Uğur BALCI, Mahmoud MUSTAFA, Mahir KARTALMIŞ, Serkan YENİGÜRBÜZ, Cengiz GİRGİN, Çetin DİNÇEL

Üreter taşlarının extracorporeal shock wave litotripsi ile tedavisi: Klinik sonuçlarımız

Bu çalışmada İzmir Atatürk Eğitim ve Araştırma Hastanesi 1.Üroloji Kliniğinde Ocak 2003-Mayıs 2008 tarihleri arasında Extracorporeal Shock Wave Litotripsi (ESWL) ile tedavi edilmiş 106 hastanın değerlendirilmesi amaçlandı. Hastaların 77’si erkek (%72.6), 29’u kadın (%27.4) ve yaş ortalaması 45.32±14.08 idi. Hastalar taşların üreterdeki lokalizasyonlarına göre 3 gruba ayrıldı. Kırkdört hastada üst, 26 hastada orta ve 36 hastada üreter alt ucunda taş mevcuttu. Gruplar taşsızlık oranı, taş boyutu, ortalama ve toplam şok sayısı ve seans sayıları yönünden karşılaştırıldı. İstatistiksel analizler Ki-Kare ve Pearson korelasyon testleri kullanılarak yapıldı. Toplam başarı oranı %83’tü. Bu oran sırasıyla üst uç taşları için %86.6, orta bölüm taşları için %88.5 ve alt uç taşları için %75 olarak bulundu. Yalnızca seans sayısının başarı oranını etkilediği izlendi (p=0.028). ESWL ayaktan uygulanabilme, anestezi gerektirmeme ve düşük morbidite gibi avantajlara sahip non-invaziv bir tedavidir ve taş üreterin neresinde olursa olsun üreter taşlarının tedavisinde ilk seçenektir.

Anahtar Kelimeler:

Litotripsi, Yüksek-enerji şok dalgaları, Üreter taşı, Tedavi sonucu

The treatment of ureteral stones with extracorporeal shock wave lithotripsy: Our clinical outcomes

The aim of this study was to evaluate 106 patients treated with Extracorporeal Shock Wave Lithotripsy (ESWL) for ureteral stones between January 2005 and May 2008 in 1st Urology Department of Izmir Atatürk Training and Research Hospital. Seventy-seven patients (72.6%) were male, twenty-nine patients were female with mean age of 45.32±14.08. Patients were diveded into three groups according to the location of ureteric stones. Fourty-four patients had upper, 26 middle and 36 lower ureteric stone respectively. These groups compared with stone-free rates, stone size, average and total number of shock, number of session and were analyzed using Pearson corelation test and chi-square. Total success rate was 83%. The stone-free rate of each group was 86.6%, 88.5% and 75% respectively. Number of session was the only significant factor corelating with success (p=0.028). ESWL is non-invasive treatment with advantages of outpatients treatment, no requirement of anesthesia and low morbidity. It is the first line management irrespective of ureteric location of stones.

Keywords:

Lithotripsy, High-Energy Shock Waves, Ureteral Calculi, Treatment Outcome,

PDF

___

1.Tiselius HS, Ackermann D, P. Alken P et al: EAU Guidelines on Urolithiasis, p 21, 2006.
2.Chaussy C, Brendel W, Schmiedt E: Extra-corporeally induced destruction of kidney stones by shock waves. Lancet, 13(2): 1265-8, 1980.
3.Sreem SB, Preminger GM: Surgical management of calculus disease; In: Gillenwater JY, Grayhack JT, Howards SS (eds). Adult and Pediatric Urology, 4th ed, vol.: 1, chp 9, 2002.
4.Teichman JM: Clinical practice Acute renal colic from ureteral calculus. N Engl J Med, 350: 684–93, 2004.
5.Tombal B, Mawlawi H, Feyaerts A, et al: Prospective Randomized Evaluation of Emergency Extracorporeal ShockWave Lithotripsy (ESWL) on the Short-Time Outcome of Symptomatic Ureteral Stones. European Urology, 47: 855–9, 2005.
6.Chaussy C, Schmiedt E, Jocham D, et al: First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol, 127(3): 417-20, 1982.
7.Osti AH, Hofmockel G, Frohmuller H: Uretero-scopic treatment of ureteral stones: only an auxiliary measure of extracorporeal shock wave lithotripsy or a primary therapeutic option? Urol Int, 59: 177-81, 1997.
8.Robert M, Delbos O, Guiter J, et al: Insitu piezoelectric extracorporeal shock wave lithotripsy of ureteric stones. Br J Urol, 76: 435–9, 1995.
9.Nabi G, Baldo O, Cartledge J, et al: The Impact of the Dornier Compact Delta Lithotriptor on the Management of Primary Ureteric Calculi. European Urology, 44(4): 482-6, 2003.
10.Gonzalez EC, Cabrera PJ, Calahorra FJ, et al: Treatment of ureteral lithiasis with shock waves. Arc Esp Urol, 54(9): 971-82, 2001.
11.Tombolini P, Ruoppolo M, Bellorofonte C, et al: Lithotripsy in the treatment of urinary lithiasis. J Nephrol, 13(3): 71-82, 2000.
12.Segura JW: Staghorn calculi. Urol Clin North Am, 24: 71-80, 1997.
13.Nabi G, Baldo O: The impact of the Dornier Compact Delta lithotriptor on the management of primary ureteric calculi. Eur Urol, 44(4): 482-6, 2003.
14.Preminger GM, Tiselius HS, Assimos DG, et al: 2007 Guideline for the Management of Ureteral Calculi. J Urol, 178: 2418-34, 2007.
15.Strohmaier WL, Schubert G, Rosenkranz T, et al: Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: a prospective study. Eur Urol, 36(5): 376-9, 1999.
16.Elashry OM, Elgamasy AK, Sabaa MA, et al: Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int, 102(8): 1010-7, 2008.
17.Pearle MS, Nadler R, Bercowsky E, et al: Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol, 166(4): 1255-60, 2001.
18.Murota-Kawano A, Ohya K, Sekine H. Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: efficacy of the third generation lithotripter as the first line treatment. Int J Urol, 15(3): 210-5, 2008.