Mehmet Çağlar ÇAKICI, yberk İPLİKÇİ, Furkan ŞENDOĞAN, Turgay TURAN, Özgür EFİLOĞLU, Ramazan Gökhan ATIŞ, Asıf YILDIRIM

Retrograd İntrarenal Cerrahi Sonrası Double-J Stent Migrasyonunu Öngören Faktörler

Amaç: Her ne kadar etkili ve güvenli bir kullanım alanı olsa da double-J stent (DJS) kullanımı ile ilgili farklı komplikasyonlar ortaya çıkabilmektedir. Bu çalışmada böbrek taşı nedeniyle retrograd intrarenal cerrahi (RIRC) yapılan hastalarda DJS migrasyonunun klinik sonuçlarını ve migrasyon gelişimini öngören risk faktörlerini belirlemeyi amaçladık. Gereç ve Yöntemler: Kliniğimizde Aralık 2013 ile Nisan 2020 tarihleri arasında böbrek taşı için RIRC yapılan ve işlem sonrasında DJS yerleştirilmiş olan 1258 hastanın verileri geriye dönük olarak tarandı. DJS migrasyonu ile ilişkili bağımsız risk faktörlerini öngörmek için ikili lojistik regresyon analizi kullanıldı. Bulgular: 1258 hastadan 71’inde (%5,6) DJS migrasyonu gözlendi. Grup 1’de renal pelvis yerleşimli taşlar kaliks taşlarına oranla istatistiksel olarak daha fazlaydı (p=0,003). Hidronefroz grup 1’de %70,4 oranındayken; grup 2’de %56,2 oranında gözlendi (p=0,019). Üreteral erişim kılıfı kullanım oranı grup 1 ve grup 2’de sırasıyla %74,6 ve %57,5 idi (p=0,004). Grup 1’de modifiye Clavien-Dindo skoru 2,2±1,3 iken; grup 2’de 0,2±0,5 idi (p<0,001). Tek değişkenli ve çok değişkenli lojistik regresyon analizine göre renal pelvis yerleşimli taş olması (Tahmini rölatif risk (TRR)=2,080, %95 Güven Aralığı (GA): 1,277-3,388, p=0,003), toplayıcı sistemde derece 3-4 hidronefroz bulunması (TRR=3,732, %95GA: 1,783-7,809, p<0,001) ve üreteral erişim kılıfı kullanılması (TRR=2,387, %95GA: 1,368-4,162, p=0,002) DJS migrasyonunu öngören bağımsız risk faktörleridir. Sonuç: RIRC sonrasında gözlenen DJS migrasyonu nadir gözlenen bir komplikasyon olmasına rağmen özellikle proksimale doğru olan migrasyon sonrasında genel anestezi gerektiren ek bir işleme yol açması nedeniyle önemli bir komplikasyondur. Yüksek derecede hidronefrozu olan, renal pelviste taşı bulunan ve üreteral erişim kılıfı kullanılan hastalarda ameliyat sonrası dönemde DJS migrasyonu olabileceği unutulmamalıdır.

Anahtar Kelimeler:

böbrek taşı, double-J stent, hidronefroz, migrasyon, retrograd intrarenal cerrahi, üreteral stent

Factors Predicting Double-J Stent Migration After Retrograde Intrarenal Surgery

Objective: Although it is an effective and safe area of use, different complications may arise with the use of double-J stents (DJS). In this study, we aimed to determine the clinical results of DJS migration and risk factors predicting the occurrence of migration in patients who underwent retrograde intrarenal surgery (RIRS) for kidney stones. Material and Methods: The data of 1258 patients who underwent RIRS for kidney stones in our clinic between December 2013 and April 2020 and had DJS inserted after the procedure were retrospectively reviewed. Binary logistic regression analysis was performed to predict independent risk factors associated with DJS migration. Results: DJS migration was observed in 71 (5.6%) of 1258 patients. In group 1, stones located in the renal pelvis were statistically more common than calyceal stones (p = 0.003). While hydronephrosis is 70.4% in group 1; it was observed with a rate of 56.2% in group 2 (p = 0.019). Ureteral access sheath usage rate was 74.6% and 57.5% in group 1 and group 2, respectively (p = 0.004). While the modified Clavien-Dindo score in Group 1 was 2.2 ± 1.3; it was 0.2 ± 0.5 in group 2 (p <0.001). Stones located in the renal pelvis according to univariate and multivariate logistic regression analysis (odds ratio (OR) = 2.080, 95% Confidence Interval (CI): 1.277-3.388, p = 0.003), grade 3-4 hydronephrosis in the collecting system ( OR = 3.732, 95% CI: 1.783-7.809, p <0.001) and use of ureteral access sheath (OR = 2.387, 95% CI: 1.368-4.162, p = 0.002) are independent risk factors predicting DJS migration. Conclusions: Although DJS migration observed after RIRS is a rare complication, it is an important complication since it causes an additional procedure that requires general anesthesia, especially after proximal migration. It should be kept in mind in the postoperative period that DJS migration may occur in patients with high degree of hydronephrosis, stones in the renal pelvis, and in patients with a ureteral access sheath used in surgery.

Keywords:

double-J stent, hydronephrosis, kidney stones, migration, retrograde intrarenal surgery, ureteral stent,

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