Mehmet Murat RİFAİOĞLU, Onur DEMİRBAŞ, Mürsel DAVARCI

Perkütan nefrolitotomi ameliyatında hidronefrozun önemi

Amaç: Bu çalışmanın amacı perkütan nefrolitotomi (PNL) ameliyatlarında renal hidronefroz derecesinin preoperatif, peroperatif ve postoperatif verilerle ilişkisini araştırmak ve klinik önemini incelemektir. Yöntemler: Şubat 2009 ile Şubat 2013 arasında aynı cerrah tarafından yapılan 132 PNL ameliyatı geriye dönük olarak tarandı. Hastaların demografik verileri, preoperatif böbrek özellikleri, peroperatif ve postoperatif verileri de- ğerlendirildi. Grade 1 ve 2 hidronefroz grup I; grade 3 ve 4 hidronefroz grup II olarak belirlendi. Gruplar ile preoperotif, peroperatif ve postoperatif özelliklerin farkları istatistiksel olarak karşılaştırıldı. Hidronefrozun bağımsız belirleyicilerini saptamak için multivariat analiz olarak lojistik regresyon analizi kullanıldı. Bulgular: Yaş ortalaması 46,2±13,7 yıl (8 -73) idi. Operasyon süresi ortalama 101 dakika (10-250) olarak hesaplandı. Grup Ide 56, Grup IIde 76 hastanın verileri analiz edildi. İki grup arasında yaş, cinsiyet, vücut kitle indeksi ve cerrahi tecrübe açısından fark saptanmadı. Preoperatif verilerden, opere böbrekte daha önce taş düşürme öykü- sü (p=0,012), taşın çapı (p=0,022), taşın bulunduğu kaliks sayısı (p=0,005), karşı böbrekte taş varlığı (p=0,027), renal parankim kalınlığı (p=0,026); peroperatif verilerden, operasyon süresinde (p=0,011); univaryant analizde anlamlı fark saptandı. Lojistik regresyon analizinde, opere böbrekte taş öyküsü, taşın bulunduğu kaliks sayısı, karşı böbrekte taş varlığı, operasyon süresi ile hidronefroz arasında ilişki izlendi. Sonuç: Perkütan nefrolitotomi operasyonlarında düşük dereceli hidronefrotik böbreklerde, taş çapının ve taşın bulunduğu kaliks sayısı azalması dolayısı ile operasyon süresinin kısa olması sonucunda komplikasyon daha az olacaktır.

The importance of hydronephrosis in percutaneous nephrolithotomy operation

Objective: The aim of this study is to investigate the relation between hydronephrosis grade and preoperative, peroperative and postoperative data and to evaluate the clinical significance of hydronephrosis in percutaneous nephrolithotomy (PNL). Methods: One hundred and thirty-two patients who had undergone PNL operation by same surgeon between February 2009 and February 2013 were reviewed retrospectively. Patients characteristics, preoperative kidney status, operative data were investigated. Grade 1, 2 hydronephrosis were determined as Group I, Grade 3, 4 hydronephrosis were determined as Group II. Preoperative, peroperative and postoperative property differences between groups were compared statistically. For the multivariate analysis, logistic regression analysis was used to determine independent predictors of hydronephrosis. Results: Patients mean age was 46.2±13.7 years (8-73). Operation mean time was 101(10-250) minutes. 56 and 76 patients data were analyzed in Group I and Group II, respectively. There was no difference in age, gender, BMI, and surgeon experience between groups. Dropping stone history in same kidney (p=0.012), stone diameter (p=0.022), the number of calyceal stones (p=0.005), presence stone in the other kidney (p=0.027), renal parenchymal thickness (p=0.026) and operation time (p=0.011) had significantly in univariate analysis. In logistic regression model, dropping stone history in the same kidney, the number of calyceal stones, presence stone in the other kidney and operation time had a relationship with hydronephrosis. Conclusion: In PNL, patients with low-grade hydronephrosis might have decreased complication rates due to diminished operation time, which resulted in reduced number of calyceal stones and stone size.

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