classified according to the modified Clavien classification.

Results: Study population consisted of 11 female
and 12 male patients with a mean±SD age of 39.78 ± 19.48 years (3-76 years).
The mean±SD stone size was 19.6 ± 5.76 mm (7-30 mm). The mean stone-free rate
was 78.3% after initial semirigid ureterorenoscopic lithotripsy. Success rates
did not differ significantly with respect to stone size, gender and grade of
hydronephrosis (p>0.05). Minor complications as classified by Clavien 1
(n:1) or 2 (n:2) occured in 3 (13%) patients. Grade 3, 4,5 complications were
not determined in any patient.

Conclusion: Semirigid ureterorenoscopic lithotripsy
is an effective and safe procedure in the treatment of < 30 mm renal pelvic
stones.  Prospective randomized
controlled trials are needed to confirm these findings.

Anahtar Kelimeler

Semirigid ureterorenoscopy, renal pelvic stone

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