HAKAN TÜRK, Cemal Selçuk İŞOĞLU, Mustafa KARABIÇAK, Mehmet YOLDAŞ, Batuhan ERGANİ, Tufan SÜELÖZGEN, Yusuf Özlem İLBEY, Ferruh ZORLU

Tecrübenin perkütan nefrolitotomi komplikasyonlarına etkisi

Amaç: Perkutanöz nefrolitotomi (PNL) minimal invaziv cerrahi bir yöntem olarak teknik ve ekipman olarak yıllar içinde gelişim göstermiştir. Ancak her cerrahi işlem gibi PNL operasyonunun da çeşitli komplikasyonları mevcuttur. Kliniğimizde PNL'lerde komplikasyonların yıllara göre dağılımı ile bunların cerrahi tecrübe ile ilişkisi değerlendirildi. Gereç ve Yöntem: Ocak 2009-Ekim 2014 yılları arasında kliniğimizde 1625 renal üniteye uygulanan PNL operasyonları yıllık toplam renal ünite temel alınarak olgular altı gruba bölünerek sık görülen komplikasyonların zaman içindeki dağılımları ve toplamdaki oranları incelendi. Kan transfüzyonu gerektiren klinik durum, ateş, üreter taşı, kolon, plevra yaralanması ve arterio-venöz fistül gibi komplikasyonlar karşılaştırıldı. Bulgular: PNL uygulanan 1625 renal ünitenin yaş ortalaması 48 yıl, ortalama taş boyutu 633 mm2, ortalama operasyon süresi 74 dk. olarak tespit edildi. Yapılan toplam transfüzyon sayısı, ateş gelişen hasta sayısı, komplikasyon gelişen hasta sayısı ve operasyon sürelerinde yıllar içinde anlamlı azalış gözlenirken taşsızlık oranında anlamlı artış saptanmıştır. Sonuç: Günümüzde böbrek taşı tedavisinde altın standart olan yüksek başarı oranlarına sahip PNL'lerde hayatı tehdit edebilecek komplikasyonların ortaya çıkabileceği unutulmamalıdır. PNL operasyonlarında komplikasyonların cerrahi tecrübenin artışıyla azaldığı görülmüştür

Impact of experience on percutaneous nephrolithotomy complications

Aim: Percutaneous nephrolithotomy (PNL) is a minimally invasive surgical procedure which has evolved in technique and instrumentation throughout the years. But just like every surgical procedure, PNL can have several complications. We have evaluated the distribution of the complications of PNL in our department throughout the years and the association between complications and surgical experience. Materials and Methods: Between January 2009 and October 2014, PNL was performed in 1625 renal units in our department. Based on the yearly total renal units, cases were divided into six groups. The distribution of frequently observed complications throughout the years and their ratios among all complications were assessed. Complications like bleeding requiring transfusion, fever, ureter stone, colonic injury, pleural injury and arteriovenous fistula were compared. Results: The mean age of 1625 renal units was 48 years. The mean stone size was 633 mm2 and the mean operation time was 74 minutes. There was a significant decrease in the number of blood transfusions, in feveracquiring patients, complications overall and duration of operations while there was a significant increase in stonefree rates throughout the years. Conclusion: PNL is considered as the gold standard method for management of renal stones offering high stonefree rates. Still, serious and life threatening complications could be expected following this procedure. A decrease in complication rates was observed with increasing surgical experience in PNL operations

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Fernstrom I, Johanson B. Percutaneous pyelolithotomy. Scand J Urol Nephrol 1976;10(3):257-9.
Matlaga BR, Assimos DG. Changing indications of open stone surgery. Urology 2002;59(4):490-3.
Kyriazis I, Panagopoulos V, Kallidonis P, Ozsoy M, Vasilas M, Liatsikos E. Complications in percutaneous nephrolithotomy. World J Urol 2015;33(8):1069-77.
Lee WJ, Smith AD, Cubelli V. Percutaneous removal of kidney stones: review of 1.000 cases. J Urol 1985;134(6):1077-81.
Marcovich R, Smith AD. Percutaneous renal access: tips and tricks. BJU Int 2005; 95(Suppl 2):78-84.
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.
Segura JW, Patterson DE, LeRoy AJ. Percutaneous removal of kidney stones Review of 1000 cases. J Urol 1985;134(6):1077- 81.
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.
Davidoff R, Bellman GC. Influence in technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 1997;157(4):1229-31.
Lahme S, Bichier KH, Strohmaier WL, Gotz T. Minimally invasive PNL in patients with renal pelvic and caliceal stones. EurUrol 2001;40(6):619-24.
Sampaio FJR How to place a nephrostomy safely. Contemp Urol 1994;6(1):41-6.
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.
Patterson DE, Segura JW, Le Roy AJ. The etiology and treatment of delayed bleeding following percutaneous lithotripsy. J Urol 1985;133(3):447-51.
Preminger GM. High burden and complex renal calculi: Aggressive percutaneous nephrolithotomy versus multimodal approaches. Arch Ital Urol Androl 2010;82(1):37-40.
Lee WJ, Smith AD, Cubelli V, et al. Complications of percutaneous nephrolithotomy. AİR Am J Roentgenol 1987;148(1):177-80.
Koras O, Bozkurt IH, Yonguc T, et al. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: A prospective clinical study. Urolithiasis 2015;43(1):55-60.
Vallanicien G, Capdeville R, Viellon B, Charton M, Brissel JM. Colonic perforation during percutaneous nephrostomy. J Urol 1985;134(6):1185-7.