Akın Soner AMASYALI, Mehmet Şirin ERTEK, MEVLÜT TÜRE, HALUK EROL

Preoperatif ve İntraoperatif Klinik Bulguların Üreter Taşı Endoskopik Tedavi Başarısına Etkisi

Amaç: Üreter taşı nedeniyle üreterorenoskopi (URS) yapılan hastaların klinik verileri ile taşsızlık oranları arasındaki ilişkiyi retrospektif olarak araştırmayı amaçladık.Yöntemler: Çalışmamız kliniğimizde üreter taşı tanısıyla URS yapılan 83 hastanın verilerinin retrospektif analizinden oluşturuldu. Preoperatif ve intraoperatif klinik veriler kaydedildi. Operasyondan 2 hafta sonrasında 4 milimetreden büyük fragmanın saptanmaması başarı olarak kabul edildi. Klinik veriler ile taşsızlık oranı arasındaki ilişki uygun istatistik yöntemlerle değerlendirildi.Bulgular: Ortalama yaş 50.48±14,41 ve erkek/kadın oranı 2 olarak bulundu. Toplam taşsızlık oranı %83,2 idi. Komplikasyon olarak 7 hastada postoperatif ateş, 2 hastada üreteral perforasyon gelişti. Yaş, cinsiyet, taraf, taş sayısı, çapı, hacmi, en geniş yüzey alanı, ortalama Hounsfield ünitesi, üreteral balon dilatasyon kullanımı, litotriptör cinsi (pnömotik, pnömotik + lazer, lazer) açısından başarılı ve başarısız hastalar arasında anlamlı farklılık saptanmazken, preoperatif hidronefroz derecesi (düşük dereceli: %95,2 vs yüksek dereceli: %69,4, p=0,006), taş lokasyonu (distal üreter: %92,9 vs proksimal üreter: %72,5, p=0,014) ve operasyon süresi (başarılı: 60,0 (45,0-60,0) dak. vs başarısız: 85,0 (60,0-97,5) dak. p=0,048) açısından taşsızlık oranında farklılık olduğu bulundu. Ayrıca antiretropulsif Stone cone kullanımında başarı %91,7, kullanılmayanlarda %81,4 olarak saptandı (p=0,347).Sonuç: Başarı oranını artırmak ve ek prosedür gereksinimini azaltmak için özellikle hidronefrotik proksimal üreter taşlarında antiretropulsif aletlerin veya fleksible URS kullanımının tercih edilmesi gerektiğini düşünüyoruz.

The Effect of Preoperative and Intraoperative Clinical Findings on Success of Endoscopic Management of Ureteral Stone

Objective: We investigated the relationship between clinical data of patients who underwent ureterorenoscopy (URS) due to ureteral stone and stone free rates retrospectively.Methods: Clinical data of 83 patients who underwent URS in our clinic were retrospectively analyzed. Preoperative and intraoperative clinical parameters were recorded. Success was defined as not to detect > 4mm stone fragments 2 weeks after the operation. Appropriate statistical analysis were done for evaluating relationship between stone free rate and clinical data.Results: Mean age was 50.48±14.41 and male to female ratio was 2. Overall stone free rate was 83.2%. Postoperative fever, ureteral perforation were detected in 7 and 2 patients, respectively. There were no differences between success and failure groups in terms of age, sex, operation side, stone number, diameter, size, surface area, mean Hounsfield unit, usage of balloon dilatation. However with respect to preoperative grade of hydronephrosis (low grade: 95.2% vs high grade: 69.4%, p=0.006), stone location (distal ureter: 92.9% vs proximal ureter: 72.5%, p=0.014) and operation time (success: 60.0 (45.0-60.0) min. vs failure: 85.0 (60.0-97.5) min. p=0.048) we found statistically significant differences between the study groups. In addition stone free rate was 91.7% with antiretropulsion device Stone cone, whereas it was 81.4% without any ureteral occlusion (p=0.347).Conclusion: We assume that anti-retropulsion devices or flexible URS should be prefered especially in patients with hydronephrotic proximal ureteral stone for higher stone free rate with lower auxiliary procedure.

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