Üst Üreter Taşlarında Tedavi Yöntemlerinin Karşılaştırılması Ve Başarı Üzerine Etkili Faktörler

Abstract

Amaç: Üst üreter taşlarının tedavisinde beden dışı şok dalga (ESWL)  ve üreteroskopi (URS ) uygulamalarının etkinliğini ve başarı üzerine etkili olabilecek faktörleri değerlendirmek.

Yöntemler: Üst üreter taşı tanısı ile tedavi edilen 233 hastanın verileri retrospektif olarak değerlendirildi. ESWL uygulanan hastalar Grup 1, URS yapılan hastalar ise Grup 2 olarak ayrıldı. Tüm hastalar kontrastsız  abdominal bilgisayarlı tomografi ile değerlendirildi. Hastaların yaş ve cinsiyetleri, vücut kitle indeksi, taş boyutu, ortalama taş dansitesi, cilt-taş mesafesi gibi faktörler kayıt edilerek tedavi başarısı üzerine etkileri değerlendirildi.

Bulgular: Hastaların yaş ortalaması 47,4 yıl idi. Ortalama taş boyutu 119,7 mm³ idi ve ortalama taş dansitesi 690,5 Hounsfield Ünitesi idi. Grup 1’de   %55,2 taşsızlık tespit edildi. Grup 2’de ise bu oran %74,1 idi.  Kadın cinsiyet, taş boyutu ve cilt taş mesafesi ESWL başarısı için prediktif faktörlerdi.  URS için herhangi bir prediktif faktör tespit edilmedi. Taş cilt mesafesi 10 cm’den uzun olanların kısa olanlara göre başarısız olma riski 13 kat daha fazlaydı (p<0.001). URS yapılan grupta ise herhangi bir parametrenin istatistiksel olarak başarıyı etkilemediği görülmüştür.

Sonuç: Bu çalışma, üst üreter taşı olan hastalarda URS’nin ESWL’ye kıyasla daha yüksek taşsızlık oranına sahip olduğunu göstermiştir.  URS daha fazla hastanede kalma süresi ve daha fazla cerrahi enstrüman gerektirmektedir.  ESWL uygulanan hastalarda ise ikincil tedavi ihtiyacı daha fazladır

Keywords

• Extrakorporeal şok dalga litotripsi,Üreter taşı,Üreteroskopi

Comparison Of Treatment Methods In Upper Uretheral Stones And Factors Affecting Treatment Success

Abstract

Aim: To evaluate the efficacy of extracorporeal shock wave (ESWL) and ureteroscopy (URS) in the treatment of upper ureteral stones and the factors that may affect the success.

Methods: The data of 233 patients treated with the diagnosis of upper ureteral stones were analyzed retrospectively. Patients divided two groups according to ESWL (Group 1) and URS (Group 2) treatment. All patients were evaluated by non-contrast abdominal computed tomography. The factors such as age and sex, body mass index, stone size, mean stone density, skin-stone distance were recorded and their effects on treatment success were evaluated.

Results: The mean age of the patients was 47.4 years and the mean body mass index was 25.9 kg/m².The mean stone size was 119.7 mm³ and the mean stone density was 690.5 Hounsfield Units. 76.4% of the patients had hydronephrosis. Stone-free status was detected in 55.2% patients in the group 1, while it is 74.1% in the group 2. Female gender, stone size and skin distance were predictive factors for ESWL success. No predictive factor was detected for URS. The risk of failure was 13 times higher than those with shorter stone skin lengths greater than 10 cm (p <0.001). In addition, when the stone volume increased by 1 unit, the risk of failure increased by 1-fold (p = 0.009). In the URS group, it was observed that any parameter did not affect statistical success.

Conclusion: This study showed that URS had a higher stone-free rate compared to ESWL in patients with upper ureteral stones. URS requires more hospital stay and more surgical instruments.  Otherwise, the need for secondary treatment is higher in patients undergo ESWL.

Keywords

• Extracorporeal shock wave lithotripsy,Ureteral calculi,Ureteroscopy

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