Metilen mavisi retroperitonoskopi tekniği: renal akses sağlanamayan perkütan nefrolitotomi vakalarında alternatif

Amaç: Perkütan Nefrolitotomi cerrahisinde (PNL) çeşitli sebeplerle ekstravazasyon gelişen ve neticesinde komplike olan vakalarda uyguladığımız ‘Metilen Mavisi Eşliğinde Retroperitonoskopi Tekniği’’ni sunmak. Gereç ve Yöntemler: 2014-2020 yılları arasında Bakırköy Dr. Sadi Konuk SUAM’da ‘Metilen Mavisi Tekniği’ uygulanarak yapılan 36 PNL vakası retrospektif olarak değerlendirildi. Renal skar ya da tüm kaliksi dolduran staghorn kalkül sebebiyle Amplatz kılıfının ilerletilemediği, Amplatz kılıfın yardımcı ekip tarafından dikkatsizlik sonucunda rehber tel ile birlikte çekildiği ve ekstravazasyon gelişen durumlarda “Metilen Mavisi” yöntemi kullanılan olgular çalışmaya dahil edildi. Hastalara ait demografik, preoperatif, perioperatif ve postoperatif verileri kaydedildi, taşsızlık ve komplikasyon oranları belirtildi.Bulgular: Hastaların ortalama yaşı 45,1 yıl (36-55), ortalama vücut kitle indeksi 27,8 ± 4 kg/m2, ortalama taş boyutu 3,4 ± 0,7 cm, taş volümü 22,3 ± 10,2 cm3 idi. Ortalama operasyon süresi 95,8 ± 30,3 dk olarak hesaplandı. Postoperatif 1. gün taşsızlık oranı %68, 3. Ayda %75 idi. 8 hastaya (%22,2) ikincil bir prosedür uygulandı (ekstrakorporeal şok dalga litotripsi (ESWL) veya fleksible üreterorenoskopi (F-URS)). Sonuç: Uyguladığımız ‘Metilen mavisi tekniği’ retroperitonoskopik direkt görüş altında daha önce kısmen veya tamamen dilatasyon sağlananan kaliksi bularak böbreğe tekrar akses sağlanması için güvenli ve pratik bir seçenektir.

Anahtar Kelimeler:

metilen mavisi, retroperitonoskopi, renal akses başarısızlığı, perkütan nefrolitotomi

Methylene blue-guided retroperitoneoscopy technique: alternative for percutaneous nephrolithotomy in cases with renal access failure

Objective: To present our ‘methylene blue-guided retroperitoneoscopy technique’ that we apply in cases where extravasation develops for various reasons and is complicated as a result in Percutaneous Nephrolithotomy surgery (PNL).Material and Methods: A total of 36 patients, who underwent PNL with the ‘methylene blue technique’ at Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2014 and 2020, were retrospectively evaluated. The study included only cases in which the ‘methylene blue-guided retroperitoneoscopy technique’ was used due to the inability to advance the Amplatz sheath to the targeted calyx due to renal scarring or a staghorn stone filling the targeted calyx, Amplatz sheath was withdrawn from the kidney with the guidewire due to the inattention of the assistant surgical team or contrast material extravasation. The patients’ demographic, preoperative, perioperative, and postoperative data were recorded, and stone-free and complication rates were noted.Results: The mean age of the patients was 45.1 (36-55) years, the mean body mass index was 27.8±4 kg/m2, the mean stone size was 3.4±0.7 cm, and the mean stone volume was 22.3±10.2 cm3. The mean operation time was calculated as 95.8±30.3 minutes. The stone-free rate was 68% on the postoperative first day and 75% on the third month. Eight patients (22.2%) underwent a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy).Conclusion: The ‘methylene blue-guided retroperitoneoscopy technique’ we apply under retroperitoneoscopic direct vision is a safe and practical option for re-accessing the kidney by locating the calyx, which is first partially or completely dilated.

Keywords:

methylene blue, retroperitoneoscopy, renal access failure, percutaneous nephrolithotomy,

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