Ömer BAYRAK, İlker SEÇKİNER, Haluk ŞEN, Elzem ŞEN

Çocukluk çağı böbrek taşı tedavisinde retrograd intrarenal cerrahinin sonuçları: Tek merkez deneyimi

Amaç: Pediatrik böbrek taşlarının cerrahi tedavisinde Retrograd intrarenal cerrahisinin etkinliğini ve güvenliğini araştırmayı amaçladık.Yöntemler: Böbrek taşhastalığı ile başvuran ve Retrograd İntrarenal Cerrahi (RİRC) prosedürü uygulanan 23 pediatrik hastanınbilgileri retrospektif olarak toplandı. İşlem sonrası rezidü taş açısından opak taşı olan hastalar direk üriner sistem grafisi, non- opaktaşı olanlar kontrastsız bilgisayarlı tomografi çekilerek değerlendirilen hastaların verileri kayıt edildi.Bulgular: Hastaların yaş ortalamaları 10,9±3 (5-15) yıl ve ortalama taş boyutu 13,7±3,5 mm idi. İşlem öncesi hidronefroz varlığı yokveya minimal ile orta veya şiddetli olarak değerlendirildiğinde sırasıyla %69,5 (16/23) ile %30,4 (7/23). Taş opasiteleri açısından;opak, semiopak ve non-opak değerlendirilmesinde %52,1, %39,1, %8,6 olarak tespit edildi. Ortalama floroskopi süreleri 39,9±15,3saniye olarak tespit edildi.Hastanede kalış sure ise 2,2±0,4 gündü. İşlemler sonrası taştan yoksunluklar %82,6 (19/23) olarak bulundu.Sonuç: Son yıllarda teknolojik gelişmelerle birlikte RİRC gibi minimal invazif yöntemin özellikle çocuk yaş grubunda etkin ve güvenilirbir tedavi yöntemi olduğunu düşünmekteyiz.

Results of retrograde infrarenal surgery in the treatment of renal stones in children: Single-center experience

Objective: We aimed to investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric nephrolithiasis. Methods: Data on 23 pediatric patients with renal stones were collected. After the procedure, while patients with opaque urinary stones were evaluated by a plain abdominal X-ray scan of the kidneys, ureters, and bladder as the imaging method, those with non-opaque urinary stones were evaluated by computed tomography. Results: The average age of the patients was 10.9±3 (range, 5-15) years, and the average stone size was 13.7±3.5 mm. Before the procedure, hydronephrosis was assessed as absent or minimal and moderate or severe. It was found to be 69.5% and 30.4%, respectively. The mean fluoroscopy time was 39.9±15.3 s. The length of hospital stay was 2.2±0.4 days. The stone-free rate was 82.6% (19/23). Conclusion: With technological advances in minimally invasive methods such as RIRC in recent years, we believe that it is an effective and safe method for children, in particular.

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1. Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age and children with different size of instruments. Urology 2010; 76: 247-252. [CrossRef]
2. Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol 2006; 175: 1742-7. [CrossRef]
3. Connors BA, Evan AP, Blomgren PM, Handa RK, Willis LR, Gao S, et al. Extracorporeal shock wave lithotripsy at 60 shock waves/min reduces renal injury in a porcine model. BJU Int 2009; 104: 1004-8. [CrossRef]
4. Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal sur- gery. Urol Int 2014; 92: 164-8. [CrossRef]
5. Salerno A, Nappo SG, Matarazzo E, De Dominics M, Caione P. Treatment of pediatric renal stones in a Western country: A changing pattern. J Ped Surg2013; 48: 835-9. [CrossRef]
6. Huffman JL, Bagley DH, Lyon ES. Extending cystoscopic techniques into the ureter and renal pelvis. Experience with ureteroscopy and pyeloscopy. JAMA 1983; 250(15):2002-5. [CrossRef]
7. Schuster TG, Russell KY, Bloom DA, Koo HP, Faerber GJ. Ureteroscopy for the treatment of urolithiasis in children. J Urol 2002; 167: 1813. [CrossRef]
8. Lesani OA, Palmer JS. Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children: Safe and effective. J Urol 2006; 176: 1570-3. [CrossRef]
9. De Dominicis M, Matarazzo E, Capozza N, Collura G, Caione P. Retrograde ureteroscopy for distal ureteric stone removal in children. BJU Int 2005; 95: 1049-52. [CrossRef]
10. Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 2005; 173: 2005-9. [CrossRef]
11. Smaldone MC, Cannon GM Jr, Wu HY, Bassett J, Polsky EG, Bellinger MF et al. Is ureteroscopy first line treatment for pediatric stone disease? J Urol 2007; 178: 2128-31. [CrossRef]
12. Gulpinar MT, Resorlu B, Atis G, Tepeler A, Ozyuvali E, Oztuna D et al. Safety and efficacy of retrograde intrarenal surgery in patients of different age groups. Actas Urol Esp 2015; 39: 354-9. [CrossRef]
13. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on urolithiasis. Available at: http://www.uroweb.org/gls/ pdf/20_Urolithiasis.pdf.
14. Akman T, Binbay M, Ozgor F, Ugurlu M, Tekinarslan E, Kezer C, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int 202; 109: 1384-9. [CrossRef]