Süleyman ATAUS, Bülent ÖNAL, Armağan ÖNER, Burçin TUNÇ, Veli YALÇIN, Cabir ALAN

2 cm'den büyük ürik asit taşlarında oral kemoliz

Medikal kemoliz ile ürik asit taşları eritilebilir tekrarlaması engellenebilir. Bu bilgiler ışığında kliniğimize 2000 ile 2004 tarihleri arasında 2 cm'den büyük ürik taşı ile başvuran 12 hastaya yeterli hidrasyon ve potasyum sitrat (1 mEq/kg/gün) tedavisi başladık. Potasyum sitrati tolere edemeyen hastalarda sodyum (650 mgr günde 3-4 kez) bikarbonat tedavisine geçildi ve bu hastalar prospektif olarak takip edildi. İdrar pH'ları kontrol edilerek 7,0 olacak şekilde doz ayarlaması yapıldı. Hiperürisemisi saptanan 3 hastaya ise Allopurinol (300 mgr/ gün) başlanıldı. Ortalama taş yükü 29 mm (20-40) olan hastaların hepsinin aşları ortalama 3.7 (2-6) ayda eritildi. Anüri ile başvuran soliter böbrekli 1 hasta dışında hiçbir hastaya kateter takıldı.Sonuç olarak oral kemoliz 2 cm'den büyük ürik asit taşlarında da güvenle,kullanılabilecek bir yöntemdir.

Oral chemolysis in uric acid calculus larger than 2 cm.

Background and Design.- By medical chemolysis, uric acid calculus can be dissolved and their recurrences can be avoided. Between 2000 and 2004, 12 patients applied to our clinics with uric acid calculus larger than 2 cm. We treated these patients with adequate hydration and potassium citrate (1 mEq/kg/day). For those who can not tolerate potassium citrate, sodium bicarbonate (650 mgr 3-4 times a day) was started. Each patient was given a pH paper to record urinary pH, and drug dozes' were titrated until urinary pH 7.0 was reached. Allopurinol (300mgr/day) was given to the ones with hyperurisemia. Patients were followed-up with urinary sediment, urinary culture, and ultrasonography and/or computerized tomography. Results.- Mean age of the patients were found to be 51 (34-70). Eight patients had left, 4 had right kidney stone. One patient had solitary kidney. Mean stone size were 29 mm (20-40). All of the stones were dissolved in 3.7 (2-6) months. None of the patients had urinary infection through out of the treatment. Conclusion.- Even for the uric acid stones larger than 2 cm, oral chemolysis can be the treatment of choice. It is simple, safe and inexpensive. However, "it requires rigid compliance by the patient and strict follow-up.

PDF

___

1. Menon M, Pparulkar BG, Drach GW: Urinary Lithiasis: Etiology, Diagnosis, and Medical Management. In Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds): Campbell’s Urology. Philadelphia, W B Saunders Co., vol 3, 1998; 2659-2733.
2. Pak CYC, Resnick MI: Introduction. In Resnick MI., Pak CYC(eds):Urolithiasis. A Medical and Surgical Reference. Philedelphia, WB Saunders, 1990; 1.
3. May P and Schindler E: Methods and results of conservative treatment of uric acid stones. In: Urinary Calculi. Recent Advances in Aetiology, Stone Structure and Treatment. Edited by L. Cifuentes Delatte, A. Rapada and A. Hodgkinson. Basel: S. Karger, 1973; 111.
4. Shekarriz B, Stoller M: Uric acid nephrolithiasis: Current concepts and controversies. J Urol, 2002; 168: 1307.
5. Kursh ED and Resnick MI: Dissolution of uric acid calculi with systemic alkalization. J Urol, 1984; 132: 286-7.
6. Holmes EW Jr: Uric acid nephrolithiasis. In: Nehrolithiasis. Edited by F. L. Coe. New York: Churchill Livingstone, Inc., chapt. 1980; 188: 9.
7. Low RK, Stoller ML: Uric acid-related nephrolithiasis. Urol Clin North Am, 1997; 24 : 135.
8. Pak CYC, Sakhaee K and Fuller C: Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int, 1986; 30: 422.
9. Chuctai MN, Khan FA, Kaleem M and Ahmed M: Management of uric acid stone. JPMA J Pak Med Assoc. 1992; 42: 153-5.
10. Pfister RC and Dretler SP: Percutaneous chemolysis of renal calculi. Urol Radiol, 1984; 6: 138-43.
11. Lee YH, Chang LS, Chen MT and Huang JK: Local chemolysis of obstructive uric acid stone with 0.1 M THAM and 0.02% chlorhexidine. Urol Int, 1993; 51: 147-51.