Çocukluk Çağı Böbrek Taşı Hastalığında Mini Perkütan Nefrolitotomi Tek Merkez Deneyimlerimizin Değerlendirilmesi

Burak Özçift

doi:10.12956/tjpd.2018.369

Araştırma Makalesi

Yıl 2019, , 227 - 233, 30.07.2019

Burak Özçift

https://doi.org/10.12956/tjpd.2018.369

Öz

Objective: Several methods including extracorporeal shock wave lithotripsy(ESWL), standard percutaneous nephrolithotomy(PCNL), mini-PCNL and retrograde intrarenal surgery(RIRS) have been recommended to treat kidney stones. A major advantage of mini-PCNL is that it provides similar stone-free and success rates and is less invasive when compared with standard PCNL. In this report, we evaluated our experiences and outcomes with mini-PCNL in a pediatric population.

Material and Methods: From January 2011 to November 2016, the medical records and radiographic images of children who underwent mini-PCNL with a 15 Fr peel-away sheath and 12 Fr miniature nephroscope were evaluated. We reviewed the patients’ demographic details, hemogram, stone characteristics, stone free rate and success rates, additional procedures, complications, hospital stay and nephrostomy retrieval. Stones were classified according to kidney localization as simple (single calyx or pelvic stones) or complex (choraliform, pelvic+calyx stones or multiple calyx stones).

Results: The study included 12 girls and 28 boys, with a mean age of 7.84±5.62 years (1-17 years). The mean diameter of the stones was 24.4±15.3 mm (10-65 mm). The mean stone size was 14.76±6.52 mm for the simple stone group and 35.05±15.22 mm for the complex stone group (p=0.000). The mean operative and fluoroscopy times were 89.17±31.48 minutes and 146.35±63.16 seconds. The first success rate was 55% (n=22). 8 patients underwent additional procedures and the success rate increased to 77.5% (n=31). The success rate was significantly higher in simple stones (95.2% vs. 57.9%; p=0.005). The complication rate of the mini-PCNL procedure was 22.5% (n=9). The mean hemoglobin decrease was 0.73±1.06 mg/dl and only 1 patient required a blood transfusion. The mean hospital stay and nephrostomy retrieval time was 3.77±2.32 and 2.00±1.70 days, respectively.

Conclusion: Our experiences indicate that mini-PCNL is a safe and effective procedure for the management of renal stones in children and stone-free and success rates similar to standard PCNL are obtained.

Anahtar Kelimeler

Kidney stone, Mini, Pediatric

Kaynakça

1. Ost MC, Schneck FX. Campbell’s Urology. In: Wein AJ, KavoussiLR, Novick AC, Partin AW, Peters CA (eds). Peadiatric Urology; Peadiatric Stone Disease Treatment. Philadelphia: W.B. Saunders, 2012: 3667-84.
2. Hulbert JC, Reddy PK, Gonzales R, Young AD, Cardella J, Amplatz K, et al. Percutaneous nephrolithotomy: An alternative approach to the management of pediatric calculus disease. Pediatrics 1985;76:610-12.
3. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC, Rule AD. Temporal trends in incidence of kidney stones among children: A 25- year population based study. J Urol 2012;188:247- 52.
4. Tekgul S, Dogan HS, Erdem E. Urinary stone disease, guidelines on pediatric urology. EAU Urol Guidel 2015; 56-8.
5. Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol 2006;175:1742–7.
6. Newman DM, Coury T, Lingeman JE, Mertz JH, Mosbaugh PG, Steele RE, et al. Extracorporeal shock wave lithotripsy experience in children. J Urol 1986;136:238-40.
7. Kroovand RL. Pediatric urolithiasis. Urol Clin North Am 1997;24:173.
8. Sen H, Seckiner I, Bayrak O, Erturhan S, Demirbağ A. Treatment alternatives for urinary system stone disease in preschool aged children: Results of 616 cases. J Pediatr Urol 2015;11:34.e1-5.
9. Straub M, Gschwend J, Zorn C. Pediatric urolithiasis: The current surgical management. Pediatr Nephrol 2010;25:1239-44.
10. Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percutaneous stone removal in children. J Urol 1985;134:1166-7.
11. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011; 108: 896-9; discussion 899-900.
12. Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “mini-perc” technique: A less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16:371-4.
13. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr; AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
14. Penn HA, DeMarco RT, Sherman AK, Gatti JM, Murphy JP. Extracorporeal shock wave lithotripsy for renal calculi. J Urol 2009;182:1824–7.
15. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-9.
16. Manohar T, Ganpule AP, Shrivastav P, Desai M. Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol 2006; 20: 547-51.
17. Boormans JL, Scheepe JR, Verkoelen CF, Verhagen PC. Percutaneous nephrolithotomy for treating renal calculi in children. BJU Int 2005;95:631-4.
18. Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F. Experience of percutaneous nephrolithotomy using adultsize instruments in children less than 5 years old. J Pediatr Urol 2009;5:351-4.
19. Zeng G, Zhao Z, Wan S, Zhong W, Wu W. Comparision of children versus adults undergoing mini-percutaneous nephrolithotomy: Large-scale analysis of a single institution. PloSOne 2013; 24;8:e66850.
20. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparativestudy of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011;108:896-9.
21. Zeren S, Satar N, Bayazit Y, Bayazit AK, Payasli K, Ozkeceli R. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol 2002;16:75-8.
22. Abdelhafez MF, Amend B, Bedke J, Kruck S, Nagele U, Stenzl A, et al. Minimally invasive percutaneous nephrolithotomy: A comparative study of the management of small and large renal stones. Urology 2013;81:241-5.
23. Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, et al. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: Results of multi-institutional analysis. Urology 2012;80:519-23.
24. Ferakis N, Stavropoulus M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature. Urol Ann 2015;7:141-8.
25. Bodakci MN, Daggulli M, Sancaktutar AA, Söylemez H, Hatipoglu NK, Utangaç MM, et al. Minipercutaneous nephrolithotomy in infants: A single-center experience in an endemic region in Turkey. Urolithiasis.2014;42:427-33.
26. Guven S, Istanbulluoglu O, Gul U, Ozturk A, Celik H, Aygün C, et al. Successful percutaneous nephrolithotomy in children: Multicenter study on current status of its use, efficacy and complications using Clavien classification. J Urol 2011;185:1419-24.
27. Ozden E, Şahin A, Tan B, Doğan HS, Eren MT, Tekgul S. Percutaneous renal surgery in children with complex stone. J Pediatr Urol 2008;4:295-8.
28. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, et al. Extra corporeal shock wave lithotripsy as firstline treatment for urinary tract stones in children: Outcome of 500 cases. Int Urol Nephrol 2012;44:661–6.
29. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: Are there any predictive factors?. Urology 2005;66:38-40.
30. Desai MR, Kukreja RA, Patel SH, Bapat SD. Percutaneous nephrolithotomy for complex pediatric renal calculus disease. J Endourol 2004; 18: 23-7.
31. Bilen CY, Kocak B, Kitirci G, Ozkaya O, Sarikaya S. Percutaneous nephrolithotomy in children: Lessons learned in 5 years at a single institution. J Urol 177: 1867–71.
32. Zeng G, Zhao Z, Wan S, Mai Z, Wu W, Zhong W, et al. Minimally invasive percutaneous nephrolithotomy for simple and complex renal caliceal stones: A comparative analysis of more than 10,000 cases. J Endourol 2013;27:1203-8.
33. Wu HY, Docimo SG. Surgical management of children with urolithiasis. Urol Clin North Am 2004;31:589-94.
34. Hatipoglu NK, Tepeler A, Buldu I, Atis G, Bodakci MN, Sancaktutar AA, et al. Initial experience of micropercutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units. Urolithiasis 2014;42:159-64.
35. Silay MS, Tepeler A, Atis G, Sancaktutar AA, Piskin M, Gurbuz C, et al. Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013;48:1578-83.

Çocukluk Çağı Böbrek Taşı Hastalığında Mini Perkütan Nefrolitotomi Tek Merkez Deneyimlerimizin Değerlendirilmesi

Yıl 2019, , 227 - 233, 30.07.2019

Burak Özçift

https://doi.org/10.12956/tjpd.2018.369

Öz

Amaç: Böbrek taşlarının tedavisinde ekstrakorporeal şok dalga litotripsi (ESWL), standart perkütan nefrolitotomi (PCNL), mini PCNL ve retrograd intrarenal cerrahi (RIRS) gibi çeşitli yöntemler önerilmiştir. Mini PCNL’nin en büyük avantajı, standart PCNL’ye kıyasla benzer taşsızlık ve başarı oranları sağlaması ve daha az invazif olmasıdır. Bu makalede çocuklardaki mini PCNL deneyimlerimizi ve sonuçlarımızı değerlendirdik.

Gereç ve Yöntemler: Ocak 2011’den Kasım 2016’ya kadar kliniğimizde 12 Fr minyatür nefroskop ve 15 Fr’lik mini PCNL kılıfı kullanarak mini PCNL uygulanan çocukların tıbbi kayıtları ve radyografik görüntüleri değerlendirildi. Hastaların demografik bilgileri, hemogramı, taş özellikleri, taşsızlık ve başarı oranları, ek müdahaleler, komplikasyonlar, hastanede kalış ve nefrostomi çekim zamanı gözden geçirildi. Taşlar, böbrek lokalizasyonuna göre basit (tek kaliks veya pelvik taşlar) veya kompleks taşlar (koraliform, pelvik + kaliks taşları veya çoklu kaliks taşları) olarak sınıflandırıldı.

Bulgular: Araştırmaya 12 kız ve 28 erkek alındı, yaş ortalaması 7.84±5.62 yıl (1-17 yıl)’dı. Taşların ortalama çapı 24.4±15.3 mm (10-65 mm)’di. Basit taşların boyutu ortalama 14.76 ± 6.52 mm iken, kompleks taşların ortalama boyutu 35.05±15.22 mm’di (p=0,000). Operasyon süresi ortalama 89.17±31.48 dakika, skopi süresi 146.35±63.16 saniyeydi. İlk başarı oranı %55 (n=22)’di. 8 hastaya ek müdahalelerde bulunuldu ve ameliyattan 12 hafta sonra başarı oranı %77.5’e (n=31) yükseldi. Basit taşlar, kompleks taşlarla karşılaştırıldığında başarı oranı belirgin olarak yüksekti (%95.2 vs %57.9; p = 0,005). Mini PCNL ameliyatının komplikasyon oranı %22.5 (n=9)’di. Ortalama hemoglobin düşüşü 0.73±1.06 mg/ dl’di ve sadece 1 hastada kan transfüzyonu gerekli oldu. Ortalama hastanede kalış süresi ve nefrostomi çekim süresi sırasıyla 3.77±2.32 ve 2.00±1.70 gündü.

Sonuç: Deneyimlerimiz mini PCNL’nin çocuklarda böbrek taşlarının tedavisi için güvenli ve etkin bir yöntem olduğunu ve standart PCNL’ye benzer taşsızlık ve başarı oranları elde edildiğini desteklemektedir.

Anahtar Kelimeler

Böbrek taşı, Mini, Pediatrik

Kaynakça

1. Ost MC, Schneck FX. Campbell’s Urology. In: Wein AJ, KavoussiLR, Novick AC, Partin AW, Peters CA (eds). Peadiatric Urology; Peadiatric Stone Disease Treatment. Philadelphia: W.B. Saunders, 2012: 3667-84.
2. Hulbert JC, Reddy PK, Gonzales R, Young AD, Cardella J, Amplatz K, et al. Percutaneous nephrolithotomy: An alternative approach to the management of pediatric calculus disease. Pediatrics 1985;76:610-12.
3. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC, Rule AD. Temporal trends in incidence of kidney stones among children: A 25- year population based study. J Urol 2012;188:247- 52.
4. Tekgul S, Dogan HS, Erdem E. Urinary stone disease, guidelines on pediatric urology. EAU Urol Guidel 2015; 56-8.
5. Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol 2006;175:1742–7.
6. Newman DM, Coury T, Lingeman JE, Mertz JH, Mosbaugh PG, Steele RE, et al. Extracorporeal shock wave lithotripsy experience in children. J Urol 1986;136:238-40.
7. Kroovand RL. Pediatric urolithiasis. Urol Clin North Am 1997;24:173.
8. Sen H, Seckiner I, Bayrak O, Erturhan S, Demirbağ A. Treatment alternatives for urinary system stone disease in preschool aged children: Results of 616 cases. J Pediatr Urol 2015;11:34.e1-5.
9. Straub M, Gschwend J, Zorn C. Pediatric urolithiasis: The current surgical management. Pediatr Nephrol 2010;25:1239-44.
10. Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percutaneous stone removal in children. J Urol 1985;134:1166-7.
11. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011; 108: 896-9; discussion 899-900.
12. Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The “mini-perc” technique: A less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16:371-4.
13. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr; AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
14. Penn HA, DeMarco RT, Sherman AK, Gatti JM, Murphy JP. Extracorporeal shock wave lithotripsy for renal calculi. J Urol 2009;182:1824–7.
15. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-9.
16. Manohar T, Ganpule AP, Shrivastav P, Desai M. Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J Endourol 2006; 20: 547-51.
17. Boormans JL, Scheepe JR, Verkoelen CF, Verhagen PC. Percutaneous nephrolithotomy for treating renal calculi in children. BJU Int 2005;95:631-4.
18. Nouralizadeh A, Basiri A, Javaherforooshzadeh A, Soltani MH, Tajali F. Experience of percutaneous nephrolithotomy using adultsize instruments in children less than 5 years old. J Pediatr Urol 2009;5:351-4.
19. Zeng G, Zhao Z, Wan S, Zhong W, Wu W. Comparision of children versus adults undergoing mini-percutaneous nephrolithotomy: Large-scale analysis of a single institution. PloSOne 2013; 24;8:e66850.
20. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparativestudy of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011;108:896-9.
21. Zeren S, Satar N, Bayazit Y, Bayazit AK, Payasli K, Ozkeceli R. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol 2002;16:75-8.
22. Abdelhafez MF, Amend B, Bedke J, Kruck S, Nagele U, Stenzl A, et al. Minimally invasive percutaneous nephrolithotomy: A comparative study of the management of small and large renal stones. Urology 2013;81:241-5.
23. Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, et al. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: Results of multi-institutional analysis. Urology 2012;80:519-23.
24. Ferakis N, Stavropoulus M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature. Urol Ann 2015;7:141-8.
25. Bodakci MN, Daggulli M, Sancaktutar AA, Söylemez H, Hatipoglu NK, Utangaç MM, et al. Minipercutaneous nephrolithotomy in infants: A single-center experience in an endemic region in Turkey. Urolithiasis.2014;42:427-33.
26. Guven S, Istanbulluoglu O, Gul U, Ozturk A, Celik H, Aygün C, et al. Successful percutaneous nephrolithotomy in children: Multicenter study on current status of its use, efficacy and complications using Clavien classification. J Urol 2011;185:1419-24.
27. Ozden E, Şahin A, Tan B, Doğan HS, Eren MT, Tekgul S. Percutaneous renal surgery in children with complex stone. J Pediatr Urol 2008;4:295-8.
28. Badawy AA, Saleem MD, Abolyosr A, Aldahshoury M, Elbadry MS, Abdalla MA, et al. Extra corporeal shock wave lithotripsy as firstline treatment for urinary tract stones in children: Outcome of 500 cases. Int Urol Nephrol 2012;44:661–6.
29. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: Are there any predictive factors?. Urology 2005;66:38-40.
30. Desai MR, Kukreja RA, Patel SH, Bapat SD. Percutaneous nephrolithotomy for complex pediatric renal calculus disease. J Endourol 2004; 18: 23-7.
31. Bilen CY, Kocak B, Kitirci G, Ozkaya O, Sarikaya S. Percutaneous nephrolithotomy in children: Lessons learned in 5 years at a single institution. J Urol 177: 1867–71.
32. Zeng G, Zhao Z, Wan S, Mai Z, Wu W, Zhong W, et al. Minimally invasive percutaneous nephrolithotomy for simple and complex renal caliceal stones: A comparative analysis of more than 10,000 cases. J Endourol 2013;27:1203-8.
33. Wu HY, Docimo SG. Surgical management of children with urolithiasis. Urol Clin North Am 2004;31:589-94.
34. Hatipoglu NK, Tepeler A, Buldu I, Atis G, Bodakci MN, Sancaktutar AA, et al. Initial experience of micropercutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units. Urolithiasis 2014;42:159-64.
35. Silay MS, Tepeler A, Atis G, Sancaktutar AA, Piskin M, Gurbuz C, et al. Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013;48:1578-83.

Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Konular	İç Hastalıkları
Bölüm	ORIGINAL ARTICLES
Yazarlar	Burak Özçift Bu kişi benim
Yayımlanma Tarihi	30 Temmuz 2019
Gönderilme Tarihi	9 Mart 2018
Yayımlandığı Sayı	Yıl 2019

Kaynak Göster

Vancouver	Özçift B. Çocukluk Çağı Böbrek Taşı Hastalığında Mini Perkütan Nefrolitotomi Tek Merkez Deneyimlerimizin Değerlendirilmesi. Türkiye Çocuk Hast Derg. 2019;13(4):227-33.

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