Çocuklarda Böbrek Taşlarında Retrograd İntrarenal Cerrahinin (RİRC) Erken Dönem Sonuçları: Ön Çalışma

Amaç: Bu çalışmada kliniğimizde böbrek taşı nedeniyle Retrograd İntrarenal Cerrahi (RİRC) uygulanan hastaların sonuçlarının sunulması amaçlandı. Gereç ve Yöntem: Dicle Üniversitesi Çocuk Cerrahisi-Çocuk Ürolojisi kliniğinde, 2015-2016 yılları arasında RİRC uygulanan hastaların demografik verileri geriye dönük olarak değerlendirilip analiz edildi. Taş boyutu ultrasonografi ve direkt üriner sistem grafisi ile tek boyutta hesaplanan en uzun ölçüm olarak belirtildi. RİRC işlemi, genel anestezi altında üretere yerleştirilen sheath içinden fleksibl üreteroskop ile böbreğe ulaşılıp, holmium lazer ile taşlar fragmante edilerek yapıldı. Nispeten büyük parçalar forseps yardımıyla dışarı alınırken küçük parçalar doğal yolla atılmaya bırakıldı. Bulgular: Yaş ortalaması 8 yıl (2-12 yaş) olan 10 hastaya RİRC uygulandı. Hastaların 7 (%70)'si erkek, 3 (%30)'ü kız idi. Taşlar, hastaların yarısında sağ, yarısında sol böbrek yerleşimli idi. Özgeçmişlerinde 4 hastaya estrakorporeal şok dalga litotiripsi , 2 hastaya ise perkütan nefrolitotomi yapılmış- tı. Taşlar 7 hastada alt kaliks, 2'sinde pelvis, 1 hastada ise orta kaliks yerleşimli idi. Taş boyutları ortalama 9,7 mm (7-12) idi. Yedi (%70) hastada RİRC öncesi pasif dilatasyon yapıldı. Yedi (%70) hastada RİRC esnasında sheath kullanıldı. Operasyon süresi ortalama 54 (46-83) dakika idi. İki (%20) hastada konservatif tedavi ile düzelen hematüri görüldü. Taşsızlık oranı tek seansta %90 olup, 1 hastada ise ikinci kez RİRC yapılarak %100 taşsızlık sağlandı. Sonuç:RİRC'in, seçilmiş çocuk hastalarda başarı şansı yüksek, hastanede kalış süresi kısa, komplikasyon oranı düşük bir endoüroloji seçeneği olduğunu düşünmekteyiz.

Early O utcomes of Retrograde Intrarenal Surgery (RIRS) in Pediatric Kidney Stones: Preliminary Study

In this study, we aimed to present the results of patients who underwent retrograde intrarenal surgery (RIRS) for kidney ston es in our clinic. Material and Method:Demographic data of the patients to whom RIRS was performed in Pediatric Surgery-Pediatric Urology clinic of Dicle University between 2015-2016 was evaluated retrospectively and outcomes were analyzed. Size of the stone was mentioned as the longest measure calculated in one dimension through with ultrasonography and direct urinary system graphy. The RIRS procedure was performed by a flexible uret eroscope through the urethral sheath under general anesthesia, and the stones were fractured with a holmium laser.While relatively large stones were taken out with the help of forceps, small pieces were left to be thrown naturally. Results: RIRS was applied to 10 patients with an average age of 8 years (2-12). Seven (70%) of the patients were male and 3 (30%) were female. The stones were located in the right half of the patients and in the left kidney. In the history of patients; 4 (60%) patients had performed Extracorporeal Shock Wave Lithotripsy and 2 patients had performed percutaneous nephrolithotomy. The stones were located in the lower calyx in 7 patients, in the pelvis in 2 patients and in the middle calyx in 1 patient. Average size of the stones were 9,7 mm (7-12 mm). Seven (70%) patients underwent passive dilatation before RIRS. Sheath was used in 7 (70%) patients during RIRS. Duration of the procedure was 54 (46 -83) minutes in average. Hematuria improved by conservative treatment was observed in two (20%) patients. The stone-free rate was 90% for one session and in one patient it was 100% stone-free with second RIRS. Conclusion: We believe that RIRS is a reliable endourologic option with a high achievement rate, shorter hospitalization period and low complication rate in selected childhood patients.

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