Perkutan Nefrolitotomide Komplikasyonları Öngörebilir Miyiz?

Giriş: Perkutan Nefrolitotomi operasyonunun başarı oranının yüksek olması yanında işlem sırasında veya sonrasında bazen ciddi boyutlarda komplikasyonlar görülebilmektedir. Çalışmamızda Perkutan Nefrolitotomi operasyonlarında başarıyı ve gelişebilecek komplikasyonları öngörebilmeyi sağlayacak faktörleri bulmayı amaçladık. Materyal – metod: Kliniğimizde 481 renal üniteye uygulanan PNL operasyonları, toplam renal ünite temel alınıp olgular komplikasyon görülen ve komplikasyon görülmeyen olarak iki gruba ayrıldı. Kan transfüzyonu gerektiren klinik durum, ateş, üreter taşı, kolon, plevra yaralanması ve arterio-venöz fistül gibi komplikasyonlar karşılaştırıldı. Bulgular: Araştırmada post operatif komplikasyon görülen grubun yaş ortalaması, komplikasyon görülmeyen grubunkine göre anlamlı düzeyde daha yüksektir. Bununla birlikte pelvise yerleşen taşlarda komplikasyon görülme sıklığı kaliks ve kaliks+pelivise yerleşenlerinkine göre anlamlı düzeyde daha düşükken, kaliks+pelvise yerleşen taşlarda komplikasyon görülme sıklığı diğer gruplarınkine göre anlamlı düzeyde daha yüksek saptanmıştır. Sonuç: Çalışmamızda PNL operasyonlarında yaşın ve taşın yerleşim yerinin komplikasyonları ön görebileceği gösterilmiştir. Yaşlı hastalarda ve kompleks taşlarda komplikasyonlar açısından daha dikkatli olunmalıdır

Anahtar Kelimeler:

Perkutan Nefrolitotomi, komplikasyon, böbrek taşı

Can We Predict Complications In Percutaneous Nephrolithotomy?

Introduction: Percutaneous nephrolithotomy (PNL) has a high success rate, but on the other hand, serious perioperative and postoperative complications can be seen occasionally. In our study, we intended to identify the factors that might help us to predict the success of PCNL and the complications that may develop. Materials and Methods: PNL operations performed in 481 renal units in our clinic were divided into two groups as the cases with and without complications. Complications such as clinical conditions requiring blood transfusion, fever, ureteral stones, colonic injury, pleural injury and arteriovenous fistulas were compared. Results: Mean age was significantly higher in the group with postoperative complications in comparison to the group without complication. However, the incidence of complications was significantly lower in cases with pelvic stones in comparison to those with calyx and calyx+pelvic stones, while the cases with calyx+pelvic stones had a significantly higher rate of complications with respect to the other groups. Conclusion: It is demonstrated in our study that patient’s age and stone localization can predict complications in PNL. More attention needs to be paid to avoid complications in elderly patients and in complex stones.

Keywords:

Percutaneous nephrolithotomy, complication, renal stone,

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1- Pearle MS, Lotan Y. Urinary lithiasis, etiology, epidemiology, and pathogenesis. In Wein AJ, Editor-in-chief. Campbell-Walsh Urology. 10th ed. Elsevier Saunders 2012;1257-87.
2- Matlaga BR, Assimos DG. Changing indications of open stone surgery. Urology. 2002;59:490-4.
3- Un S,Cakir V, Kara C,Turk H,Kose O, Balli O,Yilmaz Y. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy. Can Urol Assoc J 2015;9:594-8.
4- Türk H, Yoldaş M, Süelözgen T, Karabıçak M, Ergani B, Isoglu CS, Ün S, Zorlu F. Is Percutaneous Nephrolithotomy Safe for Elderly Kidney Stone Patients? Gerontol Geriatr Res 2016;5:1-4.
5- Türk H, Yoldaş M, Süelözgen T, Isoglu CS, Karabıçak M, Ergani B, Ün S. Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy. Arab Journal of Urology 2017;15:94–9.
6- Kyriazis I, Panagopoulos V, Kallidonis P, Ozsoy M, Vasilas M, Liatsikos E. Complications in percutaneous nephrolithotomy. World J Urol 2015;33(8):1069-77.
7- Türk H, Isoglu CS, Karabıçak M, Yoldaş M, Ergani B, Süelözgen T, et al. Impact of experience on percutaneous nephrolithotomy complications. Ege Journal of Medicine 2016;55:163-7.
8- Marcovich R, Smith AD. Percutaneous renal access: tips and tricks. BJU Int 2005;95:78-84.
9- El Tayeb MM, Knoedler JJ, Krambeck AE, Paonessa JE, Mellon MJ, Lingeman JE. Vascular complications after percutaneous nephrolithotomy: 10 years of experience. Urology 2015;85(4):777-81.
10- Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy. Prospective study. J Endourol 2004;18(4):715-22.
11- Maghsoudi R, Etemadian M, Shadpour P, Radfar MH, Ghasemi H, Shati M. Number of tracts or stone size: which influences outcome of percutaneous nephrolithotomy for staghorn renal stones? Urol Int 2012;89:103–6.
12- Stoller ML, Wolf JS, Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 1994;52(6 Pt 1):1977-81.
13- Preminger GM. High burden and complex renal calculi: Aggressive percutaneous nephrolithotomy versus multimodal approaches. Arch Ital Urol Androl 2010;82(1):37-40.
14- Zeng G, Zhao Z, Wan S, Mai Z, Wu W, Zhong W, Yuan J. Minimally invasive percutaneous nephrolithotomy for simple and complex renal caliceal stones: a comparative analysis of more than 10,000 cases. J Endourol. 2013;27:1203-8.
15- Stoller ML, Bolton D, Lezin MST, Lawrence M (1994) Percutaneous nephrolithotomy in the elderly. Urology 44: 651.
16- Streem SB (1996) Stone extraction, Smith's Textbook of Endourology. St. Louis: Quality Medical Publishing, USA.
17- Gurlich R, Maruna P, Kalvach Z, Peskova M, Cermak J, et al. (2005) Colon resection in elderly patients: comparison of data of a single surgical department with collective data from the Czech Republic. Arch Gerontol Geriatr 41: 183-190.
18- Hoekstra HJ (2001) Cancer surgery in the elderly. Eur J Cancer 37: 235-244.
19- Mulcahy HE, Patchett SE, Daly L, O'Donoghue DP (1994) Prognosis of elderly patients with large bowel cancer. Br J Surg 81:736-738.
20- Faerber GJ, Goh M. Percutaneous nephrolithotripsy in the morbidly obese patient. Tech Urol 1997;3:89-95.
21- Paerle MS, Nakada SY, Womack JS. Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 1998;160:669-673.
22- Ateş M, Karalar M, Tüzel E, Pektaş F, Yıldırım B. Obez hastalarda perkütan nefrolitotominin güvenilirliği ve etkinliği. Üroloji Dergisi. 2011;37:105-11.
23- Isoglu CS, Süelözgen T, Türk H, et al. Does Morbid Obesity Adversely Affect Success and Complication Rates in Percutaneous Nephrolithotomy? J Urol Surg 2016;3:80-3.
24- Liu L, Zheng S, Xu Y. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol 2010;24:1941-6.
25- Mazzucchi E, Vicentini FC, Marchini GS. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine positions. J Endourol 2012;26:1437-1442.
26- Segura JW, Patterson DE, LeRoy AJ. Percutaneous removal of kidney stones Review of 1000 cases. J Urol 1985;134(6):1077-81.
27- Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E. Complications of percutaneous nephrolithotomy. AİR Am J Roentgenol 1987; 148: 177.