Tarık YONGUÇ, Serkan YARIMOĞLU, İsmail BASMACI, Volkan ŞEN, Tansu DEĞİRMENCİ, Bülent GÜNLÜSOY, İbrahim Halil BOZKURT

ÜRETERAL GİRİŞ KILIFI KULLANILMADAN GERÇEKLEŞTİRİLEN RETROGRAD İNTRARENAL CERRAHİ SONUÇLARIMIZ

Kliniğimizde böbrek taşı nedeniyle üreteral giriş kılıf kullanılmadan retrograd intrarenal cerahi RİRC yapılan 39 olgunun sonuçlarını sunmak. Temmuz 2013 ile Haziran 2014 tarihleri arasında Bozyaka Eğitim ve Araştırma Hastanesi Üroloji kliniğinde böbrek taşına yönelik RİRC uygulanırken üreteral giriş kılıfı kullanılmayan 39 26 erkek, 13 kadın hastanın verileri prospektif olarak kaydedildi. Tüm hastalar ameliyat öncesi ayrıntılı bir hikaye, rutin labarotuvar testleri ve idrar kültürü ile değerlendirildi. İdrar kültüründe üreme olan hastalar antibiyotik tedavisi sonrası kültürler negatif olunca ameliyata alındı. Olguların 13’ü kadın, 26’sı erkek, yaş ortalaması 48.6 yıl idi.Ortalama taş boyutu 14.1 mm idi. Bütün işlemler üreteral giriş kılıfı kullanılmadan gerçekleştirildi. Ortalama operasyon süresi 73.1 30132 dk, fluoroskopi süresi ise 6.9 sn idi. Bütün hastalar ameliyat sonrası 1. günde taburcu edildi. Olguların 1. ay kontrollerinde 33 inde %84,6 taşsızlık sağlanırken, 5 tanesinde %12.8 rezidü taş, 1 tanesinde de %2.5 klinik önemsiz taş saptandı. Takiplerde 4 %10,2 hasta antibiyotiklerle kontrol altına alınan üriner enfeksiyon saptandı, hiçbir hastada sepsis gelişmedi. İki cm altındaki böbrek taşlarının tedavisinde RİRC işlemi güvenle uygulanabilen, taşsızlık, kısa hastanede kalış süresi ve düşük komplikasyon oranıyla günümüzde tercih sebebi olan minimal invaziv yöntemdir. Üreteral giriş kılıfı kullanılmadan yapılan RİRC işleminde başarı oranları değişmezken komplikasyon oranları belirgin olarak düşmektedir

Anahtar Kelimeler:

böbrek taşı, fleksible üreteroskop, retrograd intrarenal cerrahi

RETROGRADE INTRARENAL SURGERY OUTCOMES WITHOUT USING AN ACCESS SHEAT

To present the outcome of 39 cases who had undergone retrograde intrarenal surgery RIRS without using an access sheath for renal stones in our clinic. The data of 39 patients who underwent RİRS wıthout using an access sheath for renal stones in our clinic between July 2013 and June 2014 were noted prospectively. All patients were evaluated with a detailed medical history, routine labarotory tests and urine culture preoperatively. If the urine culture was positive, antibiotic therapy was given and the operation was postponed until a negative culture was achieved. Study population consisted of 13 female and 26 male patients with a mean age of 48.6 years range 2381 .Mean stone size was 14.1 mm. Access sheaths were not used in all cases during the RIRS. Mean operative, and fluoroscopy times were 73.1 minutes, and 6.9 seconds, respectively. All patients were discharged at postoperative 1st day . At 1st month follow-up stone-free rate was achieved in 33 84,6% patients. Clinically insignificant residual stone fragments were detected in 1 2.5% , and residual stones in 5 12.8% . During follow-up period, non-complicated urinary tract infection developed in 4 10,2 % patients . But none of the patients had developed sepsis. RIRS is a safe and effective minimally invasive method for the treatment of renal stones less than 2 cm with high stone-free rates, low complication rate and short hospitalization time. RIRS without access sheat is a safe procedure with lower complication rates and similar success rates

Keywords:

renal stone, flexible ureteroscope, retrograde intrarenal surgery,

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