Umut ÜNAL, Hakan ERÇİL, Ferhat ORTOĞLU, Ergün ALMA, Sabahattin CEBER, Durmuş Alparslan DEMİRCİ, Yalçın Kaya EVLİYAOĞLU, Zafer Gökhan GÜRBÜZ

Pediatrik hastalarda mini perkütan nefrolitotomi deneyimlerimiz

Amaç: Bu çalışmada kliniğimizde böbrek taşı sebebi ile Mini-perkütan nefrolitotomi (Mini-PCNL) yaptığımız pediatrik yaş grubundaki hastaların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Haziran 2009 ve Ocak 2016 tarihleri arasında kliğimizde böbrek taşı sebebi ile Mini- PCNL yaptığımız pediatrik yaş grubundaki (<16 yaş) hastaların dosyaları ve bilgisayar kayıtları retrospektif olarak değerlendirildi. Hastaların tamamına Mini-PCNL endikasyonu Avrupa Üroloji Birliği kılavuzunda belirtilen kriterlere göre konulmuştu. Hastalara yapılacak tedavinin tipi doktor-hasta, yasal vasisi görüşmesi sonucuna göre kararlaştırılmıştı. Hastalar öncelikle DÜSG ve/veya ultrasonografi (USG) ile değerlendirildikten sonra, tüm hastalara kontrastsız bilgisayarlı tomografi (BT) tetkiki yapılmıştı. Bulgular: Çalışmamız, ortalama yaşı 9.3±4.53 (1-16) olan 20’si kız, 40’ı erkek toplam 60 hastadan oluşmaktaydı. Hastaların ortalama taş sayısı 1.4±0.83 adet (1-5) iken bu taşların 28’i sağ, 32’si sol böbrekte bulunmaktaydı. Ortalama taş yükü ise 394.8±223.4 mm2 (143-1350) olarak hesaplandı.Hastaların preoperatif üre, kreatinin, hematokrit değerleri sırası ile 22.7±6.2 (12-39) mg/dL, 0.74±0.37 (0.3-3) mg/dL, % 35.42±2.64 (29-40) idi. Bu değerler postoperatif sırasıyla 21.7±3.7 (14-31 ) mg/dL, 0.7±0.2 (0.4- 1.1) mg/dL, % 31.6±3 (26-39) olarak bulundu. Ortalama skopi süresi 116.3±45.4 saniye (40- 234) olarak bulundu. Başarı oranımız %91.7 olarak bulundu. Minör ve majör komplikasyon oranlarımız sırasıyla %11.6 , % 1.6 idi. Sonuç: Çocukluk çağı böbrek taş hastalığının tedavisinde Mini-PCNL’de uygun hasta seçimi ve klinik tecrübenin artmasına bağlı olarak yüksek başarı, düşük komplikasyon oranları ile güvenle yapılabilmektedir.

Anahtar Kelimeler:

Pediatrik nefrolitiasis, perkütan nefrolitotomi, perkütan nefrostomi

Our experience with mini percutaneous nephrolithotomy in pediatric patients

Aim: The aim of this study was to evaluate the outcome of pediatric mini-percutaneus nephrolitotomy (Mini-PCNL). Material and Methods: The data of pediatric patients (<16 years) with kidney stones between June 2009 and January 2016 had been retrospectively reviewed. All patients were selected for Mini-PCNL according to European Association of Urology guidelines. The final treatment modality was decided with parents or heir-at-law. All patients were evaluated with noncontrast computerized tomography, kidney-ureter-bladder x-ray and/or ultrasonograpy prior to treatment. Results: A total of 60 patients (20 females, 40 males) with a mean age 9.3±4.53 (range;1-16) has been evaluated. The mean number of stones were 1.4±0.83 adet (1-5) and 28 of the stones were in right kidney and 32 of the stones were in left kidney. The mean stone-burden was 394.8±223.4 (range; 143-1350) mm2. The preoperative mean BUN, creatinine, hematocrite levels were 22.7±6.2 (12-39) mg/dL, 0.74±0.37 (0.3-3) mg/dL, % 35.42±2.64 (29-40), respectively. The mean flouroscopy time was 116.3±45.4 (40-234) seconds.The success rate was found 91.7 %. The minor and major complication rate were 11.6 %, 1.6 % respectively. Conclusion: The Mini-PCNL for pediatric kidney stones can be performed with higher success rates and low complications due to carefully selected cases and clinical experience.

Keywords:

Pediatric nephrolithiasis, per- cutaneous nephrolithotomi, percutan nephro- stomia,

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