Deniz BOLAT, Mehmet Erhan AYDIN, Serkan YARIMOĞLU, Tansu DEĞİRMENCİ, İbrahim Halil BOZKURT, Özgü AYDOĞDU, Tarık YONGUÇ

Perkütan nefrolitotomide tekli ve çoklu girişlerin glomerüler filtrasyon hizi üzerine olan etkilerinin karşılaştırılması

Amaç: Bu çalışmada böbrek taşı nedeniyle perkütan nefrolitotomi (PNL) yapılan hastalarda giriş sayısı ile glomeruler filtrasyon hızındaki (GFR) değişimler arasındaki ilişki değerlendirilmiştir. Gereç ve Yöntem: Ocak 2012-Eylül 2015 arasında PNL uygulanan 564 hasta çalışmaya dahil edildi. Hastalar tıbbi hikayeleri, laboratuvar ve görüntüleme yöntemleriyle değerlendirildiler. Tüm hastalara operasyon sırasında standard PNL tekniği uygulandı. Yapılan giriş sayısına gore hastalar iki gruba ayrıldılar: tekli giriş yapılanlar grup-1’e, çoklu giriş yapılanlar grup 2’ye dahil edildiler. GFR’yi belirlemek için Cockcroft-Gault formulü ile tahmini kreatinin klerensi hesaplandı. GFR ölçümleri preoperatif olarak ve postoperatif 1. ve 3. aylarda yapıldı.Bulgular: Ortalama yaşlar grup-1 ve grup-2 için, sırasıyla, 48.5±12.7 ve 47.6±12.9 yıl idi. Ortalama taş boyutu grup-1’de 501.88±517.61 mm2, grup-2’de 622.36±607.16 mm2 (p=0.151) idi. Ortalama preoperatif GFR değerleri 100.36±32.08 ml/dk ile 101.49±36.65 ml/dk idi ve aradaki fark anlamlı değildi (p=0.803). Postoperatif 1. ve 3. aylardaki ortalam GFR’ler grup-1 ve 2 için sırasıyla, 91.13±31.10 ml/dk karşılık 91.63±33.74 ml/dk ve 97.32±30.89 ml/dk karşılık 96.44±30.09 ml/dk idi. Bununla birlikte aradaki farklar anlamlı değildi (p=0.836 ve p=0.483). Postoperatif 3. aydaki GFR değişimi grup-1’ de grup 2’ye kıyasla daha düşüktü (-3.04±20.37 ml/dk karşılık -5.05±22.95 ml/dk) ve aradaki fark anlamlı değildi (p=0.483). Sonuç: PNL operayonu sonrası GFR düşmektedir. Tekli ve çoklu girişlerin böbrek fonksiyonları üzerine olan etkisi benzerdir. Hastaların taşsızlık oranlarını artırmak için, böbrek fonksiyonlarında herhangi bir bozulma olmaksızın, çoklu girişler yapılabilir.

Anahtar Kelimeler:

Perkütan nefrolitotomi, böbrek fonksiyonları, glomerüler filtrasyon hızı, kreatinin klerensi

Comparing the effects of single and multiple accesses on the glomerular filtration rates in percutaneous nephrolithotomy

Aim: In this study, we assessed the relationship between number of access and changes on glomerular filtration rate (GFR) in patients who underwent percutaneous nephrolithotomy (PNL) for kidney stones. Material and Method: Between January 2012 and September 2015, 564 patients who underwent PCNL were included in this study. Patients were evaluated by medical history, laboratory and imaging methods. Standard PCNL technique was applied to all the patients during the operation. According to the access number, patients were divided into two groups: Single access was performed in Group-1 and multiple accesses were performed in Group-2. To determine the GFR, estimated creatinine clearance was calculated by the Cockcroft-Gault Formula. GFR measurements were performed preoperatively and on the post-operative 1st and 3rd months. Results: The mean ages in group-1 and group-2 were 48.5±12.7 and 47.6±12.9 years, respectively (p=0.613). The mean stone size was 501.88±517.61 mm2 in group-1 and 622.36±607.16 mm2 in group-2 (p=0.151). Mean preoperative GFR levels were 100.36±32.08 ml/min and 101.49±36.65 ml/min, and the difference was not statistically significant (p=0.803). On the postoperative 1st and the 3rd months, mean GFRs were 91.13±31.10 ml/min vs 91.63±33.74 ml/min and 97.32±30.89 ml/min vs 96.44±30.09 ml/min in group-1 and group-2, respectively. However, the differences were not statistically significant (p=0.836 and p=0.483). Although the GFR changes on the postoperative 3rd month were lower in group-1 when compared to group-2 (-3.04±20.37 ml/min vs-5.05±22.95 ml/min), the difference was not statistically significant (p=0.483). Conclusion: After PNL surgery, GFR decreases. Effects of single and multiple accesses on the kidney function are similar. In order to increase the stone-free rates of the patients, multiple accesses can be performed without any impairment on renal functions.

Keywords:

Percutaneous nephrolithotomy, renal functions, glomerular filtration rate, creatinine clearance,

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