İbrahim KARTAL, Sertaç ÇİMEN, Orhan YİĞİTBAŞI, Emin Ozan AKAY, Aşır ERASLAN, Görkem ÖZENÇ, Burhan BAYLAN, Fatih YALÇINKAYA

On mm’ den küçük Proksimal Üreter Taşlarının Tedavisinde Fleksibl ve Semirijid Üreteroskopi Kullanımının Karşılaştırması

Amaç: On mm ve altındaki proksimal üreter taşlarında cerrahi gerektiren durumlarda fleksibl üreteroskopi ve semirijid üreteroskopi kullanımı sonuçlarının ve güvenilirliğinin değerlendirilmesi amaçlanmıştır.Materyal ve Metod: Kliniğimizde 2013-2019 arasında 10 mm’ den küçük proksimal üreter taşı nedeniyle opere edilen hastaların verileri retrospektif olarak değerlendirildi. Hastalar cerrahide kullanılan üreteroskopi tipine göre fleksibl ve semirijid üreteroskopi grubu olarak ikiye ayrıldı. Her iki grup demografik özellikler, operatif ve postoperatif sonuçlar ve başarı oranları açısından karşılaştırıldı.Bulgular: On mm’den küçük proksimal üreter taşlarının cerrahisinde kullanılan üretroskopi tipine göre, toplam 382 hastada fleksibl (266) ve semirijid (116) üreteroskopi grupları arasında demografik özellikler ve taş boyutu arasında fark bulunmamaktaydı. Ortalama operasyon süresi fleksibl üreteroskopi grubunda 45±10,9 dakika iken semirijid üreteroskopi grubunda 37.2±10.2 dakikaydı (p= 0.001). Fleksibl üretroskopi grubunda %91,4 (266/243) ve semirijid üreteroskopi grubunda %79,3 (116/92) başarı oranına ulaşıldı (p= 0.001). Komplikasyon oranları açısından fleksibl (%10,5) ve semirijid (%16,4) üreteroskopi grupları arasında fark yoktu. Sonuç: Küçük proksimal üreter taşlarında cerrahi gerektiren durumlarda fleksibl üreteroskopi kullanımı yüksek başarı oranları ile semirijid üreteroskopi kullanımına göre daha avantajlı gözükmektedir.

Anahtar Kelimeler:

fleksibl, semirijid, taş, üreteroskop

Comparison of Flexible and Semirigid Ureteroscopy Usage for Treatment of Smaller Than Ten Millimeter Proximal Ureteral Stones

Background:In this study, we aimed to investigate the treatment outcomes and safety profile of flexible and semi-rigid ureteroscopy performed for the treatment of proximal ureteral calculi smaller than 10 mm.Materials and Methods: Patients who underwent ureteroscopy in our clinic between 2013 and 2019 for proximal ureteral stones smaller than 10 mm were assessed retrospectively. Patients were divided into two groups with regard to ureteroscopy type. Each group were compared in terms of demographic, operative and postoperative parameters and success rates.Results: No differences were found between flexible (266) and semirigid ureteroscopy (116) groups in terms of demographic features and stone sizes. Mean operative times were 45±10.9 minutes and 37.2±10.2 minutes for flexible and semi-rigid ureteroscopy groups, respectively. Success rates were %91,4 (266/243) in flexible ureteroscopy group and %79.3 (116/92) in semi-rigid ureteroscopy group. No differences were detected in terms of complication rates (10.5% in flexible, 16.4% in semi-rigid group). Conclusion: Given its high success rate, flexible ureteroscopy appears to be more advantageous than semirigid ureteroscopy for treatment of proximal ureteral stone smaller than 10 mm.

Keywords:

Flexible, Semirigid, Calculi, Ureteroscopy,

PDF

___

1. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol. 2007;52(6):1610-31.2. Skolarikos A, Laguna MP, Alivizatos G, Kural AR, de la Rosette JJ. The role for active monitoring in urinary stones: a systematic review. J Endourol. 2010;24(6):923-30.3. Cui X, Ji F, Yan H, Ou TW, Jia CS, He XZ, et al. Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology. 2015;85(4):748-56.4. Salem HK. A prospective randomized study comparing shock wave lithotripsy and semirigid ureteroscopy for the management of proximal ureteral calculi. Urology. 2009;74(6):1216-21.5. Karadag MA, Demir A, Cecen K, Bagcioglu M, Kocaaslan R, Altunrende F. Flexible ureterorenoscopy versus semirigid ureteroscopy for the treatment of proximal ureteral stones: a retrospective comparative analysis of 124 patients. Urol J. 2014;11(5):1867-72.6. Galal EM, Anwar AZ, El-Bab TK, Abdelhamid AM. Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones. Int Braz J Urol. 2016;42(5):967-72.7. Alkan E, Saribacak A, Ozkanli AO, Basar MM, Acar O, Balbay MD. Flexible Ureteroscopy Can Be More Efficacious in the Treatment of Proximal Ureteral Stones in Select Patients. Adv Urol. 2015;2015:416031.8. Frober R. Surgical anatomy of the ureter. BJU Int. 2007;100(4):949-65.9. Desai M, Sun Y, Buchholz N, Fuller A, Matsuda T, Matlaga B, et al. Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring. World J Urol. 2017;35(9):1395-9.10. Cui Y, Cao W, Shen H, Xie J, Adams TS, Zhang Y, et al. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones. PLoS One. 2014;9(2):e87634.11. Cone EB, Pareek G, Ursiny M, Eisner B. Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy. World J Urol. 2017;35(1):161-6.12. Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol. 2004;172(5 Pt 1):1899-902.13. Lee YH, Tsai JY, Jiaan BP, Wu T, Yu CC. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology. 2006;67(3):480-4; discussion 4.14. Huang CY, Chen SS, Chen LK. Cost-effectiveness of treating ureteral stones in a Taipei City Hospital: shock wave lithotripsy versus ureteroscopy plus lithoclast. Urol Int. 2009;83(4):410-5.15. Kumar A, Nanda B, Kumar N, Kumar R, Vasudeva P, Mohanty NK. A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience. J Endourol. 2015;29(1):47-51.16. Lam JS, Greene TD, Gupta M. Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol. 2002;167(5):1972-6.17. Volkin D, Shah O. Complications of ureteroscopy for stone disease. Minerva Urol Nefrol. 2016;68(6):570-85.18. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82.19. Liu DY, He HC, Wang J, Tang Q, Zhou YF, Wang MW, et al. Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones. Chin Med J (Engl). 2012;125(9):1542-6.20. Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, et al. RIRS in the elderly: Is it feasible and safe? Int J Surg. 2017;42:147-51.21. K. Shigemura TY, M. Yamashita, S. Arakawa, and M., Fujisawa. Efficacy of combining flexible and rigid ureteroscopy for transurethral lithotripsy. Kobe Journal of Medical Sciences. 2010;56(1):E24-E8.