Yurdaer KAYNAK, Hakan KILIÇARSLAN, Emre OKEER, Burhan COŞKUN

Retrograd intrarenal cerrahinin taşsızlığını öngörmede üç boyutlu kontrastsız bilgisayarlı tomografi ile ölçülen taş volümünün taş alanına bir üstünlüğü var mıdır?

Amaç: Retrograd intrarenal cerrahi (RIRC) sonrasında preoperatif taş volümü (TV) ve taş alanı (TA) ölçümlerinin taşsızlık durumu (TD) üzerine prediktif etkisini değerlendirmek.Gereç ve yöntem: Böbrek taşları için RIRC yapılan, çalışma kriterlerine uygun 68 hastanın medikal kayıtlarını retrospektif olarak değerlendirdik. Operasyon öncesi ve sonrası kontrastsız bilgisayarlı tomografileri (KBT) olan hastalar çalışmaya dahil edilirken, sataghorn taşı olan ve taşa ulaşılamayan hastalar çalışma dışı bırakıldı. TD durumu RIRC operasyonu sonrasındaki 3. aydaki KBT’de görülebilir taş olmaması olarak tanımlandı. Bir radyolog 3 boyutlu KBT üzerindeki bir yazılım programı kullanarak TA ve TV gibi taş yükü karakteristiklerini tespit etti. Lojistik regresyon analizleri kullanılarak potansiyel TD tanımlayıcılarının değerlendirilmesi yapıldı. Bulgular: TD ile taşın dansisitesi, lokalizasyonu ve sayısı, erişim kılıfı kullanımı, önceden geçirilmiş başarısız SWL ve operasyonlar ilişkili bulunmazken, cinsiyet, TA ve TV güçlü şekilde ilişkili bulundu (p=0,014), (p<0,001), ve (p=0,002), sırasıyla. TA ve TV’nin pairwise ROC eğri analizleri kıyaslandığında özgünlükleri açısından TD belirlemede aralarında istatistiki anlamlı bir fark olmadığı görüldü (p=0.274). Bununla birlikte, multivariate analizler SA’nın TD’yi belirlemede tek bağımsız prediktör olduğunu ortaya koydu (p=0,001). Sonuç: Hem SA hem de SV RIRC operasyonu sonrasında TD’yi tahmin etmede fikir vericidir. Bununla birlikte SA, RIRC operasyonu sonrasında TD’yi bilmede tek bağımsız prediktördür ve tek başına yeterlidir.

Anahtar Kelimeler:

Taş yükü, 3 boyutlu ölçüm, lazer litotripsi, tedavi başarısı

Is there a superiority of the stone volume measured in 3-D non-contrast tomography to the stone area in predicting the stone-freeness of the retrograde intrarenal surgery success?

Objectives: To examine the predictive effect of preoperative stone volume (SV) against stone area (SA) on stone-free status (SF) following retrograde ıntrarenal surgery (RIRS).Materials and methods: We retrospectively examined the medical records of 68 RIRS patients with renal calculi who were eligible. Patients having Non-Contrast Tomography (NCCT) before and subsequent to RIRS were included, however staghorn stones and inability to access were omitted. SF status was determined by the absence of visible stones on the NCCT three months after RIRS. Using a software reconstruction tool using 3-D NCCT, a radiologist determined stone load characteristics, such as SA and SV. Using a logistic regression model, the assessment of potential SF status determinants was conducted.Results: Age, stone density, quantity and position of stones, usage of access sheath, failed prior SWL, and procedures were not substantially linked with non-SF status, however gender (p=0.014), SA (p=0.001), and SV (p=0.002) were strongly associated with non-SF status. The association between SV and SA was strong (r=0.866, p<0.001). A pairwise assessment of the ROC curves for SV and SA revealed no statistically significant difference in their specificities (p=0.274). Nevertheless, the multivariate analysis showed that SA was the sole independent predictor of SF status (p=0.001).Conclusions: Both SA and SV were strongly suggestive of SF status after the RIRS. However, SA was only identified as an independent predictor of SF status after RIRS and as a sufficient predictor of SF status after RIRS.

Keywords:

stone burden, 3-D measurement, lazer litotripsi, success treatment,

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