Üst Üreter Taşlarında Tedavi Yöntemlerinin Karşılaştırılması Ve Başarı Üzerine Etkili Faktörler

Amaç: Üst üreter taşlarının tedavisinde beden dışı şok dalga (ESWL)  ve üreteroskopi (URS ) uygulamalarının etkinliğini ve başarı üzerine etkili olabilecek faktörleri değerlendirmek. Yöntemler: Üst üreter taşı tanısı ile tedavi edilen 233 hastanın verileri retrospektif olarak değerlendirildi. ESWL uygulanan hastalar Grup 1, URS yapılan hastalar ise Grup 2 olarak ayrıldı. Tüm hastalar kontrastsız  abdominal bilgisayarlı tomografi ile değerlendirildi. Hastaların yaş ve cinsiyetleri, vücut kitle indeksi, taş boyutu, ortalama taş dansitesi, cilt-taş mesafesi gibi faktörler kayıt edilerek tedavi başarısı üzerine etkileri değerlendirildi. Bulgular: Hastaların yaş ortalaması 47,4 yıl idi. Ortalama taş boyutu 119,7 mm3 idi ve ortalama taş dansitesi 690,5 Hounsfield Ünitesi idi. Grup 1’de   %55,2 taşsızlık tespit edildi. Grup 2’de ise bu oran %74,1 idi.  Kadın cinsiyet, taş boyutu ve cilt taş mesafesi ESWL başarısı için prediktif faktörlerdi.  URS için herhangi bir prediktif faktör tespit edilmedi. Taş cilt mesafesi 10 cm’den uzun olanların kısa olanlara göre başarısız olma riski 13 kat daha fazlaydı (p<0.001). URS yapılan grupta ise herhangi bir parametrenin istatistiksel olarak başarıyı etkilemediği görülmüştür. Sonuç: Bu çalışma, üst üreter taşı olan hastalarda URS’nin ESWL’ye kıyasla daha yüksek taşsızlık oranına sahip olduğunu göstermiştir.  URS daha fazla hastanede kalma süresi ve daha fazla cerrahi enstrüman gerektirmektedir.  ESWL uygulanan hastalarda ise ikincil tedavi ihtiyacı daha fazladır

Comparison Of Treatment Methods In Upper Uretheral Stones And Factors Affecting Treatment Success

Aim: To evaluate the efficacy of extracorporeal shock wave (ESWL) and ureteroscopy (URS) in the treatment of upper ureteral stones and the factors that may affect the success.Methods: The data of 233 patients treated with the diagnosis of upper ureteral stones were analyzed retrospectively. Patients divided two groups according to ESWL (Group 1) and URS (Group 2) treatment. All patients were evaluated by non-contrast abdominal computed tomography. The factors such as age and sex, body mass index, stone size, mean stone density, skin-stone distance were recorded and their effects on treatment success were evaluated.Results: The mean age of the patients was 47.4 years and the mean body mass index was 25.9 kg/m2.The mean stone size was 119.7 mm3 and the mean stone density was 690.5 Hounsfield Units. 76.4% of the patients had hydronephrosis. Stone-free status was detected in 55.2% patients in the group 1, while it is 74.1% in the group 2. Female gender, stone size and skin distance were predictive factors for ESWL success. No predictive factor was detected for URS. The risk of failure was 13 times higher than those with shorter stone skin lengths greater than 10 cm (p <0.001). In addition, when the stone volume increased by 1 unit, the risk of failure increased by 1-fold (p = 0.009). In the URS group, it was observed that any parameter did not affect statistical success. Conclusion: This study showed that URS had a higher stone-free rate compared to ESWL in patients with upper ureteral stones. URS requires more hospital stay and more surgical instruments.  Otherwise, the need for secondary treatment is higher in patients undergo ESWL.

___

  • 1. Aboumarzouk OM, Kata SG, Keeley FX, McClinton S, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2012;(5):CD006029.
  • 2. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int 2003;63:1817-1823.
  • 3. Lopes Neto AC, Korkes F, Silva JL, Amarante RD, Mattos MH, Tobias-Machado M, et al. Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy. J Urol 2012;187:164-168.
  • 4. Turk C, Skolarikos A, Neisius A, Petřík A, Seitz C, Thomas K. EAU Guidelines on Urolithiasis 2019 Available at https:// uroweb.org/guideline/urolithiasis.
  • 5. Wu T, Duan X, Chen S, Yang X, Tang T, Cui S. Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones: A Systematic Review and Meta-Analysis. Urol Int 2017;99:308-319.
  • 6. Tugcu V, Resorlu B, Sahin S, Atar A, Kocakaya R, Eksi M. Flexible Ureteroscopy versus retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience. Urol Int 2016;96:77-82.
  • 7. Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. J Endourol. 2015;29:1248-1252.
  • 8. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 2016;196:1153-1160.
  • 9. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol 2016;196:1161-1169.
  • 10. Drake T, Grivas N, Dabestani S, Knoll T, Lam T, Maclennan S, et al. What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. Eur Urol 2017;72:772-786.
  • 11. Karlsen SR, Renkel J, Tahir AR, Angelsen A, Diep LM. Extracorporeal Shock Wave Lithotripsy versus ureteroscopy for 5- to 10-mm stones in the proximal ureter: Prospective effectiveness patient-preference trial. J Endourol 2007;21:28-33.
  • 12. Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Tepeler A, Esen T, et al. Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urol Res 2011;39:309-314.
  • 13. Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, et al. CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 2014;66:102-109.14. Takahara K, Ibuki N, Inamoto T, Nomi H, Ubai T, Azuma H. Predictors of success for stone fragmentation and stone-free rate after extracorporeal shock wave lithotripsy in the treatment of upper urinary tract stones. Urol J 2012;9(3):549-552.
  • 15. Hong YK, Park DS. Ureteroscopic lithotripsy using Swiss Lithoclast for treatment of ureteral calculi: 12-years experience. J Korean Med Sci 2009;24:690-694.16. Galal EM, Anwar AZ, El-Bab TK, Abdelhamid AM. Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones. Int Braz J Urol 2016;42:967-972.
  • 17. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 2002 Jan;167:31-34.
  • 18. Al-Ansari A, As-Sadiq K, Al-Said S, Younis N, Jaleel OA, Shokeir AA. Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones. Int Urol Nephrol 2006;38:63-67.
  • 19. Ng CF, Siu DY, Wong A, Goggins W, Chan ES, Wong KT. Development of a scoring system from noncontrast computerized tomography measurements to improve the selection of upper ureteral stone for extracorporeal shock wave lithotripsy. J Urol 2009;181:1151–1157.
  • 20. Wiesenthal JD, Ghiculete D, D'A Honey RJ, Pace KT. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 2010;38:307–313.
  • 21. Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 2003;169:1679–1681.
  • 22. Abdelhamid M, Mosharafa AA, Ibrahim H, Selim HM, Hamed M, Elghoneimy MN et al. A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi. J Endourol 2016;30:1227-1232.
  • 23. Kilinc MF, Doluoglu OG, Karakan T, Dalkilic A, Sonmez NC, Aydogmus Y et al. Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous? Can Urol Assoc J 2015;9:718-722.
Sakarya Tıp Dergisi-Cover
  • Başlangıç: 2011
  • Yayıncı: Sakarya Üniversitesi
Sayıdaki Diğer Makaleler

Tıp Fakültesi Birinci Sınıf Öğrencilerinde Probleme Dayalı Öğrenme Sürecinin Anksiyete Düzeyine Etkisinin Değerlendirilmesi

Nazan BEDİR, Elif KÖSE, Esra YAZICI, Hasan Çetin EKERBİÇER, Nurettin CENGİZ, Haldun Şükrü ERKAL

“The Importance of ROLL Tecnique at Surgical Treatment of Paratyroid Adenomas-Our Clinical Experiences”

Fadime GÜVEN, Erdem KARADENİZ, Mustafa FİLİK, Abdulmecit KANTARCI

Ateşli Silah Yaralanması Sonucu Servikal Kanal İçinde Bir Kurşun: Olgu Sunumu

Fatma DURAN MEMİŞ

Acil Serviste Herediter Anjioödem’e Yaklaşım

Öner ÖZDEMİR

Mitokondriyal Disfonksiyon ve Otizm

Mikail YENİÇERİ

Laparoskopik Appendektomide Yeni Bir Düğüm Oturtucu; Karman Kanülü

Barış MANTOĞLU, Fatih ALTINTOPRAK, Emre GÖNÜLLÜ, Emrah AKIN, Kayhan ÖZDEMİR, Ali MUHTAROĞLU

Üst Üreter Taşlarının Tedavisinde Semirijid Üreterorenoskopik Litotripsi ve Vücut Dışı Șok Dalga Litotripsi Yöntemlerinin Karşılaştırılması ve Başarı Üzerine Etkili Faktörler

Hüseyin Aydemir, Osman Köse, Salih Budak, Deniz Gül

Atipik klinik prezentasyonu olan süperior mezenterik arter sendromu :olgu sunumu

Hatice HAMARAT, Tülay BAKAR, Şafak Meriç ÖZGENEL

Üst Üreter Taşlarında Tedavi Yöntemlerinin Karşılaştırılması Ve Başarı Üzerine Etkili Faktörler

Hüseyin AYDEMİR, Osman KÖSE, Salih BUDAK, Deniz GÜL

Tanı Karmaşasına Yol Açan İki Olgu: Rett Sendromu

Hilal AYDIN, İbrahim Hakan BUCAK, Haydar BAĞIŞ