Hüseyin Cihan DEMİREL, Cumhur YEŞİLDAL, Sinan Levent KİREÇCİ, Kadir Cem GÜNAY, Çağatay GÖĞÜŞ, Sıddık Mut ŞAFAK

Büyük Koraliform Böbrek Taşlarının Tedavisinde Multitrakt Perkütan Nefrolitotripsi ve Sandviç Tedavi Yöntemlerinin Başarı ve Komplikasyon Oranları Açısından Karşılaştırılması

Amaç: Perkütan nefrolitotripsi (PNL) ve ekstrakorporeal şok dalga litotripsisi (SWL), diğer yöntemler ile beraber uzun yıllardır üriner sistem taş hastalığının tedavisinde kullanılmaktadır. PNL operasyonları kliniğimizde 1987 yılından beri her çeşit ve boyuttaki böbrek taşlarına başarı ile uygulanmaktadır. Biz de bu çalışmada 4 yıllık süre içerisinde büyük koraliform taşları olan hastalara uyguladığımız PNL operasyonlarından tek seansta yapılan multitrakt uygulamaları ve SWL ile kombine ettiğimiz iki seanslı PNL operasyonlarını (sandviç tedavi uygulamaları) başarı ve görülebilen komplikasyon oranları açısından karşılaştırmayı amaçladık. Gereç ve Yöntemler: 4 yıllık dönem içinde kliniğimizde böbrek taşı nedeniyle başvuran 462 hastaya PNL uygulandı. Bunların 126’ sında koraliform taş mevcut idi. Bu 126 hasta içinden multitrakt PNL uygulanan 23 (16E/7K) hasta ile sandviç tedavi uygulanan 16 (12E/4K) hasta değerlendirildi. Bu hastalar; operasyon sonrası erken dönem ve 6. aydaki başarı oranları,görülen majör (kanama, komşu organ yaralanması vb.) ve minör (ateş, idrar yolu enfeksiyonu vb.) komplikasyonlar, hospitalizasyon süreleri, ek tadavi ihtiyaçları ve operasyon süreleri açısından karşılaştırıldı. Bulgular: İki grup arasında hospitalizasyon süreleri (multitrakt PNL uygulanan grupta 9,74±3,19 gün, sandviç tedavi uygulanan grupta 22,12±10,19 gün), o süreleri (multitrakt PNL uygulanan grupta ortalama 110,78±35,57 dk, sandviç tedavisi uygulanan grupta 176,87±31,51 dk) (p0,05). Sonuç: Her cins ve boyuttaki taşların tedavisinde başarı ile uygulanan PNL, koraliform taşların tedavisinde de etkili ve güvenli bir yöntemdir. Bu yöntem şartlara bağlı olarak tek seansta multitrakt giriş şeklinde uygulanabileceği gibi, SWL ile kombine edilerek sandviç tedavisi şeklinde de uygulanabilir. Biz de kliniğimizde yaptığımız çalışmada iki tedavi yöntemini karşılaştırdık, yapılan replasman miktarları, hospitalizasyon ve operasyon süreleri dışında, başarı sonuçları ve komplikasyonlar açısından iki yöntem arasında anlamlı bir fark olmadığı sonucuna vardık ve sonuçlarımızın da literatür ile uyumlu olduğunu gördük.

Multitrakt Percutaneous Nephrolithotripsy Versus Sandwich Therapy for Coralliform Kidney Stones

Objective: Percutaneous nephrolitho tomy (PNL) and extracorporeal shock wave lithotripsy (SWL) are performed in treatment of kidney stone disease for a long period be side the other treatment methods. Since 1987 PNL procedure has been used successfully and safely in our clinic for treatment of kidney stones. We aimed to compare the success rates of multitract access and sandwich therapies (PNL+SWL+PNL) in staghorn kidney stones performed in four years period. Material and Methods: During last four years 462 patients underwent PNL pro cedures in our clinic. 126 of the patients had staghorn kidney stones 23 of the patients (16male/7female) had multitract PNL while 16 (12male/4female) underwent sandwich therapy. We compare these two groups for postopertive early period and in 6th month success, major (bleeding and adjecent organ injury etc.) and minor (fever, urinary tract infections) complications, total hospitalizati on period, additional treatment requirements and total operation duration. Results: Statistically significant differences were appearent between two groups while total hospitalization period (9,74±3,19 days in multitract PNL group and 22,12±10,19 days in sandwich therapy group), total operation duration (110,78±35,57 minutes in multitract PNL group and 176,87±31,51 minutes in sandwich therapy group)(p0,05). Conclusion: PNL is successfull and safe treatment method of staghorn stones. It can be performed with multitract technique in one session or with sandwich therapy technique which can be com bined with SWL due to conditions. Besides the blood replacement volumes, hospitalization period and the ooperation, the compari son of these treatment modalities did not exhibit any significant differences for success and complication rates. Our outcomes are compatible with the literature.

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