Perkütan antegrad çift J üreteral stent yerleştirilmesinin ardından gelişen hematürinin yönetiminde perkütan nefrostominin etkinliğinin değerlendirilmesi

Yıl 2024, Cilt: 17 Sayı: 4, 682 - 688, 09.10.2024

Muhammet Arslan , Halil Serdar Aslan , Burak Kurnaz Kadirhan Alver , Mahmut Demirci , Mehmet Alpua , Sinan Çelen

https://doi.org/10.31362/patd.1501235

Öz

Amaç: Bu çalışmada perkütan antegrad double j stent yerleştirilmesi sırasında hematüri gelişen hastalarda perkütan nefrostominin klinik sonuçlarının değerlendirilmesi amaçlandı.
Gereç ve yöntem: Perkütanöz antegrad double j stent yerleştirilen ve hematüri gelişen hastaları belirlemek için Ocak 2016'dan Haziran 2024'e kadar tıbbi kayıtları gözden geçiren, çok merkezli, retrospektif, kesitsel bir çalışma gerçekleştirdik. Perkütan antegrad double j stent ve nefrostomi işlemleri ultrason ve floroskopi rehberliğinde gerçekleştirildi.
Bulgular: Çalışmaya yaş ortalaması 65,9 ± 15,3 yıl olan 151 hasta dahil edildi; 46'sı (%30,5) kadın, 105'i (%69,5) erkekti. Yapılan 225 antegrad double j stent işleminin 20'sinde (%8,9) hematüri görüldü. Hematüri malignitesi olmayan hastalarda (%35) malign tümörlü olanlara (%9,2) göre anlamlı olarak daha fazla görüldü (p=0,003). İşlemlerin 118'ine (%52,4) postoperatif nefrostomi uygulandı. Hematüri gelişen hastaların 11'ine (%55) nefrostomi uygulanırken, hematürisi olmayan 9 hastaya (%45) rağmen bu fark istatistiksel olarak anlamlı değildi (p=0,811).
Sonuç: Perkütan nefrostomi, antegrad double j stent yerleştirilen hastalarda hematürinin tedavisinde etkili bir girişim gibi görülmektedir. Ancak bu çalışma, nefrostomi yerleştirilmesiyle hematüri insidansında istatistiksel olarak anlamlı bir fark bulamadı. Bu da, bulguları doğrulamak ve perioperatif yönetim stratejilerini optimize etmek için daha büyük örneklem boyutlarıyla daha fazla araştırmaya ihtiyaç olduğunu gösteriyor.

Anahtar Kelimeler

Perkütan, Nefrostomi, Stent, Hematüri

Evaluating the efficacy of percutaneous nephrostomy in managing hematuria following antegrade double j ureteral stent placement

Öz

Purpose: This study aims to evaluate the clinical outcomes of percutaneous nephrostomy in patients who develop hematuria during percutaneous antegrade double j stent placement.
Materials and methods: We conducted a multicenter retrospective cross-sectional study, reviewing medical records from January 2016 to June 2024, to identify patients who underwent percutaneous antegrade double j stent placement and developed hematuria. Percutaneous antegrade double j stent and nephrostomy procedures were performed under ultrasound and fluoroscopic guidance.
Results: The study included 151 patients with a mean age of 65.9 ± 15.3 years; 46 (30.5%) were female, and 105 (69.5%) were male. Hematuria was observed in 20 (8.9%) of the 225 antegrade double j stent procedures. Hematuria was significantly more common in patients with benign conditions (35%) compared patients with malignant tumors (9.2%) (p=0.003). Postoperative nephrostomy was performed in 118 (52.4%) of the procedures. Among patients who developed hematuria, 11 (55%) received a nephrostomy, compared to 9 (45%) without hematuria, though this difference was not statistically significant (p=0.811).
Conclusion: Percutaneous nephrostomy appears to be an effective intervention for managing hematuria in patients undergoing antegrade double j stent placement. However, the study did not find a statistically significant difference in hematuria incidence with nephrostomy placement, indicating the need for further research with larger sample sizes to confirm these findings and optimize postoperative management strategies.

Anahtar Kelimeler

Percutaneous, Nephrostomy, Stents, Hematuria

Etik Beyan

Permission was obtained from Pamukkale University Non-Interventional Clinical Research Ethics Committee for the study (12 June 2024, E-60116787-020-539785).

Destekleyen Kurum

None

Kaynakça

• 1. Okeke Z, Okhunov Z, Smith A. Smith’s textbook of endourology. 3rd ed. West Sussex: John Wiley &sons, 2012;725-734.
• 2. Kim HJ, Yoon CJ, Lee S, Lee JH, Choi WS, Lee CH. Comparison between antegrade versus retrograde ureteral stent placement for malignant ureteral obstruction. J Vasc Interv Radiol 2022;33:1199-1206. https://doi.org/10.1016/j.jvir.2022.06.024
• 3. Yoo MJ, Bridwell RE, Inman BL, Henderson JD, Long B. Approach to nephrostomy tubes in the emergency department. Am J Emerg Med 2021;50:592-596. https://doi.org/10.1016/j.ajem.2021.09.034
• 4. van der Meer RW, Weltings S, van Erkel AR, et al. Antegrade ureteral stenting is a good alternative for the retrograde approach. Curr Urol 2017;10:87-91. https://doi.org/10.1159/000447157
• 5. Tibana TK, Grubert RM, Santos RFT, et al. Percutaneous nephrostomy versus antegrade double-J stent placement in the treatment of malignant obstructive uropathy: a cost-effectiveness analysis from the perspective of the Brazilian public health care system. Radiol Bras 2019;52:305-311. https://doi.org/10.1590/0100-3984.2018.0127
• 6. Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 2006;16:2016-2030. https://doi.org/10.1007/s00330-005-0136-7
• 7. Tlili G, Ammar H, Dziri S, et al. Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: a retrospective cohort study. Ann Med Surg 2021;69:102726. https://doi.org/10.1016/j.amsu.2021.102726
• 8. Chitale S, Raja V, Hussain N, et al. One-stage tubeless antegrade ureteric stenting: a safe and cost-effective option? Ann R Coll Surg Engl 2010;92:218-224. https://doi.org/10.1308/003588410X12518836439128
• 9. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011;28:424-437. https://doi.org/10.1055/s-0031-1296085