Retrospective analysis of retrograd intrarenal surgery results and factors affecting success rate

Purpose:We evaluated predictive factors for the successful retrograd intrarenal surgery by retrospectively scrutinizing patients treated with retrograde intrarenal surgery. Materials and methods: Records of 76 renal stone patients treated between April 2014 and November 2016 were analyzed. The medical history of the patients including laboratory and radiological findings as well as preoperative and postoperative data was analyzed. Results: The mean age was 42.9±13.4 years. The mean stone number was 1.84±0.92 (total 135 stones). The mean stone size was 10.7±3.6 mm, and cumulative stone burden was 121.8±83.7 mm2 . There were a total of 135 stones: 8 of them located in the upper calyx, 25 in middle calyx, 52 lower calyx, 26 in renal pelvis and 24 in the ureteropelvic junction. We controlled our stone-free rate with CT one month after the surgery. The success rate and complete stone-free rate was 77.6% after the first session. Eleven patients had insignificant residual fragments, but 5 patients had residual stone. The total stone number, stone size and cumulative stone burden were found to be significant in the success of the surgery. Major complications were urosepsis in one patient, hemorrhage requiring transfusion in one patient and ureteral trauma that recovered with DJ placement and no need for open surgery in one patient. Conclusion: RIRS is an effective operation with high stone free rate and minimally invasive operation method with minimal morbidity and complication rate. Stone number, stone size and cumulative stone burden are found to be main factors affecting success rate of the procedure.

Retrograd intrarenal cerrahi sonuçlarının retrospektif analizi ve başarı oranını etkileyen

Amaç:Böbrek taşı nedeniyle retrograd intrarenal cerrahi uygulanan vakaların sonuçlarının ve operasyon başarısını etkileyen faktörlerin retrospektif olarak değerlendirilmesi amaçlandı. Gereç ve yöntem: Nisan 2014 ile Kasım 2016 tarihleri arasında böbrek taşı tanısı alan ve retrograd intrarenal cerrahi yapılan 76 hasta çalışmaya alındı. Hastaların demografik özellikleri, taş lokalizasyonu, taş adeti, taş büyüklüğü, toplam taş yükü kaydedildi. Ameliyat öncesi ve sonrası veriler değerlendirildi. Bulgular: Hastaların ortalama yaşı 42.9±13.4 yıl idi. Hastaların 35' inde sağ, 38' inde sol böbrek taşı ve üç hastada ise her iki böbrekte taş vardı. Taş sayısı ortalama 1.84±0.92 hesaplandı (toplam 135 adet taş). Ortalama taş büyüklüğü 10.7±3.6 mm ve kümülatif taş yükü 121.8 ±83.7 mm2 olarak hesaplandı. Toplam taşların 8'i üst kaliks, 25'i orta kaliks, 52'si alt kaliks, 26'si renal pelvis ve 24'ü üreteropelvik yerleşimli idi. Operasyondan bir ay sonra taşsızlık oranının belirlenmesi amacıyla bilgisayarlı tomografi çekildi. Birinci seans sonunda hastaların %77.6' sında taşsızlık saptanırken, 11 hastada (%14.5) 3mm'den küçük klinik önemsiz taş olduğu ve 5 hastada rezidü taş olduğu görüldü. Toplam taş sayısı, taş boyutu ve taş yükünün taşsızlık başarı şansını etkilediği görüldü. Operasyona bağlı bir hastada çoklu antibiyoterapi kullanmayı gerektiren ürosepsis, bir hastada kan transfüzyonu gerektirecek hemoraji ve bir hastada double J kateter ile düzelen üreteral travma majör komplikasyonlarımız idi. Sonuç: Retrograd intrarenal cerrahi böbrek taşlarının tedavisinde düşük morbidite ve yüksek başarı oranı ile uygulanabilen minimal invaziv bir yöntemdir. Toplam taş sayısı, taş boyutu ve taş yükünü retrograd intrarenal cerrahi başarı oranlarını etkileyen ana faktörlerdir.

Kaynakça

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