Perkütan Nefrolitotomide Balon ve Amplatz Dilatasyon Yöntemleri Uygulanan Hastalarda Komplikasyonların Modifiye Clavien Sınıflamasına Göre Karşılaştırılması

GİRİŞ ve AMAÇ: Amplatz ve balon dilatatör kullanımının Modifiye Clavien derecelendirmesine göre komplikasyon oranlarına etkisini karşılaştırmak. GEREÇ ve YÖNTEM: Kasım 2008 - Aralık 2015 tarihleri arasında böbrek taşı nedeniyle PNL yapılan 206 hastaya ait kayıtlar retrospektif olarak gözden geçirildi. Tüm hastalar operasyon öncesi ayrıntılı bir anamnez formu ile değerlendirildi. Genel dahili muayenesi yapıldı ve sistemik hastalık açısından sorgulandı. Hastalar operasyon öncesinde hemogram, seroloji, kan biyokimyası ve idrar kültürü ile değerlendirildi. 119 hastaya balon, 97 hastaya amplatz dilatasyon uygulandı. Komplikasyonlar Modifiye Clavien sistemine göre karşılaştırıldı. BULGULAR: Basit böbrek taşı olup balon dilatasyon uygulanan 66 hastanın 44'ünde, amplatz dilatasyon uygulanan 46 hastanın 31'inde; kompleks taşı olup balon dilatasyon uygulanan 53 hastanın 34'ünde, amplatz dilatasyon uygulanan 41 hastanın 24'ünde hiçbir komplikasyon gelişmedi. İki grup arasında tüm alt derecelendirmeler dahil edildiğinde komplikasyonsuzluk oranı bakımından anlamlı fark saptanmadı (p > 0,05). Alt gruplar incelendiğinde kompleks taşlarda yalnızca derece 3b komplikasyonlar balon dilatatör kullanılan grupta amplatz dilatatör kullanılanlara göre anlamlı olarak daha az izlendi (p = 0,03) TARTIŞMA ve SONUÇ: Modifiye Clavien derecelendirmesine göre tüm alt gruplar dahil edildiğinde amplatz ve balon dilatasyon yöntemlerinin komplikasyon oranları açısından birbirlerine üstünlükleri izlenmemiştir.

Comparison of Balloon and Amplatz Dilatation in Percutaneous Nephrolithotomy According to Modified Clavien Classification

INTRODUCTION: Comparing balloon and amplatz dilatation complication rates according to Modified Clavien classification in percutaneous nephrolithotomy (PCNL). METHODS: Records of 206 standard PCNLs performed between Nov 2008 and Dec 2015, were evaluated retrospectively. All patients were evaluated with a detailed medical history form preoperatively. General examination was held and interrogated in terms of systemic disease. Patients's preoperative blood count, serology, blood biochemistry and urine cultures were evaluated. 119 patients underwent balloon, 97 patients underwent amplatz dilation. Complications were compared according to the Modified Clavien classification. RESULTS: No complication was seen in 44 of 66 patients who underwent balon dilatation and 31 of 46 patients who underwent amplatz dilatation for simple kidney stones. Also no complication was seen in 34 of 53 patients who underwent balon dilatation and 24 of 41 patients who underwent amplatz dilatation for complex kindey stones. When all subgroups were included there was not any significant statistical difference seen between the two groups in terms of complication rates ( p > 0.05). Only in complex stone formers, degree of 3b complications were seen less in balloon dilatation group (p = 0.03 ). DISCUSSION AND CONCLUSION: No superiority was observed in terms of complications between amplatz and balloon dilation methods when all subgroups were included according to Modified Clavien classification except degree 3b in the complex stone formers.

___

  • 1. Lingeman JE, Newman D, Mertz JH, Mosbaugh PG, Steele RE, Kahnoski RJ, et al. Extracorporeal shockwave lithotripsy: The Methodist Hospital of Indiana experience. J Urol 1986;135:1134-7.
  • 2. Lam HS, Lingeman JE, Baron M, Newman DM, Mosbaugh PG, Steele RE, et al. Staghorn calculi: Analysis of treatment results between initial percutaneous nephrostolitotomy and extracorporeal shockwave lithotripsy monotherapy with reference to surface area. J Urol 1992;147:1219-25.
  • 3.Percutaneous Approaches to the Upper Urinary Tract Collecting System. Campbell'sUrology, Editor-in-chief: J. StuartWolf, Jr., MD, FACS, 2012, 10. Baskı, 47. Bölüm.
  • 4. Rabbani F, Yunis LH, Pinochet R, Nogueira L, Vora KC, Eastham JA, et al. Comp-rehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. EurUrol 2010;57(3):371-86.
  • 5. Ramasamy R, Afaneh C, Katz M, Chen X, Aull MJ, Leeser DB, et al. Comparison of complications of laparoscopic versus laparo-endoscopic single site donornephrectomy using the modified clavien grading system. J Urol 2011;186(4):1386-90.
  • 6. Szyde?ko T, Kasprzak J, Apozna?ski W, Tupikowski K, Pupka A, Janczak D, et al. Clavien classification of complication safter 150 laparoscopic pyeloplasties. Urology 2011;77(6):1359-64.
  • 7. Reifsnyder JE, Ramasamy R, Ng CK, Dipietro J, Shin B, Shariat SF, et al. Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system. JSLS 2012;16(1):38-44.
  • 8. Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F. Themodified Clavien classification system: A standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 2011;29(2):205-10.
  • 9. Tefekli A, Karadag MA, Tepeler K, Sari E, Berberoglu Y, Baykal M, et al. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: Lookingfor a standard. EurUrol 2008;53(1):184-90.
  • 10. Eğilmez T, Gören MR. Perkütan Nefrolitotominin Cerrahi Sonuçlarının Öngörülmesi: Guy Taş Skoru ve Nefrolitometrik Nomogramın Başarı ve Komplikasyon Va¬lidasyonu. J Clin Anal Med 2015;6(3):281-6.
  • 11. Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. J Endourol 2012;26:630-4.
  • 12. Lopes T, Sangam K, Alken P, Barroilhet BS, Saussine C, Shi L, et al. The Clinical Research Office of the Endourological Society. Percutaneous Nephrolithotomy Global Study: Tractdilation comparisons in 5537 patients. J Endourol 2011;25:755-62.
  • 13. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 1997;157:1229-31.
  • 14. Rassweiler JJ, Renner C, Eisenberger F. Themanagement of complexstones. BJU Int 2000;86(8):919-28.
  • 15. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. EurUrol 2007;51:899-906.
  • 16. Lee WJ, Smith AD, Cubelli V. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol 1985;134:1077-81.
  • Stoller ML, Wolf JS Jr, StLezin MA. Estimated blood loss and transfussion rates associated with percutaneous nephrolithotomy. J Urol 1994;152:1977-85.
  • 18. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: Prospective study. J Endourol 2004;18:715-22.
  • 19. Kervancioglu S, Gelebek YF, Erturhan S. Endovascular management of vascu-lar complications after percutaneous nephrolithotomy. Vasa 2014;43(6):459-64.
  • 20. Culkin DJ, Wheeler JS JrandCanning JR: Nephroduodenal fistula: a complication of percutaneous nephrolithotomy. J Urol 1985;134: 528.
  • 21. Kumar A, Banerjee GK, Tewari A et al: Isolated duodenal injury during relook percutaneous nephrolithotomy. Br J Urol 1994;74: 382.
  • 22. Pardalidis NP and Smith AD: Complications of stone treatment. In: Controversies in Endourology. Editedby AD Smith. Philadelphia: WB SaundersCo 1995; chapt 11;179-185.
  • 23. Duvdevani M, Razvi H, Sofer M et al: Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients. J Endourol 2007; 21: 824.
  • 24. Hadar H andGadoth N: Positionalrelations of colonandkidneydeterminedbyperirenalfat. AJR Am J Roentgenol 1984; 143: 773.
  • 25. Sherman JL, Hopper KD, Greene AJ et al: The retrorenal colon on computed tomography: a normal variant. J ComputAssistTomogr 1985; 9: 339.
  • 26. Lange EK. Percutaneous nephrostolithotomy andlithotripsy: a multi-institutional survey of complications. Radiology 1987;162:25-30.
Kocaeli Tıp Dergisi-Cover
  • ISSN: 2147-0758
  • Başlangıç: 2012
  • Yayıncı: -