Cemil AYDIN, Ramazan TOPAKTAŞ, Zeynep Banu AYDIN, Selçuk ALTIN, ALİ AKKOÇ, AYKUT AYKAÇ, Fuat DEMİREL

Seçilmiş böbrek taşı olgularında tamamen tüpsüz perkütan nefrolitotomi

Amaç: Perkütan nefrolitotomi (PNL) büyük ve kompleks böbrek taşı tedavisinde ilk seçenek tedavidir. Bu çalışmanın amacı tamamen tüpsüz PNL operasyonu uygulanan hastaların sonuçlarını değerlendirmektir. Yöntemler: Kliniğimizde, Ekim 2009 Ağustos 2013 tarihleri arasında böbrek taşı olan 68 (%23,4) olguda uygulanan tam tüpsüz PNL yönteminin sonuçları değerlendirildi. Taşlar pnömatik litotriptor ile kırıldı. Tamamen tüpsüz PNL uygulanan hastaların, ameliyatla ilgili bulguları, hastanede kalış süreleri, analjezik ihtiyacı ve başarı oranları geriye dönük olarak incelendi. Bulgular: Tam tüpsüz PNL yapılan hastaların yaş ortalaması 43,4 ± 13,6 (18-69) yıl olarak hesaplandı ve hastaların 42 (%61,7) tanesi erkek, 26 (%38,2) tanesi kadındı. Ortalama operasyon süresi, hazırlık dönemi hariç 39,5±14,8 (25-90) dakika ve ortalama skopi süresi 6,04±4,15 (1-12) olarak hesaplandı. Hiçbir hastada postoperatif birinci günde yapılan ultrasonografide ve direk üriner sistem grafisinde, ürinom kanama ya da rezidü taşa rastlanmadı. İki hastada, perkütan giriş yerinde uzamış ıslatma olması üzerine üreterorenoskopi uygulandı ve retrograd üreteral stent kondu. Kan transfüzyonuna sadece iki hastada ihtiyaç duyuldu. Ortalama hastanede kalış süresi 1,27±0,36 (1-2) gündü. Sonuçlar: Tam tüpsüz PNLnin, hafif orta taş yükü ve kar- şı böbreği sağlam olan ve ciddi komplikasyonu olmayan, tekrar PNL gerektirmeyecek uygun hastalarda kullanılabileceğini düşünmekteyiz.

Totally tubeless percutaneous nephrolithotomy in selected patients with kidney stones

Objective: Percutaneous nephrolithotomy (PNL) is the first-line treatment for large and complex renal calculi. The aim of this study is to evaluate the outcomes of totally tubeless PNL operations. Methods: Between October 2009 and August 2013, outcomes of 68 (23.4%) patients treated with totally tubeless PNL method at our clinic were analyzed. Stone disintegration was performed with a pneumatic lithotriptor. Operative findings, duration of hospital stay, analgesia requirement and success rates were retrospectively analyzed performed with totally tubeless PNL. Results: Mean age of patients treated with the totally tubeless PNL was 43.4 ± 13.6 (18-69) years and there were 42 (61,7%) men and 26 (38,2%) women. Mean operation time, excluding the preparation course, was 39.5±14.8 (25-90) minutes and mean fluoroscopy time was 6.04±4.15 (1-12) minutes. None of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Two patients had undergone ureterorenoscopy for prolonged leakage of urine and treated by retrograde ureteral double-J stent. Blood transfusion was needed only in two patients. The mean hospitalization time was 1.27±0.36 (1-2) days. Conclusion: We think that totally tubeless PNL may be used in properly suitable cases with mil-moderate stone load, intact counterside kidney and without any significant complication and need for second- look.

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