Böbrek Taş Lokalizasyonuna Göre Perkütan Nefrolitotomi Operasyonlarının Başarı Ve Komplikasyon Oranlarının Karşılaştırılması

Amaç: Perkütan nefrolitotomi (PNL), büyük ve kompleks böbrek taşları için birinci basamak cerrahi tedavi yöntemidir, ancak potansiyel morbidite ve ciddi komplikasyonlar gelişebilmektedir. Bu nedenle çalışmamızda geniş örneklem grubunda PNL sonrası taş lokalizasyonuna göre başarı ve komplikasyon oranlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya PNL uygulanan toplam 782 hasta retrospektif olarak dahil edilmiştir. Hastalar iki ana gruba ayrıldı; basit taş grubu (üst pol, pelvis, alt pol) ve kompleks taş grubu (parsiyel staghorn, multikalisyel, pelvis+alt pol, komplet staghorn). Tüm olgularda operasyon süresi, floroskopi süresi, hastanede yatış süresi ve nefrostomi kateteri çıkarma zamanı kaydedildi. Bulgular: Olgularda taşların %67,1’i (n=525) basit taşlarken, %32,9’u (n=257) kompleks taşlardı. Çalışmamızda en sık %34,3 oranıyla alt kaliks taşı gözlendi. Olguların %15,1’inde kan transfüzyonu gerçekleştirildi. Kompleks taşa sahip olgularda ölçülen ortalama akses sayısı, operasyon süresi, floroskopi süresi, nefrostomi alınma zamanı ve hastanede yatış sürelerinin, basit taş gözlenen gruba kıyasla anlamlı şekilde yüksek olduğu belirlenmiştir (Sırasıyla p-değerleri = 0.000, 0.000, 0.009, 0.000 ve 0.000). Total komplikasyon oranı %9,7 (n=36) olarak belirlenirken; en sık komplikasyon (%4,4) ciddi kanama idi. Çalışmamızda total başarı oranı %74,6 (n=583) olarak belirlendi. Kompleks taşa sahip olgularda hesaplanan komplikasyon oranının (%14.4), basit taş gözlenen gruba (%7.4) kıyasla istatistiksel olarak anlamlı olacak şekilde yüksek (p=0.002), taşsızlık oranlarının (sırasıyla; 57.6% ve 82.9%) ise düşük olduğu belirlendi (p=0.000). Sonuç: Çalışmamızda PNL prosedürünün basit taşa sahip olgularda, kompleks taşlı gruba kıyasla anlamlı şekilde yüksek başarı oranı ve düşük komplikasyon riski sağladığı açıkça gösterilmiştir. PNL, basit taşlı olgularda daha kısa ameliyat süresi ve hastanede yatış ile anlamlı olarak ilişkilendirilmiştir. Ayrıca geniş örneklem grubuna sahip çalışmamızın bulguları, yayınlanmış verilerle karşılaştırıldığında nispeten yüksek taşsızlık oranı ve düşük komplikasyon oranları gözlenmiştir.

Anahtar Kelimeler:

Böbrek taş, Ürolitiyazis, Perkütan nefrolitotomi, Taşsızlık oranı, Komplikasyon

Comparison of Success and Complication Rates of Percutaneous Nephrolithotomy Operations According to Kidney Stone Localization

Objective: Percutaneous nephrolithotomy (PNL) is first-line treatment modality for large and complex stones, however it is associated with potential morbidity and severe complications. Therefore, we aimed to evaluate the success and complication rates according to stone localization in large sample group following PNL. Material and Methods: Total number of 782 patients who underwent PNL, were included in this retrospective multicenter study. Patients were divided into two major groups; simple stones group (upper pole, pelvis, lower pole) and complex stones group (partial staghorn, multi-caliceal, pelvis+lower pole, complete staghorn). Surgery time, fluoroscopy time, complications, hospitalization and nephrostomy catheter removal day were recorded. Results: In our study, 525 cases (67.1%) had simple stones, 257 (32.9%) complex stones. The most frequent (34.3%) stone localization was lower pole. Overall blood transfusion rate was 15.1%. Significantly increased in mean number of accesses, surgery time, fluoroscopy time, nephrostomy removal time and hospitalization documented in cases with complex stones (p-values = 0.000, 0.000, 0.009, 0.000 and 0.000, respectively). Overall complication rate was 9.7% (n=76) and the most frequent complication (4.4%) was severe hemorrhage. Overall stone-free rates (SFR) are 74.6% (n=583). Furthermore, complication rate (14.4% vs. 7.4%) was statistically higher and SFR (57.6% vs. 82.9%) was lower in cases with complex stones than simple stones (p-values = 0.002 and 0.000, respectively). Conclusions: Our findings clearly demonstrated that PNL achieved higher success rate and lower complication risk in patients with simple stones than complex stones. PNL is significantly associated with shorter operation duration and hospitalization in simple stones group. Furthermore, PNL provided relatively higher overall SFR and lower complication rates in our large sample group compared to the published data.

Keywords:

Kidney stones;, Urolithiasis;, Percutaneous nephrolithotomy, Stone-free rates,

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