Is There a Relationship Between Post-ureteroscopic Lesion Scale and Irrigation Fluid Absorption in Ureteral Stone Disease Patients

Abstract

Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades.

Material and Methods: Forty-four patients to whom 7F semirigid ureteoscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Izotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded.

Results: Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume.

Conclusion: Fluid absorption during URS is not correlated with the PULS grade. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed.

Keywords

• complication
• fluid absorption
• ureteroscopy

Üreter Taşı Hastalarında Postüreteroskopik Lezyon Skalası ile Emilen Irrigasyon Sıvısı Arasında Bağlantı Var Mı?

Abstract

Amaç: Üreteroskopi esnasında üreter duvarında oluşan hasarı sınıflandırmak için Post-Üreteroskopik Lezyon Skalası (PULS) kullanılmaktadır. Bu çalışmada PULS derecelerine göre absorbe edilen irrigasyon sıvı hacimlerinin ön sonuçlarını sunduk.

Gereç ve Yöntemler: Bu çalışmaya üreter taşı nedeniyle 7 F semirijid üreteroskopi uygulanan 44 hasta dahil edildi. Tüm hastalara genel anestezi uygulandı. %1 etanol içeren izotonik irrigasyon sıvısı olarak kullanıldı. Venöz kan etanol konsantrasyonları irrigasyon kullanılmaya başlaması ile ölçülmeye başlandı, operasyon sonrası derlenme odasını kapsayacak şekilde 15 dakika arayla periyodik ölçüldü. Absorbe edilen sıvı hacmi kan etanol konsantrasyonları kullanılarak hesaplandı. İrrigasyon süresi, taş boyutu, PULS derecesi kaydedildi.

Bulgular: Ortalama operasyon süresi 44.2 ± 19.9 dakika olarak saptandı. Ortalama taş hacmi 12.7± 6 mm ve ortalama kullanılan irrigasyon sıvı miktarı 1371±1262 mL olarak ölçüldü. Hastaların 26’sınde PULS derecesi 0 iken 18’inde 1 veya üzerindeydi üzerindeydi. Hiçbir hastada PULS derecesi 3 veya 4 olmadı. Ortalama absorbe edilen sıvı hacmi 58 ± 50,6 mL olarak hesaplandı. PULS derecesi ile ortalama absorbe edilen sıvı miktarı arasında istatistiksel anlamlı fark saptanmadı.

Sonuç: Çalışmamızın ön sonuçlarında üreteral duvarda perforasyon olmayan hastalarda absorbe edilen sıvı miktarının artmadığı gösterilmiştir.

Keywords

• komplikasyon
• sıvı emilimi
• üreteroskopi

References

1. Referans1 El-Nahas AR, El-Tabey NA, Eraky I et al. Semirigid ureteroscopy for ureteral stones: a multivariate analysis of unfavorable results. J Urol 2009;181(3):1158-62.
2. Referans2 Preminger GM, Tiselius HG, Assimos DG et al. 2007 guideline for the management of ureteral calculi. EAU/AUA Nephrolithiasis Guideline Panel. J Urol. 2007;178(6):2418-34.
3. Referans3 Delvecchio FC, Auge BK, Brizuela RM et al. Assessment of stricture formation with the ureteral access sheath. Urology 2003;61(3):518-22
4. Referans4 Geavlete P, Georgescu D, Niţă G et al. Complications of 2735 retrograde semirigid ureteroscopy procedures: A single-center experience. J Endourol 2006;20:179–185.
5. Referans5 Bader MJ, Sroka R, Gratzke C et al. Laser therapy for upper urinary tract transitional cell carcinoma: Indications and management. Eur Urol 2009;56:65–71.
6. Referans6 Breda A, Ogunyemi O, Leppert JT et al. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009;55:1190–1196.
7. Referans7 Perlmutter AE, Talug C, Tarry WF et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology 2008;71:214-7.
8. Referans8 Schoenthaler M, Wilhelm K, Katzenwadel A et al. Retrograde intrarenal surgery in treatment of nephrolithiasis: Is a 100% stone-free rate achievable? J Endourol 2012;26:489–493.

9. Referans9 Schoenthaler M, Wilhelm K, Kuehhas FE et al. Postureteroscopic lesion scale: a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol. 2012;26:1425-30.
10. Referans10 Schoenthaler M, Buchholz N, Farin E, The Post-Ureteroscopic Lesion Scale (PULS): A multicenter video-based evaluation of inter-rater reliability. World J Urol 2014 Aug;32(4):1033-40.
11. Referans11 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;240:205–213.
12. Referans12 Nadler R, Hidalgo JU, Bloch T. Prediction of blood volume in normal adult. Surgery 1962; 62:224–232.
13. Referans13 Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12(2-3):e86-96.
14. Referans14 Türk C, Petřík A, Sarica K et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-74.
15. Referans15 Cybulski P, Honey RJ, Pace K.J Fluid absorption during ureterorenoscopy. Endourol. 2004 Oct;18(8):739-42.