ÇOCUKLUK ÇAĞI ÜRİNER SİSTEM TAŞ HASTALIĞININ CERRAHİ TEDAVİ YÖNTEMLERİ

Öz

Üriner sistem taşları çocuklarda değişen çevre, diyet ve genetik faktörler bağlı olarak farklı prevelansta görülür. . Bu çalışma ile üriner system taşı olgularının cerrahi tedavi endikasyonları, tedavi şekli ve sonuçları, ve komplikasyonları açısından değerlendirilmesi amaçlandı. Ocak 2009- Aralık 2013 tarihleri arasında üriner sistem taşı nedeniyle tedavi gören hastalar retrospektif olarak değerlendirildi. Hastaların yaşı , cinsiyeti, var olan taşın etyolojisi, taşın boyutu lokalizasyonu ve sayısı, tedavi şekli, taşsızlık oranları ve ameliyat sonrası komplikasyonları kaydedildi. Toplam 505 hasta değerlendirildi. Hastaların ortalama tanı yaşı 55.8±52.2 ay (0 -216 ay) idi. Çalışmaya alınan 505 olgudan 157 si (%31) opere edildi. Opere edilen hastaların yaş ortalaması 63,6 ± 55,2 ay (0-216 ay) olarak bulundu. Medikal tedavi alan hastalar ile opere edilen hastalarda bulunan taşların boyutları arasında istatistiksel olarak anlamlı fark olduğu görüldü(p>0.05). Operasyon şekli ve rezidü taş kalan hasta sayısı arsında isttistiksel olarak anlamlı fark olmadığı görüldü (p<0.05). Operasyon sonrası yapılan kontrollerde mevcut rezidü taşın lokalizasyonu boyutu ile operasyon şekli arasında istatistiksel olarak anlamlı fark olmadığı görüldü (p<0.05). Üriner sistem taş hastalığı çocukluk çağının önemli bir sağlık sorunudur. Etiyolojiyi aydınlatmak , cerrahi endikasyonları belirlemek ve uygun prosedürü kullanarak ameliyat etmek hastalığın tedavisinde önemli bir yer tutar.

Anahtar Kelimeler

• üriner sistem taşı
• çocuk
• cerrahi

SURGICAL TREATMENT METHODS FOR PEDIATRIC URINARY TRACT STONE DISEASE

Öz

Stones of the urinary system occur in children at varying prevalence depending on the changing environment, diet, and genetic factors. The aim of this study was to evaluate patients with urinary tract stones in terms of surgical treatment indications, treatment methods and outcomes, and complications. Patients who were treated for urinary tract stones between January 2009 and December 2013 were retrospectively evaluated. Patients’ age; sex; etiology; size, location, and number of their existing stones; the treatment method; stone-free rates; and postoperative complications were recorded. A total of 505 patients were evaluated. The mean age of the patients at the time of diagnosis was 55.8 ± 52.2 (0–216) months. Of the 505 cases, 157 (31%) underwent surgery. The mean age of the patients was 63.6 ± 55.2 (0– 216) months. There was a statistically significant difference between the sizes of the stones found in patients receiving medical treatment and those who underwent surgery (p > 0.05). There was no statistically significant difference between the surgical method and the number of patients with residual stones (p <0.05). In postoperative checks, there was no statistically significant difference between the size and location of the existing residual stone and the surgical method (p < 0.05). Stone disease of the urinary system is an important health concern in children. Determining the etiology, identifying surgical indications, and performing surgery using appropriate procedures play a key role in the treatment of the disease.

Anahtar Kelimeler

• urinary tract stones
• children
• surgery

Kaynakça

1. Referans 1. Srivastava and Alon, urolithiazis in adelosan children J Urol 2005)
2. Referans 2. Elder JS. Urinary Lithiasis. In: Kliegman RM, Stanton BF, St. Geme JM, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier,2011;1864.
3. Referans 3. Milliner DS. Urolithiasis. In: Avner DS, Harmon WE, Niaudet P, eds. Pediatric nephrology. 5th ed. USA: Springer,2009; 1405-31.
4. Referans 4. Clavien PA, Barkun J, Oliviera L et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. doi:10.1097/SLA.0b013e3181b13ca2
5. Referans 5. Tellaloglu S, Ander H. Stones in children. Turk J Pediatr 1984;26(1-4):51-60
6. Referans 6.Williams HE, Wandzilak TR. Oxalate synthesis, transport and the hyperoxaluric syndromes. J Urol 1989;141(3 Pt 2):742-9.
7. Referans 7. Cochat P, Pichault V, Bacchetta J, Dubourg L, Sabot JF, Saban C, et al Nephrolithiasis related to inborn metabolic diseases. Pediatr Nephrol 2010;25(3):415-24.
8. Referans 8. Boutros M, Vicanek C, Rozen R, Goodyer P. Transient neonatal cystinuria. Kidney Int 2005;67(2):443-8.

9. Referans 9. Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 2010;157(1):132-7.
10. Referans 10. Bak M, Ural R, Agin H, Serdaroglu E, Calkavur S. The metabolic etiology of urolithiasis in Turkish children. Int Urol Nephrol 2009;41(3):453-60.
11. Referans 11. Hoppe B, von Unruh GE, Blank G, Rietschel E, Sidhu H, Laube N, et al. Absorptive hyperoxaluria leads to an increased risk for urolithiasis or nephrocalcinosis in cystic fibrosis. Am J Kidney Dis 2005;46(3):440-5.
12. Referans 12. Bulent Onal, Sinharib Citgez, Nejat Tansu, Gulnaz Emin, Oktay Demirkesen, Zubeyir Talat, Veli Yalçın, Ahmet Erozenci; What changed in management of pediatric Stones after the introduction of minimally invasive procedures? Asingle centre experience over 24 years. J Urol 2013 9,910-914
13. Referans 13. Edvardsson V, Elidottir H, Indridason OS, Palsson R. High incidence of kidney stones in Icelandic children. Pediatr Nephrol 2005;20(7):940-4.
14. Referans 14. Ali SH, Rifat UN. Etiological and clinical patterns of childhood urolithiasis in Iraq. Pediatr Nephrol 2005;20(10):1453-7.
15. Referans 15. Ece A, Ozdemir E, Gurkan F, Dokucu AI, Akdeniz O. Characteristics of pediatric urolithiasis in south-east Anatolia. Int J Urol 2000;7(9):330-4.
16. Referans 16. Oner A, Demircin G, Ipekcioglu H, Bulbul M, Ecin N. Etiological and clinical patterns of urolithiasis in Turkish children. Eur Urol 1997;31(4):453-8.
17. Referans 17. Borgmann V, Nagel R. Urolithiasis in childhood. A study of 181 cases. Urol Int 1982;37(3):198-204.
18. Referans 18. Dursun I, Poyrazoglu HM, Dusunsel R, Gunduz Z, Gurgoze MK, Demirci D, et al. Pediatric urolithiasis: an 8-year experience of single centre. Int Urol Nephrol
19. Referans 19.Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 2003;88(11):962-5.
20. Referans 20. Ozokutan BH, Kucukaydin M, Gunduz Z, Kabaklioglu M, Okur H, Turan C. Urolithiasis in childhood. Pediatr Surg Int 2000;16(1-2):60-3.
21. Referans 21. Treatment of Renal Stones in Children: A Comparison Between Percutaneous Nephrolithotomy and Shock Wave Lithotripsy Ahmed A. Shokeir,* Khaled Z. Sheir, Ahmed R. El-Nahas, Ahmed M. El-Assmy, Waleed Eassa and Hamdy A. El-Kappany J Urol Vol. 176, 706-710, August 2006
22. Referans 22. Marc C. Smaldone,* Anthony T. Corcoran, Steven G. Docimo and Michael C. Ost. Endourological Management of Pediatric Stone Disease: Present Status J Urol Vol. 181, 17-28, January 2009
23. Referans 23. Müslümanoğlu AY et. al.; Int.Urol. Nephrol. ,2006
24. Referans 24. Pedıatrıc Staghorn Calculı: The Role Of Extracorporeal Shock Wave Lıthotrıpsy Monotherapy Wıth Specıal Reference To Ureteral Stenting S. S. Al-Busaıdy, A. R. Prem And M. Medhat J Urol Vol. 169, 629–633, February 2003). (Is extracorporeal shock wave lithotripsy in pediatrics a safe procedure? Alessandro D'Addessi⁎, Luca Bongiovanni, Marco Racioppi, Emilio Sacco, PierFrancesco Bassi Journal of Pediatric Surgery (2008) 43, 591–596
25. Referans 25. .Pedıatrıc Urolıthıasıs: 15 Years Of Local Experıence Wıth Mınımally Invasıve Endourologıcal Management Of Pedıatrıc Calculı Asıf Raza, Burak Turna, Gordon Smıth, Samı Moussa And Davıd A. Tolley J Urol Vol. 174, 682–685, August 2005).
26. Referans 26.Percutaneous Nephrolıthotomy In Chıldren: Early And Late Anatomıcal And Functıonal Results Mohamed S. Dawaba, Ahmed A. Shokeır,* Ashraf T. Hafez, Ahmed M. Shoma, Mohamed T. El-Sherbıny, Alaa Mokhtar, Ibrahım Eraky, Mahmoud El-Kenawy And Hamdy A. El-Kappany J Urol Vol. 172, 1078–1081, September 2004 Referans 27.Morshed A. Salah Æ Csaba To´ th Æ A. Munim Khan Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country World J Urol (2004) 22: 277–280
27. Referans 28. Mohamed S.et.all. Percutaneus nephrotitotomy in children : early and late anatomical and functional results:BJU 2004:94-1352
28. Referans 29. Samad L, Aquil S and Zaidi Z:Pediatric percutaneus nephrolithotomy setting new frontiers. BJU 2006:97;1867
29. Referans 30. Pediatric Ureteroscopic Management of Intrarenal Calculi Stacy T. Tanaka,* John H. Makari, John C. Pope, IV, Mark C. Adams, John W. Brock, III and John C. Thomas J Urol Vol. 180, 2150-2154, November 2008
30. Referans 31. John G. Van Savage, Lucio G. Palanca, Robert D. Andersen, Ganesh S. Rao, and Bruce L. Slaughenhoupt, 2000
31. Referans 32.Schuster TG, Rusell KY, Bloom DA, Koa HP and Fearber GJ:Ureteroscopy for treatment of urolithiazis in children JUrol 2002;167:1813
32. Referans 33. Lesani OA and Palmer JS : Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children: safe and effective J Urol 2006: 176;1570
33. Referans 34.Katherine C. ,Hubbert and Jefrey S, Palmer; Passive dilatation by üreteral stenting before ureteroscopy; eliminating the need for active dilation J Urol 2006 ;174: 1079-1080).
34. Referans 35. Tan AH,Al-Omar M, Destedt JD, et al. Ureteroscopy for pediatric ürolithiazis; an envolving first line terapyh. Urology 2005;65;153-6
35. Referans 36.Minevich E, Defoor W, Reddy P, et al. Ureteroscopy is safe and effective in prepubertal children. J Urol 2005;174;276-9
36. Referans 37. Cannon GM, Smaldone MC, Wu HY et al. Ureteroscopic management of lower –pole stones in a pediatric population. J Endourol 2007;21:1179-82 Referans 38. Bulent Onal, Sinharib Citgez, Nejat Tansu, Gulnaz Emin, Oktay Demirkesen, Zubeyir Talat, Veli Yalçın, Ahmet Erozenci; What changed in management of pediatric Stones after the introduction of minimally invasive procedures? Asingle centre experience over 24 years. J Urol 2013 9,910-914