OUR RETROGRADE INTRARENAL SURGERY EXPERIENCE IN THE TREATMENT OF MULTI-CALICEAL AND MULTIPLE KIDNEY STONES

Öz

Objective: Multiple kidney stones are seen in 20-25% of the patients. Treatment of multiple kidney stones is challenging. Retrograde intrarenal surgery is used in the treatment of multiple kidney stones. Success is lower than the single stones of the same size. We aimed to report our retrograde intrarenal surgery experience in the treatment of multi-caliceal and multiple kidney stones. 

Material and Methods: After approval of local ethics committee, patient data between 01.01.2014-01.01.2019 were retrospectively analyzed. Patients who had undergone retrograde intrarenal surgery for multi-caliceal and multiple kidney stones were included in our study. Demographic, intraoperative and postoperative data and complications were recorded.

Results: Forty-three patients were included in our study. The mean stone size was 13.69±6.21 mm. 

Mean stone volume was 972.48 ± 905.24 mm3. Mean Hounsfield unit was 1128.26±317.91 HU. The mean operation time was 51.97±20.18 minutes. Thirty-two patients were stone free. Postoperative complications were seen in four patients. Mucosal injury was observed in one patient and urinary tract infection was observed in three patients.

Conclusion: Multi-caliceal and multiple kidney stone treatment is challenging for urologists. There are various treatment methods. Retrograde intrarenal surgery is a safe and efficient alternative for the treatment of multi-caliceal and multiple kidney stones. Prospective and larger cohort studies are needed.

Anahtar Kelimeler

• : Experience
• multicaliceal
• retrograde intrarenal surgery

Multikalisiyel ve Multiple Böbrek Taşlarının Tedavisinde Retrograd İntrarenal Cerrahi Deneyimimiz

Öz

Amaç: Multiple böbrek taşları % 20-25 hastada görülmektedir. Tedavisi zordur. Retrograd intrarenal cerrahi multiple böbrek taşı tedavisinde kullanılmaktadır. Başarı aynı boyuttaki normal taşlara göre düşüktür. Biz çalışmamızda kliniğimizdeki multiple taş tedavisinde retrograd intrarenal cerrahi deneyimimizi sunmayı amaçladık.

Gereç ve Yöntemler: Lokal etik kurul onayı alındıktan sonra 01.01.2014-01.01.2019 arası hasta verileri retrospektif olarak tarandı. Multikaliseal ve multiple böbrek taşı için retrograd intrarenal cerrahi yapılan hastalar çalışmaya alındı. Onsekiz yaş altındaki hastalar çalışmadan çıkarıldı. Demografik, intraoperatif, postoperatif veriler ve komplikasyonlar kaydedildi.

Bulgular: Çalışmaya 43 hasta alındı. Taş boyutu ortalama 13.69±6.21 mm idi. Taş volümü ortalama 972.48 ± 905.24 mm3, Hounsfield ünitesi ortalama 1128.26±317.91 HU idi. Ortalama operasyon zamanı 51.97±20.18 dakikaydı. Taşsızlık 32 hastada sağlandı. Postoperatif komplikasyonlar dört hastada görüldü. Bir hastada mukozal yaralanma, üç hastada idrar yolu enfeksiyonu izlendi. 

Sonuç: Multikaliseal ve multiple böbrek taş tedavisi ürologlar için zorludur. Çeşitli tedavi yöntemleri mevcuttur. Retrograd intrarenal cerrahi güvenli ve etkin bir alternatiftir. Prospektif ve yüksek hasta sayılı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Deneyim
• Multikalisiyel
• retrograd intrarenal cerrahi

Kaynakça

1. 1. Quaresima L, Conti A, Vici A, Tiroli M, Cantaro D, Rreshketa A et al. Safety and efficacy of percutaneous nephrolithotomy in the Galdakao-Modified Supine Valdivia position: A prospective analysis. Arch Ital Urol Androl. 2016;88(2):93-6.
2. 2. Pu C, Wang J, Tang Y, Yuan H, Li J, Bai Y et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis. 2015;43(5):455-66.
3. 3. Michel MS, Trojan L, and Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51(4):899–906.
4. 4. Karakan T, Kilinc MF, Doluoglu OG, Yildiz Y, Yuceturk CN, Bagcioglu M et al. The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study. Urolithiasis. 2017;45(2):209-13.
5. 5. Huffman JL, Bagley DH, Lyon ES. Extending cystoscopic techniques into the ureter and renal pelvis. Experience with ureteroscopy and pyeloscopy. JAMA. 1983;250(15):2002-5.
6. 6. Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH. Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol. 2010;51(11):777-82.
7. 7. Ozgor F, Kucuktopcu O, Ucpinar B, Gurbuz ZG, Sarilar O, Berberoglu AY et al. Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300 mm2? Int Braz J Urol. 2016;42(6):1168-77.
8. 8. Gorbachinsky I, Wood K, Colaco M, Hemal S, Mettu J, Mirzazadeh M et al. Evaluation of renal function after percutaneous nephrolithotomy-does the number of percutaneous access tracts matter?. J Urol. 2016;196(1):131-6.

9. 9. McAdams S, Kim N, Ravish IR, Monga M, Ugarte R, Nerli R et al. Stone size is only independent predictor of shock wave lithotripsy success in children: a community experience. J Urol. 2010;184(2):659-64.
10. 10. Alkan E, Ozkanli O, Avci E, Turan M, Başar MM, Acar O et al. Effectiveness of flexible ureterorenoscopy and laser lithotripsy for multiple unilateral ıntrarenal stones smaller than 2 cm. Adv Urol. 2014;2014:314954.
11. 11. Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol. 2009;55(5):1190-96.
12. 12. Takazawa R, Kitayama S, Tsujii T. Single-session ureteroscopy with holmium laser lithotripsy for multiple stones. Int J Urol. 2012;19(12):1118-21.
13. 13. Cakıcı MC, Sarı S, Özok HU, Karakoyunlu N, Hepsen E, Sagnak L et al. Comparison of retrograde ıntrarenal surgery and percutaneous nephrolithotomy in the treatment of 2-3 cm multicalyceal kidney stones. J Urol Surg. 2018;5(4):143-148.
14. 14. Demirbas A, Yazar VM, Ersoy E, Demir OD, Ozcan S, Karakan T et al. comparison of percutaneous nephrolithotomy and retrograde ıntrarenal surgery for the treatment of multicalyceal and multiple renal stones. Urol J. 2018;Nov,17;15(6):318-22.
15. 15. Singla M, Srivastava A, Kapoor R, Gupta N, Ansari MS, Dubey D et al. Aggressive approach to staghorn calculi-safety and efficacy of multiple tracts percutaneous nephrolithotomy. Urology. 2008;71(6):1039-42.
16. 16. Stav K, Cooper A, Zisman A, Leibovici D, Lindner A, Siegel YI. Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy. J Urol. 2003;170(6):2198-201.
17. 17. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol. 1998;159(4):1139-43.
18. 18. Oztekin U, Caniklioglu M, Selmi V, Kantekin CU, Atac F, Gurel A et al. Do anesthesia methods in retrograde ıntrarenal surgery make difference regarding the success of ureteral access and surgical outcomes? J Laparoendosc Adv Surg Tech A. 2020;30(3):273-277.
19. 19. Cakici MC, Ozok HU, Erol D, Catalca S, Sari S, Ozdemir H et al. Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. Minerva Urol Nefrol. 2019;71(6):636-43.