Doğukan SÖKMEN, Yusuf İlker ÇÖMEZ, Volkan TUĞCU

Perkütan nefrolitotomide Guy taş skoru ve modifiye Clavien derecelendirme sistemi kullanılarak başarı ve komplikasyonların değerlendirilmesi

Amaç: Üriner sistem taş hastalığı tarihte tüm zamanlar boyunca insan hayatını ve yaşam kalitesini olumsuz etkileyen hastalıkların başında gelmiştir. Bizim amacımız ülkemizde üç merkezin perkütan nefrolitotomi deneyimini her yönüyle (hasta seçimi, başarı, ek tedavi gereksinimi, komplikasyonlar, mortalite) sunmak ve bundan sonraki çalışmalara ışık tutmaktır. Gereç ve Yöntemler: Kayıtlarına tam ulaşılabilen, klasik PNL ve miniPNL yapılan; 3 merkezden toplam 944 hastanın verileri retrospektif olarak değerlendirildi. Böbrek taşları, taş yükü ve lokalizasyonları temel alan için Guy Taş Skorlama sistemi (Guy’s Stone Skor, GSS) kullanılarak sınıflandırıldı. Hastalarda meydana gelen per-operatif ve post-operatif komplikasyonlar için de 2004 yılında kendileri tarafından modifiye edilen Clavien sınıflandırılması kullanılmıştır. İstatistiksel analizde; başarı, ek tedavi gereksinimi, komplikasyonlara etkisinin incelenmesinde ve yüzde oranlarında ki-kare testi kullanılarak karşılaştırıldı ve p<0,05 değeri istatiksel olarak anlamlı kabul edildi. Başarı, komplikasyon ve ek tedaviyi etkileyen bağımsız faktörler logistik regresyon analizleri kullanılarak tespit edildi. Bulgular: 944 hastamızın 662’ inde (%70,13) post operatif birinci günde çekilen direkt üriner sistem grafisi ve/veya kontrastsız batın BT’ de hiç rest taş kalmadan başarı elde edildi. Hastaların %23,30 una uygulanan ek tedavi sonrası, post operatif 6. ayda bu oran %83,65 ye yükseldi. GSS 1 grubundaki taşlarda başarı oranı %90,06 olup oldukça yüksekti. Bu oran GSS 3 ve GSS 4 gruplarına göre istatiksel olarak anlamlıydı (p<0,001). GSS skoru düşük olan gruplarda başarı oranı anlamlı şekilde artmaktadır.Operasyon yapılan 944 hastanın 435 (%46,08)’ inde toplamda 478 adet komplikasyon izlendi. Bu verileri modifiye Clavien derecelendirme sistemine göre düzenlediğimizde derece 1’ de 159 (16,84 %), derece 2’ de 152 (16,10%), derece 3a’ da 113 (11,97%), derece 3b’ de 15 (1,58%), derece 4a’ da 9 (0,95%), derece 4b’ de 1 (0,10%), derece 5’ te 1 (0,10%) tane komplikasyon izlendi. Komplikasyonların taş gruplarına göre dağılımı incelendiğinde derece 4a, 4b ve derece 5 komplikasyonların hepsinin GSS 4 grubu taşlarda görüldüğü izlendi.Sonuç: Böbrek taşlarının karmaşık sınıflandırılması “Guy Stone Score” kullanılarak giderilebilir. Basit şekilde kategorize edilip başarı ve komplikasyon olasılıkları öngörülür. Komplikasyonlar “Modifiye Clavien Derecelendirmesi” kullanılarak standardize edilebilir. Ayrıca klasifikasyonlar klinik araştırma ve çalışmalara ışık tutmakta, yardımcı olmaktadır.

Anahtar Kelimeler:

GSS, Böbrek taşı, Clavien, perkütan nefrolitotomi, komplikasyon, taşsızlık

Evaluation of success and complications using the Guy's stone score and modified Clavien rating system in percutaneous nephrolithotomy

Objective: Urinary system stone disease has been one of the leading diseases that negatively affect human life and quality of life throughout history. Our aim is to present the percutaneous nephrolithotomy experience of three centers in our country in all aspects (patient selection, success, additional treatment requirement, complications, mortality) and to shed light on future studies.Material And Methods: Classical PNL and miniPNL with full records; The data of 944 patients from 3 centers were evaluated retrospectively. Kidney stones were classified using the Guy Stone Scoring system (Guy’s Stone Score, GSS) based on stone burden and localization. Clavien classification, modified by them in 2004, was used for per-operative and post-operative complications in patients. In statistical analysis; success, the need for additional treatment, the effect of complications on complications and percentage rates were compared using the chi-square test, and p <0.05 was considered statistically significant. Independent factors affecting success, complications, and additional treatment were determined using logistic regression analysis.Results: In 662 of our 944 patients (70.13%), success was achieved in direct urinary system radiography and / or non-contrast abdominal CT taken on the first postoperative day without any rest stones. After additional treatment applied to 23.30% of the patients, this rate increased to 83.65% in the postoperative 6th month. The success rate for stones in the GSS 1 group was 90.06% and was quite high. This ratio was statistically significant compared to the GSS 3 and GSS 4 groups (p <0.001). The success rate increases significantly in groups with low GSS scores.A total of 478 complications were observed in 435 (46.08%) of 944 patients operated on. When we arrange these data according to the modified Clavien grading system, 159 (16.84%) in grade 1, 152 (16.10%) in grade 2, 113 (11.97%) in grade 3a, 15 in grade 3b ( 1.58%), 9 (0.95%) in grade 4a, 1 (0.10%) in grade 4b, and 1 (0.10%) in grade 5 were observed. When the distribution of complications by stone groups was examined, it was observed that all grade 4a, 4b, and grade 5 complications were seen in GSS 4 group stones.Conclusion: The complex classification of kidney stones can be eliminated using the “Guy Stone Score”. It is categorized in a simple way and the probabilities of success and complications are predicted. Complications can be standardized using the “Modified Clavien Grading”. In addition, the classifications shed light on clinical research and studies.

Keywords:

Kidney stones, GSS, Clavien, percutaneous nephrolithotomy, complications, stone-free,

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1. Thomas K, Smith NC, Hegarty N, Glasse JM. The Guy's stone score—Grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011; 77: 277–81.
2. Lai D, He Y, Dai Y, Li X. Combined minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for staghorn calculi in patients with solitary kidney. PLoS One. 2012; 7(10): 5–7.
3. Aras N, Kadıoğlu A, Muslumanoğlu AY, Ersay AR. Perkutan nefrolitotomi. Turk Uroloji Dergisi 1989;15:565-72.
4. Fernstrom I, Johansson B: Percutaneous pyelolithotomy. Scand J Urol Nephrol 1976;10.257–259.
5. Raman JD, Bagrodia A, Gupta A, et al. Natural history of residual fragments following percutaneous nephrostolithotomy. J Urol 2009;181:1163–1168.
6. Goldwasser B, John L, Carson C, et al. Factors effecting the success rate of percutaneous nephrolithotripsy and the incidence of retained fragments, J Urol 1986; 136: 358–360.
7. Hasun R, Ryan PC, Marberger M; Percutaneous coagulum nephrolithotripsy: a new approach. Br J Urol. 1985 Dec;57(6):605–9.
8. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures. Urology 2011 Aug;78(2):277–81.
9. Ingimarsson JP, Dagrosa LM, Hyams ES, Pais VM Jr. External Validation of a Preoperative Renal Stone Grading System: Reproducibility and Inter-rater Concordance of the Guy's Stone Score Using Preoperative Computed Tomography and Rigorous Postoperative Stone-free Criteria. Urology 2013 Nov:4291–4295.
10. Mandal S, Goel A, Kathpalia R, Sankhwar S, Singh V, Sinha RJ, Singh BP, Dalela D.Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's Stone Score: A single-center experience. Indian J Urol. 2012 Oct;28(4):392–8.
11. Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy. Eur Urol 2005;47: 22–28.
12. Netto NR Jr, Ikonomidis J, Ikari O, Claro JA: Comparative study of percutaneous access for stagSegura JW, Patterson DE, LeRoy AJ, Williams HJ Jr, Barrett DM, Benson RC Jr, May GR, Bender CE. Percutaneous removal of kidney stones: Review of 1,000 cases. J Urol 1985;134:1077–1081.
13. Binbay M, Akman T, Kezer C, Özgör F, Erbin A, Özkuvancı U, Berberoğlu Y, Müslümanoğlu A.Y: Effect of pelvicalicieal system anatomy on success rate in percutaneous nephrolithotomy. Eur Urol 2010;9(6):605.
14. Pearle MS, Nakada SY, Womack JS, Kryger JV; Outcomes of contemporary percutaneous nephrolithotomy in morbidly obese patients. J Urol 1998; 160: 669–673.
15. Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E. Complications of percutaneous nephrolithotomy. Am J Roentgenol 1987;148: 177–180
16. Lee WJ, Smith AD, Cubelli V; et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 1987; 148: 177.
17. Segura JW, Patterson DE, LeRoy AJ: Percutaneous removal of kidney stones. Review of 1000 cases. J Urol 1985; 134: 1077–1081.
18. Labate G, Modi P, Timoney A, et al. On Behalf Of The Croes Pcnl Study Group. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25:1275-80.
19. Lam HS, Lingeman JE, Baccon M, et al. Staghorn calculi: Analysis of treatment results between percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol 1992; 147: 1219.
20. Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: Prospective study. J Endourol 2004; 18: 715– 722.
21. Tefekli A, Karadag MA, Tepeler K, Sari E, Berberoglu Y, Baykal M, Sarilar O, Muslumanoglu AY. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol. 2008 Jan;53(1):184–90.

Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2020
Yayıncı: ENDOÜROLOJİ DERNEĞİ

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