Güner YILDIZ, Bora İRER, Mehmet Oğuz ŞAHİN, Volkan ŞEN

Bilateral Üreter Taşları Tek Seans Üreteroskopi ile Güvenli ve Etkin Olarak Tedavi Edilebilir Mi?

Amaç: Bilateral üreter taşı tedavisinde, aynı seansda üreteroskopi (URS) ile tedavinin etkinliğini ve güvenilirliğini araştırmayı amaçladık. Gereç ve Yöntemler: Tek taraflı üreter taşı tanısı ile unilateral-URS uygulanan (grup 1) 841 hastanın ve bilateral üreter taşı tanısı ile aynı seansda bilateral-URS uygulanan (grup 2) 41 hastanın; demografik verileri, üriner sistem taş hastalığı özgeçmişleri, mevcut üreter taşının verileri ve operasyon sonuçları karşılaştırıldı. Bulgular: Grup 1’de 582 (%69.2) erkek, 259 (30.8%) kadın, grup 2’de ise 27 (%65.9) erkek ve 14 (%34.1) kadın hasta bulunmaktaydı. Grup 1 için ortalama taş alanı 70.9±52.6 mm2 iken grup 2’de ise kümülatif olarak 271.1±180.2 mm2 hesaplandı ve anlamlı olarak daha büyüktü (p˂0.001).Operasyon süresi açısından da grup 2 anlamlı olarak daha uzun süreye sahipti (grup 1=36.0±19.3 dk. ve grup 2=48.9±23.7 dk.; p˂0.001). Grup 1 de genel anestezi, 50 (%5.9) hastada uygulanırken, grup 2’de ise anlamlı olarak daha fazla olmak üzere 7 (%17.1) hastada tercih edildi (p=0.013). Postoperatif 1. gün analjeziğe, grup 1’de 127 (%15.1) hasta ihtiyaç duyarken, grup 2’de 12 (%29.3) hastanın ihtiyacı oldu ve fark anlamlıydı (p=0.025). Yatış süresi grup 1’de 1.4±1.3 gün iken, grup 2’de 2.1±2.6 gün olup istatistiksel fark yoktu (p=0.082). Taşsızlık oranı açısından da gruplar arasında fark saptanmadı (Grup 1=%90.6 ve grup 2=%85.4; p=0.274). Grup 1’de 816 (%97.0) hastada, grup 2’de ise 40 (%97.6) hastada komplikasyona rastlanmadı ve gruplar arsında fark yoktu (p=0.970).Sonuç: Aynı seansda bilateral URS ile bilateral üreter taşı tedavisinin etkin ve güvenilir bir yöntem olduğu kanaatindeyiz.

Anahtar Kelimeler:

bilateral üreter taşı, bilateral üreteroskopi, üreter taşı, üreter taşı tedavisi, üreteroskopi

Can Bilateral Ureter Stones Be Treated Safely and Effectively With One Session Ureteroscopy?

Objective: We aimed to investigate the efficacy and safety of same session ureteroscopy (URS) in the treatment of bilateral ureteral calculi.Materials and Methods: 841 patients who underwent unilateral URS for unilateral ureteral stone (group 1) and 41 patients who underwent bilateral URS for bilateral ureteral stones in single session (group 2) were compared in terms of demographic data, urinary stone disease history, stone characteristics and operation outcomes.Results: There were 582 (69.2%) male and 259 (30.8%) female patients in group 1, 27 (65.9%) male and 14 (34.1%) female patients in group 2. The stone area was calculated as 70.9±52.6 mm2 in Group 1 while 271.1±180.2 mm2 in Group 2 cumulatively and it was significantly larger than Group 1 (p˂0.001). Mean operation time was also longer in Group 2 (Group 1: 36.0±19.3 min and Group 2: 48.9±23.7 min; p˂0.001). General anesthesia was preferred in 50 patients (5.9%) in Group 1 and 7 (17.1%) patients in group 2 (p=0.013). A total of 127 (15.1%) patients needed analgesia at postoperative first day in Group 1 and 12 (29.3%) patients in Group 2 (p=0.025). The hospitalization times and stone free rates were similar between the groups (1.4±1.3 vs 2.1±2.6 days; p=0.082 and 90.6% vs 85.4%; p=0.274). No complication was found in 816 (97.0%) patients in Group 1 and 40 (97.6%) patients in Group 2 (p = 0.970).Conclusion: We believe that bilateral URS in the same session is an effective and reliable method in the treatment of bilateral ureter stones.

Keywords:

bilateral ureteral stones, bilateral ureteroscopy, ureteral stone, ureteral stone treatment, ureteroscopy,

PDF

___

1. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive theraphy for distal ureteral calculi. J Urol 2005; 174: 167-172.
2. Heers H, Turney BW. Trends in urological stone disease: A 5-year update of hospital episode statistics. BJU Int 2016; 118:785–789.
3. Deliveliotis C, Picramenos D, Alexopoulou K, et al. One-session bilateral ureteroscopy: Is it safe in selected patients? Int Urol Nephrol 1996; 28: 481–484.
4. Camilleri JC, Schwalb DM, Eshghi M. Bilateral same session ureteroscopy. J Urol 1994; 152: 49–52.
5. Su LM, Sosa RE. Ureteroscopy and retrograde ureteral Access. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, eds. Campbell’s urology. 8th ed. Philadelphia, PA:WB Saunders; 2002: p. 3306-3318.
6. Gupta PK. Is the holmium-YAG laser the best intracorporeal lithotripter for the ureter? A 3-year retrospective study. J Endourol. 2007; 21(3): 305-9.
7. Hollenbeck BK, Schuster TG, Faerber GJ, Wolf JSJr. Safety and efficacy of same-session bilateral ureteroscopy. J Endourol 2003; 17: 881-885
8. Mushtaque M, Gupta CL, Shah I, Khanday MA, Khanday SA. Outcome of bilateral ureteroscopic retrieval of stones in a single session. Urol Ann 2012; 4(3): 158-61.
9. Gunlusoy B, Degirmenci T, Arslan M, et al. Is bilateral ureterorenoscopy the first choice for the treatment of bilateral ureteral stones? An updated study. Urol Int 2012; 89(4): 412-7.
10. El-Hefnawy AS, El-Nahas AR, El-Tabey NA, et al. Bilateral same-session ureteroscopy for treatment of ureteral calculi: critical analysis of risk factors. Scand J Urol Nephrol 2011; 45(2): 97-101.
11.Geraghty RM , Rai BP, Jones P, Somani BK. Bilateral Simultaneous Ureteroscopic (BS-URS) Approach in the Management of Bilateral Urolithiasis Is a Safe and Effective Strategy in the Contemporary Era-Evidence from a Systematic Review. Curr Urol Rep 2017; 18(2): 11.
12. Darabi M, Keshvari M. Bilateral same-session ureteroscopy: its efficacy and safety for diagnosis and treatment. Urol J 2005; 2: 8–12.
13. Grossi FS , Barnaba D , Raguso M , et al. Bilateral same session ureteroscopy: safety and efficacy. Arch Ital Urol Androl 2007; 79(1): 20-2.
14. Ge H, Zheng X, Na Y, et al. Bilateral Same-Session Ureteroscopy for Treatment of Ureteral Calculi: A Systematic Review and Meta-Analysis. J Endourol 2016; 30(11): 1169-1179.