Hakan POLAT, Volkan TUĞCU, Doğukan SÖKMEN, Ali İhsan TAŞÇI

Ekstrakorporal şok dalga litotripsi ve perkütan nefrolitotominin renal fonksiyonlar üzerine etkilerinin karşılaştırılması

Amaç: Bu çalışmada, ekstrakorporal şok dalga litotripsi SWL ve perkütan nefrolitotominin PNL bölgesel ve genel renal fonksiyonlar üzerine etkilerinin tek foton emisyonlu bilgisayarlı tomografi SPECT ile karşılaştırılmasını amaçladık.Gereç ve Yöntemler: Şubat 2006 ile Aralık 2011 tarihleri arasında 1,5-2,5 cm arası renal pelvis taşı olan hastalar prospektif randomize olarak SWL n:22 ve PNL n:20 gruplarına ayrıldı. SWL için elektrohidrolik spark gap jeneratör kullanıldı. PNL için hastalara posterior alt kaliksten tek giriş yapıldı. SPECT için teknesyum99m-dimerkaptosüksinik asit Tc99m-DMSA kullanıldı. Hastaların, tedaviden bir hafta önce ve 6 ay sonraki SPECT taramaları, genel ve bölgesel renal fonksiyonlar açısından karşılaştırıldı.Bulgular: SWL grubunda ortalama taş boyutu 19,3±3mm , 15 %68 vaka işlem sonrası ortalama şok sayısı 5458±1251 taşlardan tamamen temizlendi. Beş vakada işlem sonrası alt kalisiyel sistemde rest taş kaldı. İki hastada ise düşürülemeyen üreteral fragmanlar nedeni ile üreterorenoskopik pnömatik litotripsi yapıldı. PNL grubundaki ortalama taş boyutu 20,1±2,4mm tüm hastalarda taşlar tamamen temizlendi. İşlem öncesi ve sonrası SPECT taramaları karşılaştırıldığında, genel ve lokal tutulum kaybı SWL grubunda tedavi edilen böbreklerdeki %3,36±0,78 ve %2,64±0,83, PNL grubunda %2,68±1,1 ve %1,56±0,62 olup anlamlı farklılık göstermemektedir.Sonuç: Böbrek taşı tedavisinde SWL daha az travmatik yöntem olarak görünmesine karşın, büyük böbrek taşlarında tekrarlayan seanslara ihtiyaç duyulmaktadır. Bu durumda oluşan parankimal hasar daha fazla olmaktadır. Böbrek taşı tedavisinde SWL ve PNL seçimi yapılması gereken durumlarda, bu durum dikkate alınmalıdır

Anahtar Kelimeler:

Böbrek taşı, perkütan nefrolitotomi, Ekstrakorporal Şok Dalga Litotripsi

Comparison of the effects of Extracorporeal Shock Wave Lithotripsy and percutaneous nephrolithotomy on renal functions

Objective: In this study, we compared the effects of extracorporeal shock wave lithotripsy SWL and percutaneous nephrolithotomy PNL on local and global renal functions by single photon emission computed tomography SPECT . Materials and Methods: Patients with renal pelvis stones sized between 1.5 and 2.5 cm were prospectively randomised into SWL n22 and PNL n:20 groups between February 2006-December 2011. An electrohydraulic generator was used for SWL. A single posterior lower caliceal access was used for PNL. Technetium99m-dimercaptosuccinic acid Tc99m-DMSA was used for SPECT scans. SPECT scans, obtained one week before and 6 months after treatment, were compared for local and global renal functions. Results: 15 68% cases of SWL group mean stone size:19,3±3mm were stonefree after treatment average shock number: 5458±1251 . There were residual fragments in the lower calyx in 5 cases. Ureterorenoscopic pneumatic lithotripsy was performed in another 2 cases due to nonpassing ureteral fragments. Stones of the patients in PNL group mean stone size:20,1±2,4mm were removed completely. When pretreatment and posttreatment SPECT scans were compared, loss in local and global uptakes of the treated kidneys were 2,64±0,83% and 3,36±0,78% in SWL group and 1,56±0,62% and 2,68±1,1% in PNL group, respectively. There was no significant difference between groups. Conclusion: Although SWL seems a less traumatic method in treatment of renal calculi, several repeat sessions are required for large calculi. So, the consequent parenchymal injury is more after SWL. When a decision is to be made between SWL and PNL for treatment of renal calculi, this situation should be considered

Keywords:

Renal calculus, percutaneous nephrolithotomy,

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