Cabir ALAN, Hasan KOÇOĞLU, Ahmet Reşit ERSAY

Retrograd intrarenal cerrahi; uygulama tekniği, klinik sonuçlar ve ipuçları

Son 30 yılda böbrek taşlarının tedavisi belirgin olarak değişmiştir. Tedavi seçenekleri açık cerrahiden daha az invaziv olan perkütan nefrolitotomi PNL , vücut dışı şok dalga tedavisi ESWL ve retrograd intrarenal cerrahiye RİRC çeşitlenmiştir. Üroloji pratiğine hızla girip, yaygın kabul gören ESWL’nin alt kaliks taşları tedavisindeki etkinliği son yıllarda sorgulanmaktadır. Alternatif tedavi yöntemleri olan PNL ve göreceli olarak daha az invaziv olan RİRC alt kaliks taşları tedavisinde daha sık kullanılmaktadır. Son yıllarda geliştirilen, yüksek hareket yeteneğine sahip, yüksek görüntü kaliteli ve göreceli olarak daha dayanıklı fleksibl üreterorenoskoplar sayesinde alt kalisiyel sisteme ulaşmak daha kolaylaşmıştır. Ulaşılan alt kaliks taşını, yine son 15 yıl içinde geliştirilen holmium lazer ve nikel-titanyum alaşımlı basketler ile etkin bir şekilde tedavi etmek mümkün olmaktadır. Bu makalede, fleksibl üreterorenoskoplar f-URS ile uygulanan RİRC teknik, enstrümentasyon, klinik uygulama sonuçları ve ipuçları anlatılmaktadır

Anahtar Kelimeler:

retrograd intrarenal cerrahi, fleksibl üreterorenoskopi, böbrek taşı

Retrograde iıntrarenal surgery: technic, clinical results, tips and tricks

In the last three decades, the management of nephrolithiasis has definitely changed. The treatment of choice has differentiated from open surgery to less invasive methods, such as PNL, ESWL, retrograd intrarenal surgery RIRS . In lower calix stones, the efficacy of ESWL, which had a certain place and became very popular in practice, has been interrogated in the recent years. Now, as alternative choices, PNL and RIRS , which is relatively less invasive, are used more frequently in the management of lower calicsial stones. With the intruduction of flexible ureterorenoscopes in the recent years, which has the ability of high motion with a high definition quality of imagining and is relatively solid, the approach to lower calicsial system becomes much more easy. Exposed lower calicsial stone is treated very effectively by the baskets composed of holmium laser and nickel-titanium, which has developed in the last 15 years. In this article, RIRC technique performed with f-URS, instrumentation, results of clinical applications, and hints of the technique are described

Keywords:

retrograd intrarenal surgery, flexible ureterorenoscophy, kidney stone,

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