İlker AKARKEN, Ömer ERDOĞAN, Hasan DELİKTAŞ, Hayrettin ŞAHİN

Retrograd İntrarenal Cerrahi Deneyimimiz

Kliniğimizde Retrograd İntrarenal Cerrahi (RIRS) uygulanan olguların sonuçlarını değerlendirmek. Şubat 2017 ile Şubat 2018 tarihleri arasında, böbrek taşı nedeniyle RIRS yapılan 32 olgunun sonuçları retrospektif olarak değerlendirildi. Olguların 10’u kadın, 22’si erkek, yaş ortalaması 50.5 (17-80) yıl idi. Ortalama taş boyutu 12.93 (6-25) mm idi. Olguların 8’inde (%25) işlem öncesi double-j (D-J) stent varken, 24’ünde (%75) ise işlem öncesi stent uygulanmamıştı. İşlemlerin tamamında üretral giriş kılıfı kullanıldı. Ortalama operasyon süresi 56.56 (25-120) dakika, floroskopi süresi ise 53.03 (15-240) saniye olan işlemlerin tamamında operasyon sonrası D-J stent takıldı. Hastanede kalış süresi ortalama 1 gün olan olguların, 1. ay kontrollerinde, 22’sinde (%68) taşsızlık sağlanırken, 5’inde (%16) klinik önemsiz rezidüel taş ve 5’inde (%16) rezidüel taş saptandı. Perop hiçbir hastada komplikasyon gelişmedi. Retrogradintrarenal cerrahi böbrek taşı tedavisinde etkili ve güvenli bir cerrahi tekniktir.

Anahtar Kelimeler:

Böbrek Taşı, Fleksibl Üreterorenoskop, Retrograd İntrarenal Cerrahi

Our Retrograde Intrarenal Surgery Experience

To assess the results of Retrograde Intrarenal Surgery (RIRS) operations in our clinic. The data of 32 patients, who underwent RIRS operation for stone disease from February 2017 to February 2018, were retrospectively assessed. 10 of the patients were female, while 22 of the patients were male, and the mean age of the patients was 50.5 (17-80) years. We measured the mean stone diameter as 12.93 (6-25) mm. Mean operation, and fluoroscopy times were 56.56 (25-120) minute sand 53.03 (15-240) seconds, respectively. Ureteral accesss heath was used for all of the operations. 8 (25%) of the patients were pre-stented (double-j), while the 24 (75%) were not. All the patients were stented at the end of the operation and discharged from the hospital on the first day postoperatively. No complications occurred in the perioperative period. All of the patients were controlled at the first month after the discharge. 22 (68%) of the patients were stone-free. However, 5 (16%) patients had clinically in significant residual stone and the other 5 (16%) had residual stones. Retrograde intrarenal surgery is safe and effective surgical technique for renal stones.

Keywords:

Renal Stone, Flexible Ureterorenoscopy, Retrograde Intrarenal Surgery,

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1. Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. Guidelines on urolithiasis. Eur Urol. 2001;40(4):362-71.
2. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178(6):2418-34.
3. Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Costandoutcomeassessment of 112 primary ureteral calculi. Urology. 1995;45(3):372-6.
4. Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible Ureteroscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones. Eur Urol. 2009;55(5):1190-7.
5. Galvin DJ, Pearle MS. The contemporary management of renal and ureteric calculi. BJU Int. 2006;98(6):1283-8.
6. Unsal A, Resorlu B, Kara C, Bozkurt OF, Ozyuvali E. Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age and older children with different sizes of ınstruments. Urology. 2010;76(1):247-52.
7. Kara C, Resorlu B, Bayindir M, Unsal A. A randomizedcomparison of totally tubeless and standard comparison of percutaneous nephrolithotomy in elderly patients. Urology. 2010;76(2):289-93.
8. Huffman JL, Bagley DH, Lyon ES. Extending cystoscopic techniques into the ureter and renal pelvis. Experience with ureteroscopy and pyeloscopy. JAMA. 1983;250(15):2002-5.
9. Cimentepe E, Unsal A, Saglam R, Balbay MD. Comparison of clinical outcome of extra corporeal shock wave lithotripsy in patients with radiopaque v radiolucent ureteral calculi. J Endourol. 2003;17(10):863-5.
10. Resorlu B, Senocak C, Cicekbilek I, Unsal A. Percutaneous nephrolithotomy versus retrogradeintrarenal surgery for lower pole renal Stones with a dia meter of 10 to 20 milimeters. 28thWorld Congress of Endourologyand SWL, Chicago, 2010,p.220.
11. Wong MY. Flexible ureteroscopy is the ideal choicetomanage a 1.5 cm diameterlower-polestone. J Endourol. 2008;22(9):1845-6.
12. Fuchs GJ, Fuchs AM. Flexibleendoscopy of theupperuri¬narytract. A new minimally invasive method for diagnosis and treatment. Der Urologe Ausg A. 1990;29(6):313-20.
13. Preminger GM. Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithot¬omy versus flexible ureteroscopy. Urol Res. 2006;34(2):108-11.
14. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intra renal calculi. J Urology.1998;159(4):1139-43.
15. Papatsoris A, Sarica K. Flexible ureterorenoscopic management of upper tract pathologies. Urol Res. 2012;40(6):639-46.
16. Watterson JD, Girvan AR, Cook AJ, et al. Safety and ef-ficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urology. 2002;168(2):442-5.
17. Harmon WJ, Sershon PD, Blute ML, et al. Ureteroscopy: current practice and long-term complications. J Urology. 1997;157(1):28-32.
18. Singal RK, Razvi HA, Denstedt JD. Secondary ureteros-copy: results and management strategy at a referral center. J Urology. 1998;159(1):52-5.
19. Delvecchio FC, Auge BK, Brizuela RM, et al. Assessment of stricture formation with the ureteral Access sheath. Urol¬ogy. 2003;61(3):518-22.