Retrograd intrarenal cerrahi yapılan böbrek taşı hastalarında taş boyutu, yoğunluğu ve lokalizasyonunun; taşsızlık ve komplikasyon oranlarına etkisinin karşılaştırılması

Öz

Amaç: Esnek üreteroskopi ile retrograd intrarenal cerrahi (RIRS) renal kalkül için birinci basamak tedavi olarak ortaya çıkmıştır. Bu çalışma, RIRS sonrası taş boyutu, yoğunluğu ve lokalizasyonunun taşsızlık oranları ve komplikasyonlar üzerindeki etkisini değerlendirmektedir. Yöntem: Bu retrospektif kohort çalışmasında, renal taş hastalığı nedeniyle RIRS uygulanan ardışık 124 hasta analiz edildi. Taş özellikleri, boyut, yoğunluk (Hounsfield Üniteleri - HU) ve anatomik lokalizasyon için kontrastsız bilgisayarlı tomografi ile değerlendirildi. Esnek üreteroskop ve holmiyum:YAG lazer litotripsi kullanıldı. Birincil sonlanım noktası, bir ayda >3 mm rezidü fragman yokluğu olarak tanımlanan taşsızlık durumuydu. Bulgular: Çalışma grubu ağırlıklı olarak erkekti (%59.7), ortalama yaş 48.48±13.976 yıl. Ortalama taş boyutu 13.54±3.692 mm ve yoğunluk 840.47±229.785 HU idi. Genel taşsızlık oranı %74.2 (92/124 hasta) idi. Taşsızlık oranı artan boyutla anlamlı olarak azaldı: <10 mm taşlar için %94.3, 10-20 mm taşlar için %71.8, >20 mm taşlar için %45.5 (p<0.001). Orta yoğunluktaki taşlar (500-1000 HU) yumuşak (<500 HU: %71.4) ve sert taşlara (>1000 HU: %62.1) kıyasla üstün taşsızlık oranları gösterdi (%85.1) (p=0.035). >60 dakika süren operasyonlar daha yüksek taşsızlık oranlarına sahipti (%85.7 vs. %68.5. p=0.045). Genel komplikasyon oranı %10.5 idi ve rezidü taşlar komplikasyon riskini anlamlı olarak artırdı (%21.9 vs. %6.5, p=0.015). Sonuç: RIRS böbrek taşlarında yüksek etkinlik gösterir ve sonuçlar taş özelliklerinden anlamlı şekilde etkilenir. Orta yoğunluktaki taşlarda gözlenen üstün sonuçlar, taş yoğunluğu ile fragmantasyon verimliliği arasındaki ilişkinin daha karmaşık olabileceğini düşündürmekte ve ileri araştırmalar gerektirmektedir. Taş boyutu birincil başarı belirleyicisi olarak ortaya çıkar ve hasta danışmanlığı için net eşik değerler sağlar. Bulgular kapsamlı preoperatif taş değerlendirmesine dayalı bireyselleştirilmiş tedavi yaklaşımlarını destekler.

Anahtar Kelimeler

• Retrograd intrarenal cerrahi
• esnek üreteroskopi
• holmiyum lazer
• taş özellikleri
• taşsızlık oranı

Comparison of the effects of stone size, density and localization on stone-free and complication rates in kidney stone patients undergoing retrograde intrarenal surgery

Öz

Aim: Flexible ureteroscopy with retrograde intrarenal surgery (RIRS) has emerged as a first-line treatment for renal calculi. This study evaluated the impact of stone size, density, and anatomical location on stone-free rates and complications after RIRS. Method: In this retrospective cohort study, 124 consecutive patients undergoing RIRS for kidney stones were analyzed. Stone characteristics—including size, density (Hounsfield Units; HU), and anatomical location—were assessed by non-contrast computed tomography. Flexible ureteroscopes and holmium: YAG laser lithotripsy were utilized. The primary endpoint was stone-free status at one month, defined as the absence of residual fragments >3 mm. Results: The study population was predominantly male (59.7%), with a mean age of 48.48±13.976 years. The mean stone size was 13.54±3.692 mm and the mean density was 840.47±229.785 HU. The overall stone-free rate was 74.2% (92/124 patients). Stone-free rate significantly decreased with increasing stone size: 94.3% for stones <10 mm, 71.8% for 10-20 mm, and 45.5% for >20 mm (p<0.001). Stones of intermediate density (500-1000 HU) demonstrated higher stone-free rates (85.1%) compared to soft (<500 HU: 71.4%) and hard stones (>1000 HU: 62.1%) (p=0.035). Procedures lasting over 60 minutes yielded higher stone-free rates (85.7% vs. 68.5%, p=0.045). The overall complication rate was 10.5%, and residual stones significantly increased the risk of complications (21.9% vs. 6.5%, p=0.015). Conclusion: RIRS is highly effective for renal stones, with outcomes significantly influenced by stone characteristics. The superior results observed in intermediate-density stones suggest a more complex relationship between stone density and fragmentation efficiency, warranting further investigation. Stone size emerges as the primary determinant of success, providing clear thresholds for patient counseling. These findings support individualized treatment approaches based on comprehensive preoperative stone assessment.

Anahtar Kelimeler

• Retrograde intrarenal surgery
• flexible ureteroscopy
• holmium laser
• stone characteristics
• stone-free rate

Kaynakça

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