Adem ALTUNKOL, Hakan ERÇİL, Nevzat Can ŞENER, Güçlü GÜRLEN, Umut ÜNAL, Faruk KUYUCU, Zafer Gökhan GÜRBÜZ

Eş zamanlı bipolar transüretral prostat rezeksiyonu ve holmiyum lazer sistolitotripsinin etkinliği ve güvenliğinin değerlendirilmesi

Amaç: Bipolar transuretral rezeksiyon Plazmakinetik transüretral prostat rezeksiyonu PKTURP ile birlikte aynı seansta 20 mm den büyük mesane taşları için yapılmış Holmiyum: YAG Lazer Sistolitotripsinin HLS etkinliği ve güvenliğinin değerlendirilmesini amaçladık. Materyal ve Metods: Ocak 2012 ile Temmuz 2013 tarihleri arasında aynı seansta büyük mesane taşı >20 mm için HLS ve Benign Prostat Obstruksiyonu BPO için PK-TURP yapılan 33 hastanın dosyası retrospektif olarak incelendi. Çalışmada hastaların demografik özellikleri, uluslararası prostat semptom skoru IPSS , maksimum idrar akım hızları Qmax , postvoid rezidüel idrar miktarı PVR , prostat hacmi, taş boyutu, operasyon süresi, perioperatif komplikasyonlar ve hastanede kalış süreleri değerlendirildi. Bulgular: Ortalama yaş 67,54±10,52 45- 84 yıl idi. Ortalama taş boyutu, prostat hacmi, fragmantayon süresi, tüm operasyon süresi ve hastanede kalış süresi sırasıyla 31,39±8,91 20- 60 mm, 65,45±12,7 45-94 cc, 40,48±13,6 20- 90 dk, 109,39±19,75 65-150 dk ve 3,56±1,14 2-7 gün idi. İntraoperatif majör komplikasyon görülmedi. Hiçbir hastada kan transfüzyon ihtiyacı veya pıhtı retansiyonu gelişmedi. En yaygın komplikasyon cerrahi sonrası iki hastada gelişen geçici stres inkontinans idi. Postoperatif dönemde bir hasta rezidü taş sebebiyle tekrar operasyona alındı. Postoperatif dönemde üç hastada üriner sistem enfeksiyonu ve postoperatif altıncı ayda dört hastada bulber üretrada darlık gelişti. Aynı zamanda hastaların üçünde intraoperatif mesane mukoza yaralanması gelişti. Ortalama altı aylık takiplerde rekürren taş görülmedi. Komplikasyonlar modifiye Clavien sınılamasına uygun olarak değerlendirildi Tablo 3-4 . Preoperatif yaşam kalitesi ile postoperatif 3. ay yaşam kalitesi karşılaştırıldığında istatistiksel olarak anlamlı bulundu p20 mm ve BPO’su olan hastaların tedavisinde aynı cerrahi seansta HLS ve PK-TURP yapılmasının çok düşük morbidite, yüksek etkinlikli ve güvenli olduğu kanısındayız.

Anahtar Kelimeler:

Mesane taşı, Prostat, Lazer

Evaluation of efficacy and safety of simultaneous bipolar transurethral prostate resection and holmium: YAG laser cystolithotripsy

Objective: We aimed to evaluate the efficacy and safety of Holmium: YAG Laser Cystolithotripsy HLS procedures performed for bladder stones >20 mm in the same session with bipolar transurethral prostate resection Plasmakinetic Transurethral Prostate Resection PK-TURP . Material and Methods: Files of thirty-three patients underwent HLS for large bladder stones >20 mm and PK-TURP for Benign Prostatic Obstruction BPO in the same session in our clinic between January 2012 and July 2013 were analyzed retrospectively. Patient demographics, IPSS, Qmax, PVR, prostate volume, stone size, operative time, perioperative complications, length of hospital stay, were evaluated. Results: The mean patient age was 67,54±10,52 45-84 years. The mean stone size, preoperative prostate volume, fragmentation duration, all operation duration and length of hospital stay were 31,39±8,91 20-60 mm, 65,45±12,7 45-94 cc, 40,48±13,6 20-90 minutes, 109,39±19,75 65-150 minutes and 3,56±1,14 2-7 days, respectively. No major intraoperative complications occurred. After a mean follow-up of 6 months, no recurrent stones were recorded. No patients required blood transfusions nor developed blood clot retentions. The most common complication after surgery was transient stress urinary incontinence in two patients. One patient needed another surgical intervention for a residual stone post operatively. Three patients developed urinary tract infection and bulbar urethral strictures developed in four patients after six months post operatively. Three of them also had intraoperative bladder mucosal injury. Complications were graded using modified Clavien grading system. Post operative third month life quality was found to be statistically better than preoperative quality of life p20 mm in the same session with PK-TURP for BPO

Keywords:

Bladder Stone, Prostate, Laser,

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