Yaşar BOZKURT, Ahmet Ali SANCAKTUTAR, Muhammet KUVEL, Murat KAPAN, Mehmet TOKSÖZ

Alt ve orta üreter taşlarının üreteroskopik yöntemle rutin kılavuz tel (guide wire) kullanmaksızın çıkarılması

Üreter taşlarının üreteroskopik yöntemle çıkarılmasında rutin olarak kılavuz tel kullanılmaktadır. Bu çalışmanın amacı 15 mm’den küçük orta ve alt üreter taşlarının üreteroskopik yöntemle fakat kılavuz tel kullanmaksızın çıkarılmasının etkinlik ve güvenilirliğini araştırmaktır. Üreteral taş boyutu 15 mm’den küçük olan toplam 116 hastaya (62 alt ve 54 orta üreter taşı olan) rutin kılavuz tel kullanılmadan üreterorenoskopik (URS) taş çıkarma uygulandı. URS işlemi spinal anestezi altında, rijid üreteroskop ile yapıldı. Taşlar basket ile veya pnömatik litotriptörle kırıldıktan sonra basket kateter veya taş forsepsi ile alındı ve 15 gün sonra taşsızlık oranları değerlendirildi. Hastaların ortalama yaşı alt üreter taş grubunda 35,6 yıl (22-49), orta üreter taş grubunda ise 44,7 yıl (20-70) idi. Ortalama taş boyutu sırasıyla 9,5 mm (7-14) ve 9,4 mm (7-14 ) idi (P>0,05). Ortalama operasyon süreleri alt ve orta üreter taş gruplarında sırasıyla 23,3 dakika (5-60) ve 31,9 dakika (15-65) idi. Basketle alt üreter taşlarının %48,4’ü, orta üreter taşlarının %46,3’ü alındı. Alt ve orta üreter taşlarının sırasıyla, %50’si ve %51,9’u pnömatik litotriptörle kırıldıktan sonra alındı ve sırasıyla, 19 (%30,6) ve 13 (%24) hastaya üreter kateteri takıldı. Ameliyat sonrası 15. günde alt üreter taşlarında %95,2 ve orta üreter taşlarında %96,3 oranlarında taşsızlık saptandı. Üreteral perforasyon ve avulsiyon hiçbir hastada görülmezken, minör komplikasyonlara her iki grupta benzer oranlarda rastlandı. URS yapılırken büyük olmayan alt ve orta üreter taşlarında kılavuz tel takılmadan, tel takılanlarda rapor edilenlere benzer taşsızlık ve komplikasyon oranları elde edilmekle birlikte, daha kesin sonuçlara ulaşmak için yeni çalışmalara gereksinim vardır.

Anahtar Kelimeler:

Ürolojik cerrahi prosedürler, Geriyedönük çalışma, Tedavi sonucu, Üreter taşı, Ameliyat sonrası komplikasyonlar, Üreteroskopi

Ureteroscopic extraction of distal and mid ureteral stones without using a guide-wire

Guide-wire has been routinely used in ureteroscopic stone extraction (URS) of ureteral stones. The aim of this study was to evaluate the effectiveness and safety of URS in distal and mid-ureteral stones without using a guide-wire. URS was performed in a total of 116 patients who had mid ureteral stone (MUS) or distal ureteral stone (DUS) smaller than 15 mm in diameter. URS was applied with rigid ureteroscope under spinal anesthesia without using a guide-wire. Stone-free ratios were determined after 15 days of the procedure. The mean age of patients was 35.6 years (22-49) for DUS and 44.7 (20-70) for MUS. The mean stone diameters were 9.5 mm (7-14) and 9.4 (7-14) for both groups, respectively (P>0.05). Mean operation durations were 23.3 min (5-60) and 31.9 min (15-65) for both groups (P<0.001). Of all, 48.4% of DUS and 46.3% of MUS were taken by a basket, and respectively, 50.0% and 51.9% of them were taken after broken by a lithotripter. Ureteral catheters were placed in 30.6% and 24.0% of patients. At the 15th day following URS, stonefree ratios were 95.2% in DUS and 96.3% in MUS (P>0.05). Ureteral perforation or avulsion was not observed in any patient and the frequency of minor complications were similar in both groups. In URS of not-large ureteral stones, we obtained similar successful results without using guide-wire compared with previously reported data that routinely used guidewire. However, in order to reach more clear conclusions, further studies with more patients are needed.

Keywords:

Urologic Surgical Procedures, Retrospective Studies, Treatment Outcome, Ureteral Calculi, Postoperative Complications, Ureteroscopy,

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medical management, in: Walsh PC, Retik AB, Vaughan ED, Wein AJ: Campbell’s Urology, WB Saunders Company 2002, pp, 3229-305.
2. Matthew T, Gettman MT, Segura JW. Management of ureteric stones: issues and controversies. BJU Int 2005; 95: 85-93.
3. Bierkens AF, Hendrikx AJ, De La Rosette JJ, Stultiens GN, Beerlage HP, Arends AJ, et al. Treatment of mid and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of cost, morbidity and effectiveness. Br J Urol 1998; 81: 31-7.
4. Su LM, Sosa RE: Ureteroscopy and retrograde ureteral access, in: Walsh PC, Retik AB, Vaughan ED, Wein AJ: Campbell’s Urology, 8th edn. Saunders, Philadelphia, 2002, pp, 3306-19.
5. Ünsal A, Çimentepe E, Balbay MD. Routine ureteral dilatation is not necessary for ureteroscopy. Int Urol Nephrol 2004;36: 503-6.
6. Rane A, Cahill D, Larner T, Saleemi A, Tiptaft R. To stent or not to stent? That is still the question. J Endourol 2000;14: 479-81.
7. Netto NR Jr, Ikonomidis J, Zillo C. Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary? J Urol 2001;166: 1252–4.
8. Srivastava A, Gupta R, Kumar A, Kapoor R, Mandhani A. Routine stenting after ureteroscopy for distal ureteral calculi is unnecessary: results of a randomized controlled trial. J Endourol 2003;17: 871–4.
9. Hosking DH, Bard RJ. Ureteroscopy with intravenous sedation for treatment of distal ureteral calculi: a safe and effective alternative to shock wave lithotripsy. J Urol 1996;156: 899-902.
10. Yalçınkaya F, Topaloglu H, Özmen E, Ünal S. Is general anaesthesia necessary for URS in women? Int Urol Nephrol 1996;28: 153-6.
11. Puppo P, Ricciotti G, Bozzo W, Introini C. Primary endoscopic treatment of ureteric calculi. A review of 378 cases. Eur Urol 1999;36: 48-52.
12. El Gabry EA, Bagley DH. Retrieval capabilities of different stone basket designs in vitro. J Endourol 1999;13: 305-7.
13. Tan PK, Tan SM, Consigliere D. Ureteroscopic lithoclast lithotripsy: a cost-effective option. J Endourol 1998;12: 341-4.
14. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol 1997; 157: 28-32.
15. Netto NR Jr, de Almeida Claro J, Esteves SC, Andrade EFM. Ureteroscopic stone removal in the distal ureter. Why change? J Urol 1997;157: 2081-3.
16. Hosking DH, McColm SE, Smith WF. Is stenting following ureteroscopy for removal of distal ureteral calculi necessary? J Urol 1999; 161: 48-50.
17. Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, Armiento M. Early and late complications of double pigtail ureteral stents. Urol Int 2002;69: 136-9.
18. Chow GK, Patterson DE, Blute ML, Segura JW. Ureteroscopy:effect of technology and technique on clinical practice. J Urol 2003;170: 99-102.
19. Lingeman JE, Preminger GM, Berger Y, Denstedt JD, Goldstone L, Segura JW. Use of a temporary ureteral drainage stent after uncomplicated ureteroscopy: results from a phase II clinical trial. J Urol 2003;69: 1682-5.
20. Damiano R, Autorino R, Esposito C, Cantiello F, Sacco R, de Sio M. Stent positioning ureteroscopy for urinary calculi: the question is still open. Eur Urol 2004;46: 381-4.
21. Leblanc B, Paquin JM, Valiquette L, Perreault JP, Faucher R, Mauffette F, et al. Ureteroscopy versus in situ extracorporeal shockwave lithotripsy in the treatment of calculi of the distal ureter. Prog Urol 1996;6: 535-8.
22. Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS. Complications of ureteroscopy. Analysis of predictive factors. J Urol 2001;166: 538-40.
23. Turk TM, Jenkins AD. A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol 1999;161: 45-7.
24. Roberts WW, Cadeddu JA, Micali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol 1998;159: 723-6.
25. Martin X, Ndoye A, Konan PG, Tajra LCF, Gelet A, Dawahra M, et al. Hazards of lumbar ureteroscopy: apropos of 4 cases of avulsion of the ureter. Prog Urol 1998;8: 358-62.
26. Atuğ F, Akay F, Akkuş Z, Örgen S, Alar S, şahin H. Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir? Türk Üroloji Derg 2006;32: 225-9.
27. Netto NR Jr, Ikonomidis J, Zillo C. Routine ureteral stenting after ureteroscopy for ureteral lithiasis: Is it really necessary? J Urol 2001;166: 1252-4.
28. Byrne RR, Auge BK, Kourambas J, Munver R, Delvecchio F, Preminger GM. Routine ureteral stenting is not necessary after ureteroscopy and ureteropyeloscopy: a randomized trial. J Endourol 2002;16: 9-13.
29. Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS. Complication of ureteroscopy: Analysis of predictive factors. J Urol 2001;166: 538-40.
30. Preminger GM,Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 Guideline for the Management of Ureteral Calculi. J Urol 2007;178: 2418-34.