Mehmet YILDIZHAN, Yalçın KIZILKAN, Cüneyt ÖZDEN, Erem ASİL, Ünsal EROĞLU

Taş Cilt Mesafesinin Supin Perkütan Nefrolitotomi Sonuçlarına Etkileri

PCNL’nin pron PCNL’ye göre, daha düşük ağrı, daha kısa operasyon süresi, daha iyi drenaj ve eş zamanlı üreteroskopik girişimler yapılabilme gibi potansiyel avantajları bulunmaktadır. PCNL başarısını etkileyebilecek risk faktörlerinden bir tanesinin de taş-cilt mesafesi (TCM) olduğu öne sürülmektedir. Çalışmamızda, TCM’nin supin PCNL cerrahi sonuçlarına etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, Ocak 2017 ile Ekim 2021 tarihleri arasında, Galdakao modifiye supin Valvidia pozisyonunda PCNL operasyonu yapılan 113 hasta dahil edildi. Hastaların yaş, taş boyutu, taş hounsfield ünitesi, vücut kitle indeksi (VKİ), TCM’si, ameliyat süresi, floroskopi süresi, komplikasyonlar ve hastanede kalış süresi verileri geriye dönük olarak hastane veritabanı taranarak çıkartıldı ve kayıt edildi. Hastalar ortanca taş cilt mesafesine (11,80 cm (min-max: 8,20-13,10)) göre 2 gruba ayrıldı. TCM ≤11,80 cm olan hastalar Grup 1’i (n = 64) ve TCM>11,80 cm olan hastalar ise Grup 2’yi (n =49) oluşturdu. Bulgular: Çalışmaya alınan toplam 113 hastanın ortalama yaşı 45,17±15,2 yıl idi. Grup-1’deki VKİ, Grup-2’ye göre anlamlı olarak düşüktü (28,37; 29,89, p ˂0,0001). TCM’de Grup-1’de anlamlı olarak daha kısa bulundu (9,77 mm; 12,48 mm, p ˂0,0001). Taşsızlık oranları Grup-1’de yüksek olsa da bu istatistiksel olarak anlamlı değildi (%84,3; %79,6, p =0,663). Rezidüel taşa yönelik uygulanan ikincil müdahalelere bakıldığında 3 hastaya vücut dışı şok dalga tedavisi, 12 hastaya retrograd intrarenal cerrahi ve 7 hastaya PCNL yapıldığı izlenmektedir. İkincil müdahaleler açısından gruplar arasında anlamlı fark izlenmemiştir (p >0,05). Sonuç: Taş-cilt mesafesinin, supin PCNL yapılan hastalarda, cerrahi başarı, komplikasyon oranı, hospitalizasyon süresi, skopi süresi ve re-operasyon oranları üzerine herhangi bir etkisi bulunmamaktadır.

Effects of Stone to Skin Distance on Supine Percutaneous Nephrolithotomy Outcomes

Objective: Supine Percutaneous Nephrolithotomy (PCNL) is a minimally invasive method that is frequently used in the treatment of kidney stones larger than 2 cm. It has been suggested that one of the risk factors that may affect the success of PCNL is the stone to skin distance (SSD). We aimed to investigate the effect of SSD on surgical outcomes in patients who underwent supine PCNL surgery. Material and Method: One hundred and thirteen patients who underwent PCNL operation in the Galdakao modified supine Valvidia position between January 2017 and October 2021 were included in this study. Patients’ demographic information, stone characteristics, SSD, operation time, fluoroscopy time, complications and hospital stay data were collected retrospectively from the hospital database. The patients were divided into 2 groups according to the median skin to stone distance (11.80 cm (min-max: 8.20-13.10)). Patients with SSD ≤11.80 cm formed Group 1 (n = 64) and patients with SSD>11.80 cm formed Group 2 (n =49). Results: The mean age of 113 patients included in the study was 45.17±15.2 years. BMI in Group-1 was significantly lower than Group-2 (28.37; 29.89, p ˂0.0001). It was found to be significantly shorter in SSD than in Group-1 (9.77 mm; 12.48 mm, p ˂0.0001). Although stone-free rates were high in Group-1, this was not statistically significant (84.3%; 79.6%, p =0.663). There was no significant difference between the groups in secondary interventions (p >0.05). Conclusion: According to our data, SSD has no effect on success rate, complications, hospitalization time, fluoroscopy time and re-operation rates in supine PCNL surgeries.

PDF

___

1. Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976; 10: 257-9.
2. Nour HH, Kamal AM, Ghobashi SE et al. Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience. Arab J Urol 2013; 11: 62-7.
3. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51: 899-906
4. Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998; 160: 1975-8.
5. Gofrit ON, Shapiro A, Donchin Y et al. Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 2002; 16: 383-6.
6. Micoogullari U, Kamaci D, Yildizhan M et al. Prone versus Barts "flank-free" modified supine percutaneous nephrolithotomy: a match-pair analysis. Turk J Med Sci 2021; 51: 1373-9.
7. Baard J, Kamphuis GM, Westendarp M, de la Rosette JJ. How well tolerated is supine percutaneous nephrolithotomy? Curr Opin Urol 2014; 24: 184-8.
8. Papatsoris A, Masood J, El-Husseiny T, Maan Z, Saunders P, Buchholz NP. Improving patient positioning to reduce complications in prone percutaneous nephrolithotomy. J Endourol 2009; 23: 831-2.
9. Gonulalan U, Akand M, Coban G et al. Skin-tostone distance has no impact on outcomes of percutaneous nephrolithotomy. Urol Int 2014; 92: 444-8.
10. Tiselius HG, Andersson A. Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 2003; 43: 275-81.
11. Chew BH, Brotherhood HL, Sur RL et al. Natural History, Complications and re-ıntervention rates of asymptomatic residual stone fragments after ureteroscopy: A report from the EDGE Research Consortium. J Urol 2016; 195: 982-6.
12. Olvera-Posada D, Ali SN, Dion M, Alenezi H, Denstedt JD, Razvi H. Natural History of residual fragments after percutaneous nephrolithotomy: Evaluation of Factors related to clinical events and ıntervention. Urology 2016; 97: 46-50.
13. Amer T, Ahmed K, Bultitude M et al. Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int 2012; 88: 373-82.
14. Pearle MS, Nakada SY, Womack JS, Kryger JV. Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 1998; 160: 669-73.
15. El-Assmy AM, Shokeir AA, El-Nahas AR et al. Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 2007; 52: 199-204.
16. Carson CC, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. J Urol 1988; 139: 243-5.
17. Ferreira TAC, Dutra MMG, Vicentini FC et al. Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy. J Endourol 2020; 34: 1219-22.
18. Fuller A, Razvi H, Denstedt JD et al. The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol 2012; 188: 138-44.
19. Mazzucchi E, Vicentini FC, Marchini GS, Danilovic A, Brito AH, Srougi M. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol 2012; 26: 1437-42.
20. Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: Effective approach to high-risk and morbidly obese patients. J Endourol 2007; 21: 44-9.
21. Pareek G, Hedican SP, Lee FT Jr, Nakada SY. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 2005; 66: 941-4.
22. Wiesenthal JD, Ghiculete D, RJ DAH, Pace KT. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 2010; 38: 307-13.