Murat TUKEN, Kasim ERTAS, Emrah YURUK, Mehmet Nuri GUNES, Feyzi Arda ATAR, Mustafa Zafer TEMİZ MD, Murat TUKEN MD, Kasim ERTAS MD, Mehmet Nuri GUNES MD, Feyzi Arda ATAR MD, Erçin ALTIOK, Ahmet Yaser MUSLUMANOGLU, Murat BİNBAY

KOMPLİKE OLMAYAN ÜRETEROSKOPİK LASER TAŞ

Amaç: Bu çalışmamızda rutin DJ stend kullanımının lazer litotripsi uygulanan komplike olmayan üreterorenoskopi olgularında postoperatif ağrı üzerine etkilerini araştırmayı amaçladık.Materyal Method: Kanuni Sultan Suleyman Eğitim Araştırma Hastanesi üroloji kliniğinde Aralık 2011 ve Şubat 2013 tarihleri arasında Holmium-YAG laser (365 micron; 0.5-1.4J/5-10 Hz) ile lithotripsi uygulanan 139 üreterorenoskopi olgusu retrospektif olarak incelendi. Komplike olmayan üreterorenoskopi uygulanmış 98 hasta çalışmaya dahil edildi. Random olarak 24-26 F DJ stend yerleştirilen hastalar grup 1 ve DJ stend uygulanmayan diğer hastalar ise grup 2 olacak şekilde iki hasta grubu oluşturuldu. Tüm hastalarda postoperatif ilk gün, 5. ve 7. günlerde visuel ağrı skoru (VAS) ile ağrı şiddeti değerlendirmesi uygulandı. Bulgular: Toplam 48 hastada (% 48.9) DJ stend uygulandı. Hastaların 59' u kadın 39' u erkekti (1.5:1). Ortalama yaş 36.7 saptandı. Taş lokalizasyonu olguların 34' ünde (%34.6) proksimal yerleşimliyken, 64' ünde (% 65.4) distal yerleşimliydi. Ortalama taş çapı 12.3 mm olarak belirlendi. Ortalama yaş, cinsiyet dağılımı ve ortalama taş çapı her iki grupta benzer saptandı. Postoperatif ilk gün, 5. ve 7. günlerde hesaplanan VAS skorları grup 1 hastalarında anlamlı derecede daha düşük saptandı (sırasıyla p: 0.01, 0.01, 0.03). Sonuç: Lazer litotripsi uygulanan komplike olmayan üreterorenoskopi olgularında özellikle cerrahiden sonra ilerleyen günlerde postoperatif ağrının önlenmesi veya azaltılması amacıyla rutin DJ stend uygulanması tercih edilebilir.

POSTOPERATİF AĞRI ÜZERİNE ETKİSİ

Objectives: We aimed to clarify the role of routine DJ stent insertion during the procedure on postoperative pain after uncomplicated ureteroscopy with laser lithotripsy. Material and Methods: A total of 139 patients with treated semirigid ureteroscopy (URS) with Holmium-YAG laser (365 micron; 0.5-1.4J/5-10 Hz) lithotripsy in Department of Urology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey between December 2011 and February 2013 were retrospectively assesed for this case-control study. Among 139 patients, 98 of them underwent primary uncomplicated URS (UURS) and were enrolled the study. A 6F 24 to 26 cm Double J stent was used randomly some patients. Patients diveded to two groups as stended (group1) and nonstended control (group 2) groups. Mean visual analog scale (VAS) scores were evaluated at postoperative first, 5th and 7th days for patients in each group.Results: Fourty eight of the 98 (48.9 %) patients had Double J stent. Fifty nine patients were women and 39 men (1.5:1), with a mean age of 36.7 years . The stones included 34 proximal (34.6%) and 64 distal localizations (65.4%). Average stone diameter was 12.3 mm (8-22 mm). Mean age, gender distrubition and average stone diameter were similar in groups. A statistically significant difference was found between the two groups for mean VAS scores at postoperative first, 5th and 7th days (p: 0.01, 0.01, 0.03 respectively). Conclusion: Routine stenting may be performed for preventing or reducing postoperative pain especially in the upcoming days after uncomplicated ureteroscopy with laser lithotripsy.

PDF

___

1. C Turk, T Knoll, A Petrik, K Sarica, M Straub, C Seitz. European Association of Urology Guidelines on Urolithiasis; 2012. Available via www.uroweb.org/gls/pdf/20_Urolithiasis_LR%20March%2013%202012.pdfAccessed: 19 April 2013.
2. Gettman MT, Segura JW. Management of ureteric stones: issues and controversies. BJU Int 2015; 95(Suppl 2):85-93. 3. Netto NR Jr, Ikonomidis J, Zillo C. Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary? J Urol 2001; 166: 1252-1254.
4. Nabi G, Cook J, N'Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007; 334: 572.
5. Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, et al. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 2011; 186(5):1904-1909.
6. Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, et al. Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it? Urology 2011; 78(6):1248-1256.
7. Gunlusoy B, Degirmenci T, Arslan M, Kozacioglu Z, Minareci S, Ayder AR. Is ureteral catheterization necessary after ureteroscopic lithotripsy for uncomplicated upper ureteral stones? J Endourol 2008; 22: 1645-1648.
8. Abdelsayed M, Onal E, Wax SH. Avulsion of the ureter caused by stone basket manipulation. J Urol 1977; 118:868- 870.
9. Srivastava A, Gupta R, Kumar A, Kapoor R, Mandhani A. Routine stenting after ureteroscopy for distal ureteral calculi is unnecessary: results of a randomized controlled trial. J Endourol 2003; 17:871-874.
10. Kau EL, Ng CS, Fuchs GJ. Complications of ureteroscopic surgery. In Taneja SS ed. Complications of ureteroscopic surgery, 4th edn Elsevier, Philadelphia; 2010.
11. Byrne RR, Auge BK, Kourambas J, Munver R, Delvecchio F, Preminger GM. Routine ureteral stenting is not necessary after ureteroscopy and ureteropyeloscopy: a randomized trial. J Endourol 2002; 16:9-13.
12. Chew BH, Knudsen BE, Denstedt JD. The use of stents in contemporary urology. Curr Opin Urol 2004; 14: 111-5.
13. Chen YT, Chen J, Wong WY, Yang SS, Hsieh CH, Wang CC. Is ureteral stent necessary after uncomplicated ureteroscopic lithotripsy?A prospective randomized controlled trial. J Urol 2002; 167:1977-1980.
14. Matani YS, Al-Ghazo MA, Al-azab RS, Bani-hani O, Rabadi DK (2013) Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations. Int Braz J Urol 2013; 39(2):203-208.
15. Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, D'A Honey RJ. A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 2001; 165(5):1419-22.
16. El Harrech Y, Abakka N, El Anzaoui J, Ghoundale O, Touiti D. Ureteral Stenting after Uncomplicated Ureteroscopy for Distal Ureteral Stones: A Randomized, Controlled Trial Minim Invasive Surg. 2014;2014:892890. doi: 10.1155/2014/892890.
17. Ibrahim HM, Al-Kandari AM, Shaaban HS, Elshebini YH, Shokeir AA (2008) Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. J Urol 2008; 180(3):961-965.