Deniz Abat, Fatih Gökalp, Ali Çam, Onur Karslı

RENAL PELVİSTEKİ İDRARIN ÜRETER TAŞININ İMPAKTASYONUNU BELİRLEMEDEKİ ROLÜ

Giriş: Üreter taşının olduğu taraftaki renal pelvisin Hounsfield Ünitesi değerinin taşın impaktasyonu hakkında fikir verip veremeyeceğini değerlendirmek amaçlandı. Gereç ve Yöntemler: Üreter taşı nedeniyle opere edilen hastaların, demografik verileri ile operasyon öncesi çekilen kontrastsız tomografi filmine göre hesaplanan, taşın transvers ve en uzun boyutu, üst üreterin çapı, üst üreterin alt üreter çapına oranı, taş dansitesi, renal pelvisin ön arka çapı ile renal pelvisteki idrarın ve mesanedeki idrarın HU değeri, taşın impakte olduğu ve olmadığı iki grup arasında karşılaştırıldı. Bulgular: Hastaların ortanca yaşı 44 (37-53) yıl olup, %86,4’ü erkekti. Yaş, cinsiyet, komorbidite, taraf ve taş lokalizasyonu bakımından gruplar arasında fark yoktu (p=0.067, p=0.073, p=0.093, p=0.0141 ve p=0.074, sırasıyla). Renal pelvisteki idrarın HU değeri ile mesanedeki idrarın HU değeri gruplar arasında karşılaştırıldığında anlamlı farklılık görülmedi (p=0.511, p=0.376, sırasıyla). Mesanedeki idrar dansitesinin renal pelvis dansitesine oranına bakıldığında gruplar arasında anlamlı fark yoktu (p=0.461). Transvers taş uzunluğu, en uzun taş boyutu, üst üreter çapı ve üst üreter çapının alt üreter çapına oranı, taş dansitesi ve renal pelvis AP çapı, taş impaktasyonu olan grupta istatistiksel olarak anlamlı olacak şekilde daha büyüktü (p

THE PREDICTIVE VALUE OF URINE IN RENAL PELVIS ON IMPACTION STATUS OF URETERAL STONE

Introduction: To evaluate whether the Hounsfield Unit value of the renal pelvis on the side of the ureteral stone has any predictive value about the impaction of the stone. Materials and Methods: Demographic data of the patients who were operated for ureteral stones and preoperative radiological parameters such as the transverse and longest size of the stone, the diameter of the upper ureter, the ratio of the upper ureter to the lower ureter diameter, the stone density, the anterior-posterior diameter of the renal pelvis, HU values of urine in the renal pelvis and urine in the bladder based on noncontrast computerized tomography were compared between the two groups with and without impacted stone. Results: The median age of the patients was 44 (37-53) years, and 86.4% of patients were male. There was no difference between the groups in terms of age, gender, comorbidity, side and stone localization (p=0.067, p=0.073, p=0.093, p=0.0141 and p=0.074, respectively). When the HU value of urine in the renal pelvis and the HU of urine in the bladder were compared between the groups, no significant difference was observed (p=0.511, p=0.376, respectively). When the ratio of urinary density in the bladder to the renal pelvis density was analyzed, there was no significant difference between the groups (p=0.461). Transverse stone length, longest stone size, upper ureter diameter, and the ratio of upper ureter diameter to lower ureter diameter, stone density, and renal pelvis AP diameter were statistically significantly greater in the stone impaction group (p

PDF

___

1. Sarica K, Eryildirim B, Akdere H, et al. Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones? Actas Urol Esp (Engl Ed). 2019;43(9):474-9. https://doi.org/10.1016/j.acuro.2018.10.003
2. Seitz C, Tanovic E, Kikic Z, et al. Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-laser ureterolithotripsy. Eur Urol. 2007;52(6):1751-7. https://doi.org/10.1016/j.eururo.2007.04.029.
3. 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. https://doi.org/10.1016/j.juro.2008.10.167.
4. Georgescu D, Mulţescu R, Geavlete B, et al. Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management. Chirurgia (Bucur). 2014;109(3):369-74.
5. Sarica K, Eryildirim B, Sahin C, et al. Impaction of ureteral stones into the ureteral wall: Is it possible to predict? Urolithiasis. 2016 Aug;44(4):371-6. https://doi.org/10.1007/s00240-015-0850-9
6. Yoshida T, Inoue T, Omura N, et al. Ureteral Wall Thickness as a Preoperative Indicator of Impacted Stones in Patients With Ureteral Stones Undergoing Ureteroscopic Lithotripsy. Urology. 2017;106:45-9. https://doi.org/10.1016/j.urology.2017.04.047
7. Legemate JD, Wijnstok NJ, Matsuda T, et al. Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol. 2017;35(10):1497-506. https://doi.org/10.1007/s00345-017-2028-2.
8. Elibol O, Safak KY, Buz A, et al. Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters. Investig Clin Urol. 2017;58(5):339- 45. https://doi.org/10.4111/icu.2017.58.5.339.
9. Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Adv Urol. 2018 Feb 4;2018:3068365. https://doi.org/10.1155/2018/3068365.
10. Mugiya S, Ito T, Maruyama S, et al. Endoscopic features of impacted ureteral stones. J Urol. 2004;171:89–91.
11. Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. J Urol. 1990;143:263–6
12. Deliveliotis C, Chrisofos M, Albanis S, et al. Management and follow-up of impacted ureteral stones. Urol Int. 2003;70(4):269-72. https://doi.org/10.1159/000070133.
13. Abat D, Börekoglu A, Altunkol A, et al. Is there any predictive value of the ratio of the upper to the lower diameter of the ureter for ureteral stone impaction?. Curr Urol. 2021 https://doi.org/10.1097/CU9.000000000000001 9
14. Hwang E, Kim YH, Yuk SM, et al. Factors that predict spontaneous passage of a small distal ureteral stone <5 mm. J Endourol. 2010 Oct;24(10):1681-5. https://doi.org/10.1089/end.2010.0092
15. Pan J, Xue W, Xia L, et al. Ureteroscopic lithotripsy in Trendelenburg position for proximal ureteral calculi: a prospective, randomized, comparative study. Int Urol Nephrol. 2014 Oct;46(10):1895-901. https://doi.org/10.1007/s11255-014-0732-z.