Üreteroskopi öncesi üreter orifisinin balon dilatasyonu; hala aydınlanmamış bir soru

Stensiz üreterorenoskopinin kriterleri tam olarak bilinmemekle birlikte, randomize klinik çalışmalar seçilmiş vakalarda üreteroskopi sonrası stent kullanılmamasını desteklemektedir. Bu çalışmada stentsiz üreteroskopik taş tedavisi öncesi üreter orifisleri balonla dilate edilen hastalardaki postoperatif klinik semptomlar değerlendirilmiştir. Kasım 2006 ile Ekim 2007 tarihleri arasında üreter taşı nedeniyle üreteroskopik girişim uygulanan 35 hasta (23 erkek, 12 kadın) çalışmaya alındı. Hastaların yaşları 17 ila 74 arasında değişmekte olup ortalama 46.63 idi. Ortalama taş çapı 7.6 mm (5-15) idi. Taşlar 30 (%85.71) hastada alt üreterde, 3 (%8.57) hastada orta üreterde ve 2 (%5.71) hastada üst üreterde yerleşmiş bulunmaktaydı. Hastaların tamamında semirijid üreteroskop (7.5/12 Fr) yerleştirilmeden ünce üreter orifisleri balonla dilate edildi. Hastalar ilk bir hafta boyunca; kolik ağrısı, alt üriner sistem semptomları, taşsızlık gözlenme oranları ve parenteral analjezik gereksinimi açısından takip edildiler. Otuz üç hastada (%94.28) ilave analjezik ihtiyacı olmadı. (Ağrı skalası5) Üç hasta orta derecede kolik ağrısından yakınmakla birlikte ilave analjezik gerekli olmadı. (Ağrı skalası

Anahtar Kelimeler:

Kolik, Analjezikler, Ağrı, ameliyat sonrası, Ağrı ölçümü, Üreteroskopi, Üreter taşı, Stentler, Balon dilatasyonu

Balloon dilation of ureteral orifice prior to ureteroscopy; the question is still open?

Randomized trials support stent omission after ureteroscopy in select cases, though generalizeability is unclear and criteria for stenless ureterorenoscopy are unknown. In this study we evaluate the postoperative clinical symptoms in patients who undergo balloon dilation of ureter orifice prior to ureteroscopic stone therapy without stenting. The study cohort consisted of 35 patients (23 males, 12 females) with mean age of 46.63 years (range: 16-74) who had undergone ureteroscopic intervention due ureteral stone between November 2006 and October 2007. The average stone diameter was 7.6 mm (range: 5-15). The stones were located in lower, middle and upper parts of the ureter in 30 (85.71%), 3 (8.57%) and 2 patients (5.71%) respectively. Intra-operative ureter orifice balloon dilation were routinely done for all patients before insertion of semirigid ureteroscope (7.5/12Fr). All patients were assessed during the first 7 days following the operation for colicky pain, lower urinary tract symptoms, stone free rate and requirement for intramuscular or/and intravenous analgesics. Thirty three patients (94.28%) did not need any additional analgesics (pain scale < 2). Only two patients (5.71%) were in need of intramuscular or/and intarvenous analgesics (pain scale > 5). Three patients suffered from moderated coliky pain but they did not need another form of analgesics (pain scale < 4). All patients became free of stone by the end of the first week after the operation. Balloon dilation of ureter orifice before ureteroscopic intervention is harmless step. It is not an indication for stenting in uncomplicated successful ureteroscopic ureteral calculi management.

Keywords:

Colic, Analgesics, Pain, Postoperative, Pain Measurement, Ureteroscopy, Ureteral Calculi, Stents, Balloon Dilation,

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