Abdurrahim İMAMOĞLU, Fuat DEMİREL, Can TUYGUN, Adnan GÜCÜK, Uğur ALTUĞ, Berk BURGU

İmpakte proksimal üreter taşlarında antegrad perkütan, laparoskopik ve retrograde üreteroskopik tedavilerin karşılaştırılması

Amaç: Büyük impakte proksimal üreter taşlarının tedavisinde laparoskopik üreterolitotomi, antegrad perkütan ve retrograd üreteroskopik litotripsi tedavilerinin karşılaştırılması.Yöntemler: Kliniğimizde büyük impakte proksimal üreter taşı tanısı ile antegrad perkütan litotripsi (PNL), laparoskopik üreterolitotomi, ve retrograde üreteroskopik (URS) litotripsi tedavisi uygulanan hastalar çalışmaya alındı. Bu tedavilerin uygulandığı ve retrospektif olarak verilerine ulaşılabilen hastalardan her gruptan randomize olarak seçilen 25 hasta çalışmaya dahil edildi. Daimi antikoagülan kullanan, üreteral darlık, multipl taş, anatomik anomali, kronik böbrek yetmezliği olan hastalar çalışma dışında bırakıldılar. Hasta özellikleri, preoperatif ve postoperatif sonuçlar karşılaştırıldı.Bulgular: Toplam 75 hasta çalışmaya alındı. Gruplar hasta yaşı, cinsiyet ve taş boyutları açısından benzer bulunmuştur (p>0.05). Ameliyat sonrası taşsızlık oranları değerlendirildiğinde URS grubunda diğer iki grupdan anlamlı sayılacak oranda daha düşüktü (p=0.011). Hematokrit düşüşü, analjezik gereksinimi farkı yine anlamlıydı ve en düşük URS grubunda en yüksek PNL grubunda saptandı. Hospitalizasyon süresi en yüksek laparoskopi grubunda olup 3 grup arasında anlamlı farklılık vardı. Operasyon süresi en kısa URS grubunda olup fark anlamlıydı (p=0.021). Sekonder prosedür gereksinimi yine URS grubunda diğerlerinden anlamlı olarak yüksekti (p=0.37).Sonuç: Bu taş grubunda laparoskopik üreterolitotomi ve PNL ile yüksek başarı oranları vardır. Pnömotik litotriptör ile uygulanan URS tedavisinin başarı oranı düşük, ek prosedür gereksinimi yüksek olması gibi önemli dezavantajları vardır. Bu nedenle cerrahi deneyim ve ekipman varlığında PNL ve laparoskopik üreterolitotomi daha öncelikli düşünülmesi gereken tedavi alternatifleridir.

Comparison of antegrade percutaneous, laparoscopic, and retrograde ureteroscopic treatments in impacted proximal ureteral stones

Objective: To compare the efficacy of laparoscopic ureterolithotomy, antegrade percutaneous ureterolithotomy (PNL), and retrograde ureteroscopic lithotripsy (URS) in the treatment of large, impacted proximal ureteral stones.Methods: Patients with large impacted ureteral stones were included on condition that their data was available retrospectively. Twenty five patients were selected randomly for each group. Patients on permanent anticoagulants or those with ureteral strictures, multiple stones, anatomical abnormalities, or renal insufficiency were excluded. Patient characteristics along with preoperative and postoperative findings were analyzed.Results: A total of 75 patients were included. There was no difference in the groups in terms of patient age, gender, or stone size (p>0.05). Regarding postoperative stone-free rates, the URS group had significantly lower rates compared with the other groups (p=0.011). Decreases in hematocrit and analgesic values were significantly different between groups, with the lowest being in the URS group and the highest in PNL group. The duration of hospitalization was also significantly different between the three groups and was highest in the laparoscopy group. The operation time was shortest in the URS group and was significant (p=0.21). The need for a secondary intervention was also significantly higher in the URS group (p=0.037).Conclusion: Laparoscopic ureterolithotomy and PNL had high rates of success, but URS performed with a pneumotic lithotriptor had disadvantages, such as a low success rate and high rate of secondary intervention. PNL and laparoscopic ureterolithotomy should be considered as the first treatments of choice provided there is the necessary surgical experience and equipment available.

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