Mut ŞAFAK, Özcan KILIÇ, C. Orhun ECEMİŞ, Berkan REŞORLU, A. Hakan HALİLOĞLU

Çocukluk çağı üriner sistem taş hastalığında “Extracorporeal Shockwave Lithotripsy” (ESWL) etkinliği: 10 yıllık tecrübemiz

Amaç: Çocukluk çağı ürüner sistem taş hastalığında "Extracorpacal Shockwave Lithotripsy" (ESWL)'nin etkinliği ve komplikasyonlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya Ocak 1994 ve Şubat 2004 tarihleri arasında böbrek ve üreter taşlarının tedavisi için Dornier MPL 9000 X ve PCK V-5 Stonelith Lithotriptor cihazları kullanılarak ESWL uygulanmış ve taş analizleri yapılmış 135 çocuk hasta (59 kız ve 76 erkek) alınmıştır. Hastaların bilgileri retrospektif olarak değerlendirilmiştir. Ortalama hasta yaşı 7.8 (10 ay- 16 yaş) olarak hesaplanmıştır. Her ESWL seansı için ortalama 1540 (600-2000 ) şok dalgası uygulanmıştır. Bir aylık periyod içinde 3mm veya daha küçük rezidüel taş parçalarının kalması halinde ESWL başarılı olarak kabul edilmiştir. Bulgular: 135 hastada büyüklükleri 4-28 mm (ort. 8.7) arasında değişen toplam 179 adet taşa 281 seans ESWL yapılmıştır. Toplamda ESWL başarı oranı % 86.7 (117/135 hasta) olarak bulunmuştur. Minör komplikasyonlar olarak 81 hastada (%60) hematüri, 60 hastada (%44,4) deri ekimozları görülmüştür. Hastaların uzun dönem takiplerinde, ortalama 72 ay (3-120 ay), hiçbirisinde hipertansiyon, proteinüri veya kalıcı renal hasar gibi major komplikasyon saptanmamıştır. Ek girişim olarak 135 hastadan sadece 1 hastaya "double-j" kateteri konulmuş ve sadece 3 hastaya üreterorenoskopi yapılmıştır. Sonuç: Çocukluk çağı taş hastalığında ESWL taşın lokalizasyon ve boyutundan bağımsız olarak, yüksek etkinliği, güvenilirliği ve komplikasyonlarının azlığıyla tedavi seçenekleri arasında ilk sırada yer almaktadır.

The efficacy of extracorporeal shockwave lithotripsy (ESWL) in pediatric urinary stone disease: 10 years experience

Aim: In this study the efficacy and complications of ESWL in pediatric urinary stone disease were evaluated. Patients and Methods: 135 children (59 girl and 76 boy), underwent ESWL for treatment of kidney and ureter stones using Dornier MPL 9000 X and PCK V-5 Stonelith Lithotriptor between January 1994 and February 2004 are included in this study. The records of all children were retrospectively reviewed. The mean age of children is 7.8 years (10 months- 16 years). The pulse rate per treatment varied from 600 to 2000 (mean 1540). ESWL was considered to be successful if there were residual fragments less or equal to 3 mm in largest diameter in one month period after treatment. Results: A total of 281 ESWL sessions were performed for 179 stones between 4-28 mm (mean 8.7 mm) diameter in 135 patients. The overall success rate of ESWL is found to be % 86.7 (117 of 135 patients). In 81 (%60) patients hematuria, in 60 (%44,4) patients skin echymoses were seen as minor complications. Major complication such as hypertension, proteinuria or permanent renal damage was seen in any of our patients during follow-up, mean 72 months (3-120 months). Only 1 patient required double-j stent as an auxiliary procedure and 3 patients underwent ureterorenoscopy for stone manipulation. Conclusions: ESWL is the first step treatment option with high efficacy, safety and low complication rate in pediatric urinary stone disease regardless of location and size of stone.

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