Salih POLAT, Serkan YARİMOĞLU, İbrahim Halil BOZKURT, Tarık YONGUÇ, Özgü AYDOĞDU, Tansu DEĞİRMENCİ

Perkutan Nefrolitotomi Tedavi Başarısını ve Komplikasyonlarını Öngörmek için Kullanılan Croes Taş Skorlama Sisteminin Validasyonu

Giriş: Çalışmamızda perkütan nefrolitotomi (PNL) uygulanan hastalarda tedavi başarısı ve komplikasyon oranlarını öngörmek için kullanılan Endoüroloji derneği klinik araştırma ofisi taş skorlama sisteminin (CROES) validasyonunun yapılması amaçlanmıştır. Gereç ve Yöntem: Ocak 2012 ile Ağustos 2015 tarihleri arasında İzmir Bozyaka Eğitim ve Araştırma Hastanesi Üroloji Kliniği’nde PNL uygulanan 568 hasta retrospektif olarak değerlendirildi. Bu hastalardan 2 (iki) ve üzeri giriş yapılan 60 hasta çalışmaya dahil edilmedi. Tüm hastalar operasyon öncesi kontrastsız spiral bilgisayarlı tomografi (BT) ile değerlendirildi. Hastalar postoperatif 1. aydaki kontrollerinde direkt üriner sistem grafisi (DÜSG) ile değerlendirildi. Semptomatik hastalar, non-opak taşı olan ve/veya DÜSG’de şüpheli opasite saptanan hastalar kontrastsız BT ile değerlendirildi. DÜSG ya da BT’de saptanan 4 mm’den küçük rezidü taşlar klinik önemsiz olarak tanımlandı ve bu hastalarda taşsızlık sağlandığı kabul edildi. CROES skorlama sistemi her hastaya tek tek uygulandı. Bu skorlama sistemi ile taşsızlık oranları, operasyon süreleri, skopi süreleri, hastanede kalış süreleri ve tahmini kan kaybı miktarı korele edildi. Postoperatif komplikasyonlar modifiye Clavien skorlama sistemine göre hesaplandı ve CROES taş skorlama sistemi ile korele edildi. Bulgular: Ortalama CROES taş skoru 203,70 olarak saptandı. Taşsızlık saptanan hasta sayısı 394 (%77,9) idi. Ortalama taş boyutu 502,01 ± 517,5 (55-2869) mm² olarak hesaplandı. PNL uygulanan hastaların 112 (%22,1)’sinde rezidü taş tespit edildi. Komplikasyon gözlenen toplam hasta sayısı 159 (%32,5) idi. CROES skoru ile taşsızlık (p<0,01) arasında pozitif korelasyon saptanırken, komplikasyon gelişimi (p=0,001) ile arasında negatif korelasyon saptandı. Ayrıca CROES skoru ile operasyon süresi (p<0,001), hastanede kalış süresi (p=0,026), kanama miktarı (p=0,007) ve taş yükü (p<0,001) arasında negatif bir korelasyon gözlendi. Çok değişkenli analizde CROES skoru taşsızlığı öngörmede bağımsız bir faktör olarak saptandı. (p<0,001) Komplikasyonu öngörmede CROES skorunun bağımsız bir faktör olmadığı görüldü. Sonuç: Çalışmamızda CROES skorlama sisteminin taşsızlığı ön görmede etkili ve güvenilir bir skorlama sistemi olduğu gösterilmiştir. Ayrıca postoperatif komplikasyonları öngörmede de etkili bir skorlama sistemidir. CROES skorlama sistemi perioperatif ve postoperatif sonuçları öngörmede klinisyenlere rehberlik edebilir.

Anahtar Kelimeler:

Perkütan Nefrolitotomi, CROES skorlama sistemi, Modifiye Clavien skorlama sistemi

External Validation of Croes Stone Score System to Predict Treatment Success and Complications of Percutaneous Nephrolithotomy

Introduction: To validate CROES scoring system for predict treatment success and complication rates of patients who underwent percutaneous nephrolithotomy (PNL). Material and Methods: We retrospectively analysed 568 patients who underwent PNL from January 2012 to August 2015 at Izmir Bozyaka Research and Training Hospital Urology Department. Sixty-one patients who had more than one access were excluded from the study. All patients evaluated with non-contrast spiral computed tomography (CT) scan before operation. Stone-free status was assessed on 1-month postoperative visit using kidney-ureter-bladder (KUB) radiograph. CT is reserved for only symptomatic patients, radiolucent stones, and/or suspicion of residual fragments seen on KUB radiography. Residual stone size of <4 mm on KUB or CT was described as clinically insignificant residual fragments, and these patients were considered as stone free. All patients were evaluated one by one with CROES scoring system. Stone-free status, operation time, fluoroscopy time, length of hospital stay and estimated blood loss were correlated with CROES score. Postoperative complications were scored with Modified Clavien scoring systems and correlated with CROES score. Results: The mean CROES score was 203,70. Overall stone free rates was %77,9. The mean stone size was 502,01 ± 517,5 (55-2869) mm.. 112 (%22,1) of the patients had residue stone. 159(32,5%) patients experienced postoperative complications. There was positive correlation between CROES stone scoring system with stone-free rates (p<0,001) and negative correlation with complication rates (p<0,001). There was negative correlation with statistically significant between CROES scoring system with operative time (p<0,001), stone burden (p<0,001), estimated blood loss (>250 mL) (p=0,007) and length of hospital stay (p=0,026). CROES score was found to be independent predictor of SFR in a multivariate logistic regression analysis. (p<0,001). CROES score was not an independent factor for predicting complication. Conclusion: In the present study, we demonstrated that CROES scoring system can be effectively and reliably used to predict SFR after PCNL. Also, CROES was effective to predict postoperative complications. This scoring system can guide the clinician to predict perioperative and postoperative PCNL outcomes.

Keywords:

Percutaneous Nephrolithotomy, CROES scoring systems, Modification Clavien score system,

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