sdü tıp fak derg Medical Journal of Süleyman Demirel University 2602-2109 Süleyman Demirel Üniversitesi 10.17343/sdutfd.1068305 Surgery Cerrahi RETROGRADE İNTRARENAL CERRAHİ (RIRS): CERRAHİ DENEYİMİMİZ VE KLİNİK SONUÇLARIMIZ RETROGRADE INTRARENAL SURGERY (RIRS): OUR SURGERY EXPERIENCE AND CLINICAL RESULTS https://orcid.org/0000-0002-7719-5753 Çifteci Tayfun yüksekova devlet hastanesi https://orcid.org/0000-0003-4586-9298 Öztürk Sefa Alperen SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0001-7611-0933 Ergün Osman SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR. https://orcid.org/0000-0003-0926-4216 Özorak Alper SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0001-9860-5910 Oksay Taylan SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR. https://orcid.org/0000-0002-7345-3452 Soyupek Sedat SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR. https://orcid.org/0000-0003-1996-4654 Koşar Alim SÜLEYMAN DEMİREL ÜNİVERSİTESİ, TIP FAKÜLTESİ 12 27 2022 29 4 515 519 02 28 2022 11 04 2022 Copyright © 1994, Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi 1994 Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi

AmaçÜriner sistem taş hastalıkları ülkemizde ve dünyadasık görülmektedir. Flexıble üreterorenoskop (flexURS) ilk defa 1964 yılında Marshall tarafından tanımlanmıştırve ilerleyen teknoloji ile birlikte 1987 yılındacerrahi teknik olarak kılavuzlarda yerini almıştır. Endikasyonlarıhızla genişlemektedir. Bu çalışmamızdakliniğimizde retrograde intrarenal cerrahi (RIRS) uygulananhastaların verileri retrospektif olarak değerlendirilmiştir.Gereç ve YöntemMart 2017 ile Ocak 2019 tarihleri arasında SüleymanDemirel Üniversitesi Tıp Fakültesi (SDÜ) üroloji kliniğindeRIRS yapılmış 106 hastanın demografik verileri,taş boyutları, lokalizasyonları, skopi süresi, taşsızlıkoranları ve postoperatif komplikasyonlar retrospektifolarak değerlendirildi. İşlem sonrası tüm hastalar 4hafta sonra direkt üriner sistem grafisi ve bilgisayarlıtomografi görüntüleme yöntemleriyle değerlendirildi.BulgularRIRS uygulanan 106 hastanın (66 erkek, 40 kadın)ortanca yaşı 52 (23-73) yıl olup, ortalama taş boyutu13,9 (7-19) mm olarak hesaplandı. Ortalama operasyonve floroskopi süresi sırayla;74 (30-135) dakika,62 (20-136) saniyedir. İşlem öncesinde hiçbir hastadaDJ kateteri yoktu ancak tüm hastalara işlem sonundaDJ kateteri yerleştirildi ve kateter 4 hafta sonra lokalanestezi altında çekildi. On bir (%10,3) olguda üreterdarlığı nedeniyle, 8(%7,5) olguda da rezidü taşnedeniyle 2. seans yapıldı.RIRS yapılan taşların 19(%17,9) üst kalikste, 9(%8,4) orta kalikste, 40 (%37,7)alt kalikste, 38(%35,8) olguda renalpelviste olduğudeğerlendirildi. Hastalarımızın % 82,1’ inde ilk seanstataşsızlık sağlandığı bulundu. İkinci seans sonrasıtaşsızlık oranı % 92,5 olarak tespit edildi. Hastalarınortalama yatış süreleri 1,5 gün (1-9) gündü. Beş hastadapostoperatif dönemde üriner sistem enfeksiyonugelişti. RIRS uygulanan hastalarda cerrahi ya da cerrahidışı nedenle mortaliteye rastlanmadı.SonuçRIRS, taş cerrahisinde etkinlik ve komplikasyonlaraçısından güvenilir bir yöntemdir. Özellikle ESWL dirençlitaşlarda, obez, kas iskelet deformiteli hastalarda,soliter taşlı böbrekte, gebelikte, kanama diyatezindeönemli cerrahi alternatifitir. Teknolojik ilerlemelerile birlikte tekniğin avantajları da düşünüldüğündeilerleyen zamanlarda daha aktif kullanılacağı ve yaygınlaşacağıgörüşündeyiz.

ObjectiveUrinary system stone diseases are common in ourcountry and in the world. The flexible ureterorenoscope(flex URS) was first described by Marshall in 1964 andtook its place in the guidelines as a surgical techniquein 1987 with the advancing technology. Its indicationsare expanding rapidly. In this study, the data ofpatients who underwent retrograde intrarenal surgery(RIRS) in our clinic were evaluated retrospectively.Material and MethodDemographic data, stone sizes, localizations,fluoroscopy duration, stone-free rates andpostoperative complications of 106 patients whounderwent RIRS in the urology clinic of SüleymanDemirel University Faculty of Medicine (SDU)between March 2017 and January 2019 wereevaluated retrospectively. After the procedure, allpatients were evaluated with direct urınary systemgraphy and computer tomography imaging methods4 weeks later.ResultsThe median age of 106 patients (66 males, 40females) who underwent RIRS was 52 (23-73 years)and the mean stone size was calculated as 13.9(7-19) mm. The mean duration of operation andfluoroscopy were respectively;74 (30- 135 minutesis 62 (20-136) seconds. None of the patients had aDJ catheter before the procedure, but a DJ catheterwas placed in all patients at the end of the procedureand the catheter was removed under local anesthesia4 weeks later. A second session was performed in11 (10.3%) cases due to ureteral stenosis and in 8(7.5%) cases because of residual stones. calyx, 40(37.7%) lower calyx, 38 (35.8%) cases were foundin the renal pelvis. It was found that 82.1% of ourpatients were stone-free in the first session. After thesecond session, the stone-free rate was 92.5%.ConclusionRIRS is a reliable method in terms of efficacy andcomplications in stone surgery. It is an importantsurgical alternative especially in ESWL resistantstones, obese patients with musculoskeletaldeformities, solitary kidney stones, pregnancy andbleeding diathesis. Considering the advantages of thetechnique together with the technological advances,we think that it will be used more actively and becomewidespread in the future.

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