Evaluation of Thoracic Complications After Urological Operations: A Single-center Experience

Objective: To present cases of thoracic complications that developed after urologic interventions and were treated in collaboration with thoracic surgery. Materials and Methods: Patients who were operated in the urology clinic at our hospital between January 2014 and December 2017 and required thoracic surgery consultation were retrospectively reviewed. Forty-two patients with pneumothorax, pleural effusion, hydropneumothorax and diaphragm injury were included in the study. Six patients, who had preoperative diaphragm invasion and underwent preoperative diaphragm incision, were excluded. Results: Tube thoracostomy (TT) was applied in only 5 patients who developed pneumothorax. Three patients with isolated pleural effusion were treated with TT and 3 with thoracentesis. All patients who developed hydropneumothorax were found to have undergone nephrectomy (3 left, 1 right). All patients with iatrogenic diaphragmatic injury were diagnosed perioperatively and all of these patients were nephrectomized (5 right, 1 left). All the patients underwent primary diaphragm repair and 5 patients underwent TT. The mean duration of tube drainage was 5.5±2.1 (2-13) days. The mean length of hospital stay in patients who underwent percutaneous nephrolithotomy, nephroureterectomy, nephrectomy and prostatectomy with thoracic complications was 4.12±1.08, 8.26±2.87, 4.04±1.23 and 4.17±0.72 days, respectively. There was no significant difference in mean duration of hospital stay between patients with and without thoracic complications (p=0.729). Conclusion: Thoracic complications may develop after urological interventions. In particular, evaluation of chest pain in patients with right-sided percutaneous nephrolithotomy and nephrectomy by chest X-ray is important for early diagnosis.

Ürolojik Operasyonlar Sonrası Ortaya Çıkan Torasik Komplikasyoların Değerlendirilmesi: Tek-merkez Deneyimi

Amaç: Bu çalışmada ürolojik girişimler sonrası torasik komplikasyon gelişen ve göğüs cerrahisi-üroloji işbirliği ile tedavi edilen olgular sunuldu. Gereç ve Yöntem: Ocak 2014 - Aralık 2017 tarihleri arasında hastanemiz Üroloji Anabilim Dalı tarafından opere edilen ve göğüs cerrahisi konsültasyonu istenilen olgular retrospektif incelendi. Çalışmaya pnömotoraks, plevral effüzyon, hidropnömotoraks ve diyafragma yaralanması saptanan 42 hasta dahil edildi. Operasyon öncesi diyafragma invazyonu saptanan ve peroperatif diyafragma insizyonu yapılan altı hasta çalışmadan çıkarıldı. Bulgular: Pnömotoraks gelişen hastaların sadece 5’ine tüp torakostomi (TT) uygulandı. İzole plevral effüzyon izlenen hastaların 3’ü TT, 3’ü ise torasentez ile tedavi edildi. Hidropnömotoraks gelişen hastaların tamamına nefrektomi (3 sol, 1 sağ) uygulandığı görüldü. İyatrojenik diyafragma yaralanması gelişen hastaların tamamına perioperatif dönemde tanı kondu ve hastaların tamamı nefrektomi (5 sağ, 1 sol) hastası idi. Hastaların tamamında diyafragmanın primer onarımı yapıldı, 5 hastaya TT uygulandı. Hastaların ortalama dren kalış süresi 5,5±2,1 (2-13)/gündü. Toraks komplikasyonu gelişen hastalardan perkütan nefrolitotomi, nefroüreterektomi, nefrektomi ve prostatektomi operasyonu geçiren hastaların ortalama hospitalizasyon süreleri, sırasıyla, 4,12±1,08, 8,26±2,87, 4,04±1,23 ve 4,17±0,72 gündü. Toraks komplikasyonu gelişen ve gelişmeyen hastaların ortalama hospitalizasyon süreleri arasında anlamlı bir farklılık yoktu (p=0,729). Sonuç: Ürolojik girişimler sonrası torasik komplikasyonlar gelişebilir. Özellikle sağ taraflı perkutan nefrolitotomi ve nefrektomi sonrası göğüs ağrısı tarifleyen hastaların akciğer grafisi ile değerlendirilmesi erken tanı için önemlilik arz etmektedir.

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