Ahmet GUZEL, Hakan ANIL, Ali YILDIZ, Kaan KARAMIK, Serkan AKDEMİR, Taylan OKSAY, Murat ARSLAN

10-20 MM ALT POL BÖBREK TAŞLARININ TEDAVİSİNDE RETROGRAD İNTRARENAL CERRAHİYE KARŞI MİNİ PERKÜTAN NEFROLİTOTOMİ: EĞİLİM SKORU EŞLEŞTİRMELİ BİR ANALİZ

Amaç Üroloji kılavuzlarında 10-20 mm arası alt pol taşlarında özellikle ekstrakorporal şok dalga litotripsi (SWL)'nin başarısız olduğu veya SWL'nin uygun olmadığı durumlarda endoürolojik tedaviler olan perkütan nefrolitotomi (PCNL) ve retrograd intrarenal cerrahi (RİRC) önerilmektedir. Bu çalışmada 10-20 mm arası alt pol taşlarında RİRC ile mini perkütan nefrolitotomi (m-PCNL) uygulanan hastaların sonuçlarını karşılaştırdık. Gereç ve Yöntem 2020 ile 2022 yılları arasında 10-20 mm arası alt pol böbrek taşı nedeniyle endoürolojik tedavi (RİRC veya m-PCNL) uygulanan 116’sı RİRC, 71’i m-PCNL olan toplam 187 hastanın dosyaları retrospektif olarak incelendi. Preoperatif yanlılıkları önlemek için 1:1 oranı temel alınarak eğilim skoru eşleştirmesi (propensity score-match) uygulandı. Analiz sonucuna göre RİRC uygulanan 65 hasta ve m-PCNL uygulanan 65 hasta çalışmaya dahil edildi. İki grup arasında intraoperatif (operasyon süresi, floroskopi süresi) ve postoperatif bulgular (hastane yatış süresi, hematokrit düşüşü, taşsızlık oranları ve komplikasyonlar) karşılaştırıldı. Operasyon sonrası 4 mm veya daha büyük taş saptanması klinik anlamlı rezidü olarak tanımlandı. Komplikasyonlar Clavien skorlama sistemine göre ve intraoperatif-postoperatif olarak sınıflandırıldı. Bulgular Her iki grup, demografik özellikler (yaş, cinsiyet, vücut kitle indeksi), radyografik taş karakteristikleri (taş boyutu, taş lateralitesi, taş opasitesi, ve taş dansitesi) açısından karşılaştırıldığında istatistiksel olarak anlamlı fark gözlenmedi. Operasyon süresi, floroskopi süresi, hastane yatış süresi açısından gruplar karşı- laştırıldığında, RİRC grubunda bu süreler istatistiksel olarak anlamlı derecede daha kısaydı (p<0.001). Ayrıca RİRC grubunda hematokrit miktarındaki düşüş m-PCNL grubuna göre istatistiksel olarak anlamlı derecede daha azdı (p<0.001). Postoperatif taşsızlık oranları ile intraoperatif ve postoperatif komplikasyon oranlarına bakıldığında her iki gruptaki sonuçların benzer olduğu görüldü. Sonuç RİRC operasyonu 10-20 mm arası alt pol böbrek taşlarında m-PCNL operasyonu ile benzer taşsızlık ve komplikasyon oranlarına sahip olan etkili ve başarılı bir endoürolojik tedavi alternatifidir. Bununla birlikte RİRC operasyonunun m-PCNL operasyonuna göre daha kısa operasyon, floroskopi ve hastane yatış sürelerine sahip olması ile daha az kan kaybına neden olması daha güvenilir şekilde uygulanabileceğini göstermektedir.

Anahtar Kelimeler:

Böbrek Taşı, Mini Perkütan Nefrolitotomi, Retrograd İntrarenal Cerrahi

RETROGRADE INTRARENAL SURGERY VS MINI-PERCUTANEUS NEPHROLITHOTOMY IN THE MANAGEMENT OF 10-20 MM LOWER POLE KIDNEY STONES: A PROPENSITY MATCHED ANALYSIS

Objective In urology guidelines, endourological treatments such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are recommended for lower pole stones with a diameter of 10-20 mm, especially in cases where extracorporeal shock wave lithotripsy (SWL) fails or SWL is not appropriate. In this study, we compared the results of patients who underwent RIRS and mini percutaneous nephrolithotomy (m-PCNL) for lower pole stones with a diameter of 10-20 mm. Material and Method The data of 187 patients (116 RIRS, 71 m-PCNL) who underwent endourological treatment (RIRS or m-PCNL) for 10-20 mm lower pole kidney stones between 2020 and 2022 were retrospectively analyzed. To avoid preoperative biases, propensity score-matching was applied based on a 1:1 ratio. According to the results of the analysis, 65 patients who underwent RIRS and 65 patients who underwent m-PCNL were included in the study. Intraoperative (operation time, fluoroscopy time) and postoperative findings (hospitalization time, drop in hematocrit, stone-free rates, and complications) were compared between the two groups. Postoperative stone detection of 4 mm or larger was defined as clinically significant residue. Complications were classified according to the Clavien scoring system and as intraoperative-postoperative. Results When the two groups were compared in terms of demographic characteristics (age, gender, body mass index) and radiographic stone characteristics (stone size, stone laterality, stone opacity, and stone density), no statistically significant difference was observed. When the groups were compared in terms of operation time, fluoroscopy time and hospitalization time, these periods were statistically significantly shorter in the RIRS group (p<0.001). In addition, the decrease in the amount of hematocrit in the RIRS group was significantly less than in the m-PCNL group (p<0.001). When the postoperative stone-free rates and intraoperative and postoperative complication rates were examined, it was seen that the results in both groups were similar. Conclusion RIRS operation is an effective and successful endourological treatment alternative with stonefree rates and complication rates similar to m-PCNL operation in lower pole kidney stones between 10-20 mm. However, the fact that the RIRS operation has shorter operation, fluoroscopy and hospitalization times compared to the m-PCNL operation and causes less blood loss shows that it can be applied more reliably.

Keywords:

Kidney Stone, Mini Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery,

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