Serkan YARIMOĞLU, Mehmet Erhan AYDIN, Murat ŞAHAN, Ömer KORAŞ, Onur ERDEMOĞLU, Salih POLAT, Ertugrul SEFİK, Serdar CELİK, Tansu DEĞİRMENCİ

Böbrek Fonksiyonunun Perkütan Nefrolitotomi’de Başarı ve Komplikasyonlar Üzerine Etkisi

Amaç: Bu çalışmada böbrek taşları sebebiyle perkütannefrolitotomi (PNL) yapılan hastaların operasyon öncesi glomerüler filtrasyon hızlarına (GFR) göre PNL’nin başarı ve komplikasyon oranlarının karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Ocak 2012-Aralık 2016 tarihleri arasında böbrek taşı nedeniyle PNL yapılan 794 hasta geriye dönük olarak incelendi. Hastaların operasyon öncesi GFR değerleri Cockcroft–Gault formülüne göre hesaplandı. Operasyon öncesi GFR değerleri >90 ml/dk olanlar grup-1, 60-90 ml/dk arasında olanlar grup-2 ve 30-60 ml/dk olanlar grup-3 olarak tanımlandı. Gruplar arasında operasyon öncesi ve esnasındaki değerler,taşsızlık oranları ve komplikasyon oranları karşılaştırıldı. Operasyon sonrası <4 mm taş saptanması başarı olarak tanımlandı.Bulgular: Grup-1 de 466, grup-2 de 259 ve grup-3 de 67 hasta mevcut idi. Hastaların ortalama operasyon öncesi GFR değerleri grup-1, grup-2 ve grup-3 de sırasıyla 118.53 ml/dk, 77.76 ml/dk ve 48.52 ml/dk idi (p<0.001). Hastaların ortalama yaşları grup-1, grup-2 ve grup-3 de sırasıyla 43.48±11.47,51.86±11.10 ve 60.31±12.7 idi (p<0.001). Hastaların ortalama taş yükleri grup-1, grup-2 ve grup-3 de sırasıyla 497.34±518.60 mm2, 517.6±493.8 mm2 ve 711.06±679.07 mm2 idi (p=0.013). İki yüz elli ml üzeri kanama gözlenen hasta sayısı grup-1, grup-2 ve grup-3 de sırasıyla 183 (%39.3), 92 (%35.5) ve 22 (%32.8) idi (p=0.348). Gruplar arasında operasyon sonrası başarı saptanan hasta sayısı grup-1, grup-2 ve grup-3 de sırasıyla 355 (%86.2),195 (%76.1) ve 50 (%74.6) idi (p=0.542).Komplikasyon gelişen hasta sayısı ise grup-1, grup-2 ve grup-3 de sırasıyla 114 (%24.65),57(%22)ve 11 (%16.4) idi (p=0.310).Sonuç: Operasyon öncesi GFR değerleri PNL sonrası başarı ve komplikasyonları öngörmede tek başına yeterli bir faktör değildir.

Anahtar Kelimeler:

Perkütan nefrolitotomi, böbrek fonksiyonu, böbrek taşı, glomerüler filtrasyon hızı

Effect Of Renal Function Reserve on Results of Percutaneous Nephrolithotomy

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones.Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success.Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3.The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310).Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL.

Keywords:

Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates,

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