Okul Çağı Öncesi Çocuklarda Perkütan Nefrolitotomi Sonuçları: Tek Merkez Deneyimi

Yıl 2018, Cilt: 12 Sayı: 2, 108 - 111, 01.08.2018

Bülent Katı Eyyüp Sabri Pelit Mustafa Erman Dörterler Eser Ördek Yiğit Akın Halil Çiftçi Ercan Yeni

Öz

Amaç: Böbrek taşı yetişkinlerde olduğu gibi çocukluk döneminde de önemli bir ürolojik problemdir. Bunlara genetik ve metabolik hastalıklar da eşlik etmekte ve ülkemizdeki taş hastalarının yaklaşık %20’si çocuk yaş grubundadır. Bu çalışmada; kliniğimizde 6 yaş ve altı okul öncesi çocuklarda uygulanan perkütan nefrolitotomi (PNL) sonuçlarımızı sunmayı amaçladık.Gereç ve Yöntemler: Mart 2012 ile Haziran 2016 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Hastanesinde böbrek taşları 1.5 cm’den büyük veya ESWL’ye dirençli taşı olan, 0-6 yaş arası (okul öncesi) 54 çocuk hasta uygun tetkikler ile değerlendirildikten sonra genel anestezi uygulanarak mini-PNL uygulandı. Hastalara, önce supin pozisyonda sistoskopi eşliğinde üreter kateteri takıldı ve üretral foley katetere tespit edildi, daha sonra prone 17 fr nefroskopla giriş sağlandı. İşlem sonrası gerektiği düşünülen hastalara renal kılıf içerisinden nefrostomi kateteri yerleştirildi. PNL sonrası 4 mm’den küçük taşlar, klinik önemsiz taş rezidüleri olarak kabul edildi.Bulgular: Toplamda PNL operasyonu yapılan 54 hastanın yaş ortalaması 3.16±0.8 yıldı ve bu hastaların 25’ine sol PNL, 29’una sağ PNL uygulandı. Üç hastada bilateral böbrek taşı vardı. Eş seanslı uygulama olmadı. Dokuz hastanın (%16.6) daha önce ESWL hikayesi mevcuttu. Ortalama taş boyutu 370±45 mm2’di. Ortalama operasyon zamanı 55±21 dk’dı. Operasyon sonrası taşsızlık sıklığı 45(%83.3) hastada mevcuttu. Post op 2 (%3.7) hastada serbest sıvı ve ileus tablosu gelişti. Post op toplam 6 (%11.1) hastaya kan transfüzyonu yapıldı. Bunlara ek JJ stent takılarak stabil hale geldi. Tüpsüz PNL uygulanmadı. Nefrostomi çıkarılması sonrası akıtma nedeniyle 4 (%7.4) hastaya JJ stent takıldı. Ortalama nefrostomi kalış zamanı 3.1±0.9 gündü.Sonuç: PNL her yaşta olduğu gibi 2’cm den büyük böbrek taşları ve ESWL’ye dirençli taşların tedavisinde, okul öncesi çocuklarda da başarısı yüksek minimal invaziv bir yöntemdir.

Anahtar Kelimeler

Böbrek taşı, Okul-öncesi, PNL

The Results of Percutaneous Nephrolithotomy in Pre-School Age Children: Single Center Experience

Öz

Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery.Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine.PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16± 0.8. 25 left-sided and 29
right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was
370±45 mm2
, while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After
a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days.
Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens.
Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure

Anahtar Kelimeler

Kidney stone, Pre-school, PCNL

Kaynakça

• Remzi D, Çakmak F, Erkan I. A study on urolithiasis incidence in Turkish school-age children. J Urol 1980;123:608.
• Oner A, Demircin G, Ipekcioglu H, Bulbul M, Ecin N. Etiological and clinical patterns of urolithiasis in Turkish children. Eur Urol 1997;31: 453-8.
• Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percutaneous stone removal in children. J Urol 1985;134:1166-7.
• Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010;76:247-52.
• Guven S, Istanbulluoglu O, Ozturk A, Ozturk B, Piskin M, Cicek T, et al. Percutaneous nephrolithotomy is highly efficient and safe in infants and children under 3 years of age. Urol Int 2010;85:455-60.
• Lu P, Wang Z, Song R, Wang X, Wang X, Qi K, Dai Q, et al. The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: A systematic review and meta-analysis. Urolithiasis 2015;43:199-206.
• Akin Y, Yucel S. Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function. Res Rep Urol 2014;6:21-5.
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
• Akıncı M, Esen T, Tellaloğlu S. Urinary stone disease in Turkey: An update epidemiological study. Eur Urol 1991;20:200-3.
• Ünsal A. Çocuklarda böbrek taşı tedavisinde perkütan nefrolitotomi. Endoüroloji Bülteni 2008;4:1-6.
• Dogan HS, Onal B, Satar N, Aygun C, Piskin M, Tanriverdi O, et al. Factors affecting complication rates of ureteroscopic lithotripsy in children: Results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society. J Urol 2011;186:1035-40.
• Salerno A, Nappo SG, Matarazzo E, De Dominicis M, Caione P. Treatment of pediatric renal stones in a Western country: A changing pattern. J Pediatr Surg 2013;48:835-9.
• El-Hout Y, Elnaeema A, Farhat WA. Current status of retrograde intrarenal surgery for management of nephrolithiasis in children. Indian J Urol 2010;26:568-72.
• Wu HY, Docimo SG. Surgical management of children with urolithiasis. Urol Clin North Am 2004;31:589-94.
• Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on Urolithiasis. European Association of Urology; Percutaneous nephrolithotomy (PNL). European Association of Urology 2014;5.6.1:31. https://uroweb.org/wp-content/ uploads/22-Urolithiasis_LR.pdf
• Kapoor R, Solanki F, Singhania P, Andankar M, Pathak HR. Safety and efficacy of percutaneous nephrolithotomy in the pediatric population. J Endourol 2008;22:637-40.
• Erdenetsesteg G, Manohar T, Singh H, Desai MR. Endourologic management of pediatric urolithiasis: Proposed clinical guidelines. J Endourol 2006;20:737-48.
• Onal B, Dogan HS, Satar N, Bilen CY, Güneş A, Ozden E, et al. Factors affecting complication rates of percutaneous nephrolithotomy in children: Results of a multi-institutional retrospective analysis by the Turkish Pediatric Urology Society. J Urol 2014;191:777-82.
• Zeren S, Satar N, Bayazit Y, Bayazit AK, Payasli K, Ozkeçeli R. Percutaneous nephrolithotomy in the management of pediatric renal calculi. J Endourol 2002;16:75-8.