Serkan YARIMOĞLU, Mehmet Erhan AYDIN, Ertuğrul ŞEFİK, Serdar ÇELİK, İsmail BASMACI, İBRAHİM HALİL BOZKURT, TANSU DEĞİRMENCİ

ÜST VE ALT KALİKS BÖBREK TAŞLARININ TEDAVİSİNDE UYGULANAN PERKÜTAN NEFROLİTOTOMİNİN KOMPLİKASYONLARINA YAKLAŞIM

Giriş: Biz çalışmamızda üst veya alt kaliks taşları sebebiyle perkütan nefrolitotomi yapılan hastaların komplikasyonlarının ve bu komplikasyonlara yaklaşımın karşılaştırılmasını amaçladık. Gereç ve Yöntem: İzmir Bozyaka Eğitim ve Araştırma Hastanesi Üroloji Anabilim Dalı'nda Ocak 2011-Ağustos 2015 tarihleri arasında böbrek taşı nedeniyle ameliyat edilen 567 hastayı retrospektif olarak incelendi. Bu hastalardan izole üst kaliks veya izole alt kaliks taşı olan 90 hasta çalışmaya dahil edildi. Bu 90 hasta izole alt kaliks taşı olanlar ve izole üst kaliks taşı olanlar olarak iki gruba ayrıldı. Bulgular: Hastalar taş yerleşime göre iki farklı gruba ayrıldı. Grup 1'de üst kaliks taşı olan 76 hasta ve grup 2'de alt kaliks taşı olan 14 hasta yer muvcuttu. Gruplar komplikasyonlar açısından değerlendirildiğinde; grup 1’de 8 hastada narkotik analjezikler kullanılmadan opiyoidlerle kontrol edilen postoperatif ağrı, 2 hastada sadece intravenöz (i.v) sıvı yönetimini gerektiren bozulmuş böbrek fonksiyonu, 2 hastada kan transfüzyonu ihtiyacı olmadan i.v sıvı tedavisi ile gerileyen kanama,5 hastada antibiyotik tedavisine cevap veren >38 ateş, 2 hastada kan tranfüzyon ihtiyacı gerektiren kanama, 1 hastada üretere stent yerleştirme ile tedavi edilen idrar kaçağı, 1 hastada anjioembolizasyon ile tedavi edilen kanama görüldü. Bir hastada ise işlem esnasında kolon perforasyonu saptanması üzerine genel cerrahi tarafından laparatomiyle primer onarım yapıldı ve kolostomi açıldı. Grup 2 de ise 1 hasta da narkotik analjezikler kullanılmadan opiyoidlerle kontrol edilen postoperatif ağrı, 1 hastada antibiyotik tedavisine cevap veren >38 ateş, 1 hastada anjioembolizasyon ile tedavi edilen kanama görüldü. Bir hastada pnömo-hidrotoraksa rastlandı ve gögüs cerrahisi tarafından gögüs tüpü takılarak ek işleme gerek duyulmadan hasta tedavi edildi. Sonuç: Taşın lokalizasyonuna göre perkutan nefrolitotomi de görebileceğimiz komplikasyonlar farklılık gösterebilir. Bu komplikasyonların yönetimi de o yüzden farklılık gösterir.

MANAGEMENT OF THE COMPLICATIONS OF PATIENTS WHO UNDERWENT PERCUTANEOUS NEPHROLİTHOTOMY FOR UPPER OR LOWER CALYX KIDNEY STONES

Introduction: In this study, we aimed to comparison and management of the complications of patients who underwent percutaneous nephrolithotomy for upper or lower calyx stones. Material and Methods: We record retrospectively of 567 patients operated at Izmir Bozyaka Training and Research Hospital Department of Urology between January 2011-August 2015 for renal stones. Ninety patients with isolated upper calyces or isolated lower calyceal stones from these patients were included in the study. These 90 patients were divided into two groups as isolated lower calyx stone and isolated upper calyx stone. Results: The patients were divided into two different groups according to stone location. Group 1 consists of 76 patients with upper calyx stone and group 2 consists of 14 patients with lower calyx stone. When the groups are evaluated in terms of complications; ın 8 patients postoperative pain managed by opioid with or without adjunct analgesic regimen, ın 2 patients deranged renal function that requires IV fluid management only, ın 2 patients bleeding managed using IV fluid without need for blood transfusion, ın 5 patients postoperative fever (>38.0_C) managed with antibiotics in the ward, ın 2 patients bleeding requiring blood transfusion, in 1 patients urine leakage managed by ureteric stenting without general anesthesia, in 1 patients bleeding managed by angioembolization were observed at group-1. In 1 patient at group-1, colon perforation was detected during the procedure and primary repair was performed by laparotomy by general surgery and colostomy was applied at group-1. In 1 patients postoperative pain managed by opioid with or without adjunct analgesic regimen, in 1 patients postoperative fever (>38.0_C) managed with antibiotics in the ward, in 1 patients bleeding managed by angioembolization were observed at group-2. One patient had pneumo-hydrotoraxa. And the chest tube was inserted by the chest surgeon and the patient was treated without any further treatment at group-2. Conclusion: Complications after percutaneous nephrolithotomy can vary according to stone localization. The management of these complications also varies.

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