Mustafa ÇALIK, Fatih BÜYÜKCAM, Yılmaz ZENGİN, Mustafa Ahmet AFACAN, Öner ODABAŞ

Acil servise yan ağrısı ile başvuru nedenleri ve ürolitiyaziste klinik değerlendirme

Amaç: Yan ağrısı ile acil servise başvuran hastalardaki taş görülme sıklığı, üriner sistem taş hastalığı ile karışabilen durumlar, tanı yöntemleri, taş lokalizasyonu, taş büyüklüğü ve tercih edilen tedavi yöntemleri araştırıldı.Gereç ve Yöntemler: Acil servise dört aylık süreçte yan ağrısı ile başvuran 377 hasta çalışmaya dahil edildi. Yan ağrısı ile acil servise başvuran hastalarda üriner sistem taş hastalığı sıklığı, cinsiyet, yaş, meslek, vücut kitle indeksi, laboratuar bulguları ve tercih edilen görüntüleme yöntemleri araştırıldı; yan ağrısında karşılaşılan patolojiler belirlendi, üriner sistem taş hastalığında taşın lokalizasyonu, büyüklüğü ve ilave patolojiler değerlendirildi.Bulgular: Yan ağrısı ile acil servise başvuran hastaların %71.4’ünde üriner sistem taş hastalığı saptandı. Acil servise yan ağrısı ile başvuran erkek hastalarda taş görülme olasılığı daha fazlaydı. Tek taraflı kostovertebral açı hassasiyeti KVAH pozitif olanlarda çift taraflı pozitif olanlara göre daha fazla oranda taş saptandı. Sonuç: Acil servise yan ağrısı ile başvuran hastaların büyük çoğunluğunda taş tespit edildi. Radyolojik olarak görüntüleme tetkiklerinden özellikle üriner sistem USG’nin çabuk ulaşılabilirliği, yan etkisinin olmaması ve ekonomik olmasından dolayı acil servis’te ilk bakıda öncelikle tercih edilmesi gerekir

Anahtar Kelimeler:

Üriner sistem taşı, ultrasonografi, direkt üriner sistem grafisi, taş protokolü batın bilgisayarlı tomografi

The causes of emergency department visits due to flank pain and the clinical investigation of urolithiasis

Objective: In this study, the incidence of stones, the conditions that can be confused with urolithiasis, diagnostic methods, localization and size of the stone and the preferred treatment methods in patients with flank pain were evaluated.Material and Methods: 377 patients were admitted to the emergency department with flank pain over a four-month period. The frequency of urinary tract stone disease, gender, age, occupation, body mass index, laboratory findings, the preferred diagnostic methods in patients with flank pain, the localization and size of the stones and other pathologies that is seen in patients with flank pain were evaluated.Results: 71.4% of the patients who were admitted to the emergency room with flank pain had urinary tract stone disease. Men with flank pain had higher rate of urinary stone disease than women. Patients suffering from one-sided costovertebral point tenderness CVPT had higher rate of urinary stone disease than those who suffered from two-sided costovertebral point tenderness. Conclusion: The majority of patients admitted to the emergency department with flank pain were diagnosed with urinary system stones. Ultrasonography should be preferred in the first examination in the emergency department because it is a cheap and safe method which is also easily accessible and non-invasive

Keywords:

Urinary tract stone, ultrasonography, plain urinary system graph, noncontrast-enhanced computer tomography,

PDF

___

Anderson KR, Smith RC. CT for the evaluation of flank pain. J Endourol 2001;15:25-9.
Brown J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol 2006;38:87- 92.
Tanagho EA. Embryology of the Genito Urinary System. In: Tanagho EA, McAninch JW, editors. Simith’s General Urology. 14th ed. San Francisco: McGraw- Hill Companies; 1995. p. 17-31.
Akinci M, Esen T, Tellaloglu S. Urinary stone disease in Turkey: an updated epidemiological study. Eur Urol 1991;20:200-3.
Menon M, Parulkar BG, Drach GW. Urinary Lithiasis. Eti- ology, Diagnosis, and Medical Management. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campbell’s Uro- logy. 7th ed. Philadelphia: W.B.Saunders; 1998. p. 2661-733.
Hesse A, Siener R. Current aspects of epidemiology and nut- rition in urinary stone disease. World J Urol 1997;15:165-71.
Long LO, Park S. Update on nephrolithiasis management. Minerva Urol Nefrol 2007;59:317-25.
Guidelines on urolithiasis [database on the Internet]. Euro- pean Association of Urology. 2012.
Varma G, Nair N, Salim A, Marickar YM. Investigations for recognizing urinary stone. Urological research 2009;37:349- 52.
Kennish SJ, Bhatnagar P, Wah TM, Bush S, Irving HC. Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era? Clinical radiology 2008;63:1131-5.
Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol 2002;41:351-62.
Jellison FC, Smith JC, Heldt JP, et al. Effect of low dose radi- ation computerized tomography protocols on distal ureteral calculus detection. J Urol 2009;182:2762-7.
Niemann T, Kollmann T, Bongartz G. Diagnostic perfor- mance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR American journal of roentgenology 2008;191:396-401.
Li J, Kennedy D, Levine M, Kumar A, Mullen J. Absent he- maturia and expensive computerized tomography: case cha- racteristics of emergency urolithiasis. J Urol 2001;165:782- 4.
Bove P, Kaplan D, Dalrymple N, et al. Re-examining the va- lue of hematuria testing in patients with acute flank pain. J Urol 1999;162:685-7.
Ather MH, Faizullah K, Achakzai I, Siwani R, Irani F. Al- ternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain. Urol J 2009;6:14-8.
Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Gu- ideline for the management of ureteral calculi. Eur Urol 2007;52:1610-31.
Anagnostou T, Tolley D. Management of ureteric stones. Eur Urol 2004;45:714-21.
Guvel S, Tekin MI, Kilinc F, Peskircioglu L, Ozkardes H. Bladder stones around a migrated and missed intrauterine contraceptive device. Int J Urol 2001;8:78-9.