Barbaros BAŞESKİOĞLU

RETROGRAD İNTRARENAL CERRAHİ: OSMANGAZİ SONUÇLARI Retrograde Intrarenal Surgery: Osmangazi Results

ÖZETAmaç: Kliniğimizde Retrograd İntrarenal Taş Cerrahisi Yapılan 234 hastanın sonuçları retrospektifolarak değerlendirildi.Gereç ve Yöntem: Kliniğimizde RİRC operasyonu 2011 ve 2016 tarihleri arasında 234 hastayauygulanmıştır. Bütün hastalara genel anestezi altında flexibl URS ve holmiyum lazer kullanılmıştır.Hastaların kontrolleri birinci ve altıncı ayda direk grafiler ve üriner sistem ultrasonografisiile yapılmıştır. Operasyonun başarı oranı tamamen taşsız ve 2 mm’den küçük rezidüeltaşların varlığı olarak tanımlanmıştır.Bulgular: 133 hasta erkek, 101 hasta kadın idi. Hastaların ortalama yaşı 46.82±14.58 yıldır.Ortalama taş boyutu 17 (±6,3) mmdir. 101 (%43.2) hastanın preoperatif double J stenti mevcuttu.234 hastadan 95 (%40.5)’inde akses kılıfı kullanılmıştır. Operasyon sonrası 154 (%65.8)hastaya Double j stent takılmıştır. Başarı oranın olarak %78.2’dir. 29 (%12.4) hastada gelişenenfeksiyon dışında diğer hastalarda herhangi bir komplikasyon gelişmemiştir.Sonuç: Üst üriner sistem taşları laser teknolojisi ve fleksibl üreterorenoskopideki gelişmelersayesinde düşük morbidite yüksek başarı oranları ile tedavi edilebilmektedir.Anahtar Sözcu¨kler: Fleksibl üreterorenoskopi; Retrograd intrarenal taş cerrahisi; ÜrolitiyazisABSTRACTObjectives: The outcomes of 234 cases performed retrograde intrarenal surgery (RIRS) in ourclinic were evaluated retrospectively.Material and Methods: RIRS was performed on 234 cases between 2011 and 2016 in ourclinic. All patients were underwent flexible URS with holmium laser under general anesthesia.Controls of the patients were assessed by plain films and urinary tract ultrasonography oneand sixth month after the operation. Success rate of the procedure was defined as the stonefreestatus or presence of residual fragments less than 2mm.Results: 133 of the patients were male and 101 were female. The mean age of the patientswas 46.82±14.58 years. 39 (16.7 %) stones were located at the ureter. The mean stone sizewas 17(±6,3)mm. Preoperatively 101 (43.2 % ) patients had double J ureteral stent. In 234patients access sheath was used in 95(40.5) patients. Double J stents were inserted to 154(65.8 %) patients after operation. Our stone free rate was 78.2 %. Any complication was notobserved for all cases except postoperative developed infection for 29 (12.4 %) patients.Conclusion: With advances in laser technology and flexible ureterorenoscopy, upper urinarytract stones can be treated with lower morbidity and high success rates.Keywords: Flexible ureterorenoscopy; Retrograde intrarenal surgery; urolithiasis

Anahtar Kelimeler:

RETROGRAD İNTRARENAL CERRAHİ: OSMANGAZİ SONUÇLARI Retrograde Intrarenal Surgery: Osmangazi Results

PDF

___

1. Mariani AJ: Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy for 20 to 40 mm renal calculi. J Urol 2004;172: 170. 2. Breda A, Ogunyemi O, Leppert JT, ve ark. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greaterdis this the new frontier? J Urol 2008; 179: 981. 3. Hyams ES and Shah O: Percutaneous nephrostolithotomy versus flexible ureteroscopy/ holmium laser lithotripsy: cost and outcome analysis. J Urol 2009; 182: 1012. 4. Riley JM, Stearman L and Troxel S: Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol 2009; 23: 1395. 5. Skolarikos A, Gross AJ, Krebs A, ve ark. Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones in the CROES URS Global Study.. J Urol. 2015 Jul;194(1):137-43. 6. Elbir F, Basıbuyuk I, Topaktaş R, Kardaş S ve ark. Flexible ureterorenoscopy results: Analysis of 279 cases. Turk J Urol. 2015 Sep;41(3):113-8. 7. Turk C, Knoll T, Petrik A, ve ark. Guidelines on Urolithiasis. EAU 2013. http://uroweb.org/wp-content/uploads/22-Urolithiasis_LR_ full.pdf. Erişim Tarihi: 24.4.2017 8. Sahinkanat T, Ekerbicer H, Onal B, ve ark. Evaluation of the effects of relationships between main spatial lower pole calyceal anatomic factors on the success of shock-wave lithotripsy in patients with lower pole kidney stones. Urology 2008;71:801–805. 9. Danuser H, Mu¨ller R, Descoeudres B, ve ark. Extracorporeal shock wave lithotripsy of lower calyx calculi: how much is treatment outcome influenced by the anatomy of the collecting system? Eur Urol 2007;52:539–546. 10. Sorensen CM, Chandhoke PS. Is lower pole caliceal anatomy predictive of extracorporeal shock wave lithotripsy success for primary lower pole kidney stones? J Urol 2002;168:2377–2382