Comparison of Efficacy and Safety of Isolated Single Different Calyx Accesses in Percutaneous Nephrolithotomy

Objective: We aimed to compare the safety and efficacy of upper, middle and lower calyx accesses obtained as isolated and single access in percutaneous nephrolithotomy (PCNL) operation which is performed for treating renal stones. Materials and Methods: The records of patients who had undergone PCNL via isolated single pole access due to renal stone between September 2007 and June 2018 were retrospectively evaluated. The patients were divided into three groups as isolated single upper calyceal access patients (group 1), isolated single middle calyceal access patients (group 2) and isolated single lower calyceal access patients (group 3). The patient groups were compared in terms of patient characteristics, stone size and location, operative data, postoperative outcomes and complications. Results: Fifty-seven (2.8%) patients who underwent isolated single calyceal access PCNL were included in group 1 (upper calyx), 542 (26.9%) in group 2 (middle calyx) and 1427 (70.4%) were included in group 3 (lower calyx). The mean age of the patients in groups 1, 2 and 3 was 43.09±15.00, 38.23±22.47 and 39.40±19.93, respectively. A thousand hundred and seventy-six (58%) patients were male and 850 (42%) were female. The mean stone burden was 367.19±266.48, 335.7±301.85 and 353.73±346.47 mm2 in groups 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.45, p=0.77, p=0.29, respectively). The mean operative time, mean fluoroscopy time, and mean nephrostomy time, and the mean length of hospitalization were statistically significantly longer in group 2 than in group 3. Stone-free rates in patients with clinically insignificant stones (SF + CIRF) were 89.5%, 89.6% and 91.6% in group 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.25, p=0.43 and p=0.6 respectively). There was no significant difference between the three groups in terms of postoperative fever, blood transfusion and overall complications. Conclusion: As a result, different isolated single calyceal accesses do not have superiority over each other in terms of stone-free rate and complications. A proper access is required while performing PCNL to remove the stones, decrease the comorbidity rates and prevent complications and the ideal way is the way that provides the shortest and the smoothest reach all stones.

Perkütan Nefrolitotomide İzole Tek Farklı Kaliks Girişlerinin Güvenliği ve Etkinliğinin Karşılaştırılması

Amaç: Böbrek taşı tedavisinde uygulanan perkütan nefrolitotomi (PNL) operasyonunda izole ve tek giriş olarak yapılan üst, orta ve alt kaliks girişlerinin güvenlik ve etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Eylül 2007 ve Haziran 2018 tarihleri arasında böbrek taşı nedeniyle izole tek giriş ile PNL yapılan hastalar retrospektif olarak incelendi. Hastalar izole tek üst kaliks girişi (grup 1), izole tek orta kaliks girişi (grup 2) ve izole tek alt kaliks girişi (grup 3) olmak üzere üç gruba ayrıldı. Hastaların demografik özelikleri, taş boyutu ve lokalizasyonu, operasyona ait veriler, postoperatif sonuçlar ve komplikasyonlar açısından karşılaştırıldı. Bulgular: İzole tek kaliks girişi ile PNL yapılan hastaların 57’si (%2,8) grup 1 (üst kaliks), 542’si (%26,9) grup 2 (orta kaliks), 1427’si (%70,4) ise grup 3’te (alt kaliks) yer almaktaydı. Hasta yaşları sırasıyla 43,09±15,00, 38,23±22,47 ve 39,40±19,93 yıl idi. Bu hastaların 1176’sı (%58) erkek, 850’si (%42) kadın idi. Taş boyutları grup 1, 2 ve 3’de sırasıyla 367,19±26,48, 335,7±301,85 ve 353,73±346,47 mm2 olup istatistiksel olarak anlamlı bir fark yoktu (p=0,45, p=0,77 ve p=0,29). Ortalama Skopi süresi, ortalama nefrostomi çekilme süresi ve ortalama hastanede kalış süresi grup 2 ve 3 kıyaslandığında grup 2’de bu süreler anlamlı derecede yüksek bulundu. Grup 1, 2 ve 3’te klinik önemsiz taşlarla birlikte taşısızlık oranları sırasıyla 51 (%89,5), 486 (%89,6), 1308 (%91,6) idi ve gruplar arası anlamlı fark saptanmadı (p=0,25, p=0,43, p=0,6). Postoperatif ateş, kan transfüzyonu açısından ve total komplikasyon açısından her üç grup arasında anlamlı bir farklılık saptanmadı. Sonuç: Sonuç olarak izole tek farklı kaliks girişlerinde taşsızlık oranı ve komplikasyon açısından birbirlerine üstünlükleri yoktur. PNL kullanılarak taşların tamamen temizlenmesi, PNL komorbitidesi azaltmak ve komplikasyon oluşmaması için iyi bir erişim şarttır ve ideal yol, tüm taşlara en kısa ve en düz erişimi sağlayan yoldur.

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Kaynak Göster

Journal of Urological Surgery
  • ISSN: 2148-9580
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2014

5b3.1b

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