Namık Kemal HATİPOĞLU, Mehmet Nuri BODAKÇI, Necmettin PENBEGÜL, Haluk SÖYLEMEZ, Ahmet Ali SANCAKTUTAR, Murat ATAR, MANSUR DAĞGÜLLİ, Yaşar BOZKURT

Retrograd intrarenal cerrahi deneyimlerimiz

Amaç: Kliniğimizde retrograd intrarenal cerrahi (RIRS) uygulanan olguların sonuçlarını değerlendirmek. Yöntemler: Şubat 2012 ile Mayıs 2013 tarihleri arasında, böbrek taşı nedeniyle RIRS yapılan 100 olgunun sonuç- ları retrospektif olarak değerlendirildi. Bulgular: Olguların 35sı kadın, 65sı erkek, yaş ortalaması 36,81 (1-76) yıl idi. Bir olguya rest double J (D-J), 99 olguya da böbrek taşı nedeniyle RIRS işlemi uygulandı ve ortalama taş boyutu 15,26 (5-27) mm idi. Olguların 61inde (% 61) işlem öncesi double- j (D-J) stent varken, 39unda (39%) ise işlem öncesi stent uygulanmamıştı. İşlemlerin 86sında (%86) üretral giriş kılıfı kullanılırken, 14ünde (%14) ise işlem kılıfsız uygulandı. Ortalama operasyon süresi 52,72 (10-120) dakika, floroskopi süresi ise 57,32 (10-180) saniye olan işlemlerin, 88inde (%88) operasyon sonrası D-J stent takılırken, 12 (%12)sine ise takılmadı. Hastanede kalış süresi ortalama 1,3 (1-7) gün olan olguların, 1. ay kontrolerinde, 87 (%87)inde taşsızlık sağlanırken, 6sında (%6) klinik önemsiz rezidüel taş (CIRF) ve 7sinde (%7) de rest taş saptandı. Rest taş kalan olgulardan biri atnalı, biri pelvik böbrek, bir tanesi kifoskolyozlu, iki tanesi ise işlem sırasında kanama nedeniyle görüntünün bozulmasından dolayı işleme son verilen olgulardı. Bu hastalar dışında perop hiçbir hastada komplilkasyon gelişmedi. Takiplerde üç hastada üriner sistem infeksiyonu ve bir hastada ise D-J üretere migre olmuştu. Sonuç: Retrograd intrarenal cerrahi böbrek taşı tedavisinde etkili ve güvenli bir cerrahi tekniktir.

Our experiences on retrograde intrarenal surgery

Objective: To evaluate outcomes of the cases who had undergone retrograde intrarenal surgery (RIRS) in our clinics. Methods: Outcomes of 100 cases who had undergone RIRS because of renal stones between February 2012, and May 2013 were retrospectively evaluated. Results: Study population consisted of 35 female and 65 male patients with a mean age of 36.81(1-76) years. RIRS was performed with the indication of rest double J (D-J) stent (n=1), and renal stone (n=99). Mean stone size was 15.26 (5-27) mm. Preoperatively, 61 cases (61%) had preexisting D-J stents, while 39 (39%) cases were stentless. Access sheaths were used in 86 (86%) cases, while in 14 (14%) cases the procedure was applied without using an access sheath. Mean operative, and fluoroscopy times were 52.72 (10-120) minus, and 57.32 (10-180) seconds, respectively. Postoperatively D-J stents were implanted in 88 (88%) cases, and 12 (12%) cases were stent-free. Mean hospital time was 1.3 (1-7) days. After one month postoperatively, stone-free rate was achieved in 87 (87%) patients. Clinically insignificant residual stone fragments (CIRF) 6 (6%), and residual stones 7 (7%) were also detected. The latter group consisted of cases with horseshoe kidney (n=1), pelvic kidney (n=1), and kyphoscoliosis (n=1). Also in two case procedure was terminated prematurely, because of blurring of the vision secondary to bleeding. Apart from these patients, any preoperative complication did not develop. During follow-up period, urinary tract infection developed in 3 patients with resultant renal parenchymal damage in one patient. In one patient, D-J stent migrated into ureter. Conclusion: Retrograde intrarenal surgery is an effective and safe technique in the management of renal stones.

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1. Türk C, Knoll T, Petrik A, et al, & Seitz, C. Guidelines on Urolithiasis. 2012.
2. Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology 1995;45:372-376.
3. Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009;55:1190-1196.
4. Unsal A, Resorlu B, Kara C, et al. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments. Urology 2010;76:247-252.
5. Kara C, Resorlu B, Bayindir M, Unsal A. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology 2010;76:289-293.
6. Wong MY. Flexible ureteroscopy is the ideal choice to manage a 1.5 cm diameter lower-pole stone. J Endourol 2008;22:1845-1846
7. Fuchs GJ, Fuchs AM. [Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment]. Der Urologe Ausg A 1990;29:313-320.
8. Preminger GM. Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 2006;34:108- 111.
9. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urology 1998;159:1139-1143.
10. Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urology 1999;162:1904-1908.
11. Papatsoris A, Sarica K. Flexible ureterorenoscopic management of upper tract pathologies. Urol Res 2012;40:639-646.
12. Auge BK, Dahm P, Wu NZ, Preminger GM. Ureteroscopic management of lower-pole renal calculi: technique of calculus displacement. J Endourol 2001;15:835-838.
13. Watterson JD, Girvan AR, Cook AJ, et al. Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urology 2002;168:442-445.
14. Harmon WJ, Sershon PD, Blute ML, et al. Ureteroscopy: current practice and long-term complications. J Urology 1997;157:28-32.
15. Singal RK, Razvi HA, Denstedt JD. Secondary ureteroscopy: results and management strategy at a referral center. J Urology 1998;159:52-55.
16. Delvecchio FC, Auge BK, Brizuela RM, et al. Assessment of stricture formation with the ureteral access sheath. Urology 2003;61:518-522