Özgü AYDOĞDU, İbrahim Halil BOZKURT, Tansu DEĞİRMENCİ, Tarık YONGUÇ, İsmail BASMACI, Volkan ŞEN, Zafer KOZACIOĞLU, Serkan YARIMOĞLU, Süleyman MİNARECİ, Salih POLAT

BÖBREK TAŞLARININ CERRAHİ TEDAVİSİ: BİR EĞİTİM ARAŞTIRMA HASTANESİ ÜROLOJİ KLİNİĞİNDEKİ CERRAHİ YÖNTEM TERCİHLERİ

Bu çalışmada kliniğimizde son 5 yıl içerisinde böbrek taşı olan hastalardaki cerrahi yöntem tercihlerimizi özetlemeyi amaçladık. Çalışmamızda 2009-2014 yılları arasında kliniğimizde böbrek taşı tanısı ile perkütan nefrolitotomi PNL , açık nefrolitotomi ve retrograd intrarenal cerrahi RİRC yapılan ve kayıtlarına ulaşabildiğimiz toplam 494 hasta dahil edildi. Hastaların demografik özellikleri, perioperatif veriler, postoperatif başarı oranları ve komplikasyonlar not edildi. Hastaların 428’ine %86 PNL, 41’ine %8 RİRC ve 25’ine %6 ise açık nefrolitotomi yapıldığı tespit edildi. Hastaların yaş ortancası PNL, RİRC ve açık nefrolitotomi yapılan gruplarda sırasıyla 51 , 47 ve 44 olarak tespit edildi. Ortalama taş yükü PNL yapılan hastalarda 2.4 cm2, RİRC yapılan hastalarda 1.4 cm2 ve açık nefrolitotomi yapılan hastalarda ise 3.2 cm2 olarak izlendi. Ortalama floroskopi süresi PNL’de 3.4 dk ve RİRC yapılan grupta 1.8 dk olarak tespit edildi. Ortalama operasyon süresi PNL’de 107 dk, RİRC yapılan grupta 64 dk ve açık nefrolitotomi gerçekleştirilen hastalarda ise 78 dk olarak tespit edildi. Hastanede kalış süreleri PNL, RİRC ve açık nefrolitotomi yapılan hastalarda sırasıyla 3.4, 1.1 ve 3.7 gün olarak izlendi. PNL yapılan hastalardan 98’ine %22.8 ve açık nefrolitotomi yapılan hastalardan 6’sına %24 postoperatif dönemde kan transfüzyonu yapılırken, RİRC yapılan hastalardan hiçbirinde kan transfüzyonu ihtiyacı olmadı. PNL grubunda 87 %20 , açık nefrolitotomi grubunda 3 %12 ve RİRC grubunda 2 hastada %5 ≥5mm rezidü taş izlendi. Böbrek taşlarının cerrahi tedavisinde kliniğimizde en sık kullanılan yöntem PNL’dir. Uygun hastalarda daha kısa operasyon ve hastanede yatış süresi ile RİRC avantajlı bir cerrahi yöntemdir. Açık nefrolitotomi minimal invazif yöntemlerin gelişmesi ile giderek daha nadir başvurulan bir cerrahi seçenek haline gelmiştir

Anahtar Kelimeler:

PNL, ürolitiazis, retrograd intrarenal cerrahi, nefrolitotomi

SURGICAL MANAGEMENT OF RENAL STONES: SURGICAL METHOD PREFERENCES IN AN EDUCATION AND RESEARCH HOSPITAL UROLOGY CLINIC

In the recent study we aimed to summarize our surgical management preferences in patients with renal stones in our clinic during the last 5 years. 494 renal stone patients who underwent percutaneous nephrolithotomy PNL , open nephrolithotomy and retrograde intrarenal surgery RIRS in our clinic between 2009 and 2014 were included. Demographic characteristics, perioperative data, postoperative success rates and complications were noted. 428 86% , 41 8% and 25 6% patients underwent PNL, RIRS and open nephrolithotomy respectively. Median age was 51 , 47 and 44 years in patients who underwent PNL, RIRS and open nephrolithotomy respectively. Mean stone burden was 2.4 cm2, 1.4 cm2 and 3.2 cm2 in PNL, RIRS and open nephrolithotomy groups respectively. Mean operation time was 107, 64 and 78 minutes in PNL, RIRS and open nephrolithotomy groups respectively. Mean hospitalization time was 3.4, 1.1 and 3.7 days in PNL, RIRS and open nephrolithotomy groups respectively. Postoperative blood transfusion was required in 98 22.8% and 6 24% patients in PNL and open nephrolithotomy groups respectively. None of the patients required blood transfusion in RIRS group. Residual fragments ≥ 5mm were observed in 87 20% , 3 12% and 2 5% patients in PNL, open nephrolithotomy and RIRS groups respectively. The most preferred surgical option for renal stones is PNL in our clinic. RIRS is an advantageous surgical procedure with relatively lower operation and hospitalization times. Open nephrolithotomy is rarely preferred with improvements in minimal invasive surgical procedures

Keywords:

PNL, retrograde intrarenal surgery, urolithiasis, nephrolithotomy,

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