Göksel BAYAR, Hüseyin ACINIKLI, Sinan Levent KİREÇÇİ, Kaya HORASANLI, Ayhan DAlKILINÇ

Üreteroskopi sırasında görülen komplikasyonlar ve öngörücü faktörler

Amaç: Çalışmamızda kliniğimizde üreteroskopi sırasında yaşanan komplikasyonları, bu komplikasyonları öngörücü faktörleri değerlendirmeyi amaçladık.Gereç ve Yöntem: Kliniğimizde 2001-2014 yılları arasında üreter taşı için üreteroskopi yapılan hastaların dosyaları retrospektif olarak incelendi. Toplam 1015 hastaya uygulanan 1214 ünite üreteroskopi çalışmaya dahil edildi. Komplikasyonları evrelendirmek için Clavien- Dindo sınıflaması kullanıldı. Hastaların demografik verileri, taşın lokalizasyonu, boyutu ve impakte olması, litotripsi için kullanılan enerji kaynağı, taş kırma stratejisi, peroperatif gelişen komplikasyonlar incelendi. Komplikasyon gelişen Grup-1 ve gelişmeyen Grup-2 hastalar arasında karşılaştırma yapıldı.Bulgular: Hastaların ortalama yaşları 43± 17 olup; tek seansta taşsızlık oranı % 89 olarak bulundu. Hastaların median takip süresi 7 ay olup, bu süre komplikasyon gelişen grupta 12 aydır. Toplam 227 % 22 hastada komplikasyon gelişti. Bunların 80’i % 35 medikal tedaviyle düzeltilebilen evre 1-2 komplikasyonlardı. Taşın üst üreterde p= 0,041 , 10 mm’den büyük p= 0,02 ve impakte p= 0,016 olmasının komplikasyonu öngörücü faktörler olduğunu gözlemledik. Kır-bırak yöntemi uygulananlarda daha az komplikasyon geliştiğini gördük % 1,3 vs. 7,6 p=0,001 . Hastaların yaşının, cinsiyetinin, üreteroskopi yapılan tarafın ve yapan kişinin üroloji uzmanı yada asistanı olması , işlem başında balon dilatasyon uygulamanın ve kullanılan taş kırma enerji kaynağının komplikasyon gelişen grupla diğer grup arasında farklı olmadığını gördük. Sonuç: Çalışmamızda üreter taşı için yapılan üreteroskopide taşın üst üreterde, 10 mm’den büyük veya impakte olmasının komplikasyon gelişimini artırdığı, kır-bırak yönteminin ise azalttığını tespit ettik

Anahtar Kelimeler:

Üreteroskopi, komplikasyon, impakte taş

Complications encountered during the ureteroscopy and predictive factors

Objective: We aimed to evaluate complications that occurred during ureteroscopy and predictive factors.Material and Method: Patients’ files were retrospectively analyzed, who underwent ureteroscopy for ureteral stone between 2001-2014. Totally 1015 patients and 1214 renal units ureteroscopy interventions were included in our study. Clavien- Dindo classification was used for evaluation of the complications. Patients’ demographics, stone localization, stone size, impacted or not, power supply used for lithotripsy, strategy for the stone breaking and complications that occurred peri-operatively were analyzed. Patients with Group-1 and without Group-2 complications were compared.Results: Patients’ mean age was 43± 17 190 years, stone free rate was 89% at first session. Median follow time was 7 months in all patients and 12 months inpatients with complications. Overall, 227 22 % had complications. Of the patients, 80 had grade 1 or 2 complications. Upper stone localization p=0.041 , stone size bigger than 10 mm p=0.02 and impacted stones p= 0.016 were predictive factors for development of complications. Less complication rate was detected in patients who underwent ureteroscopy with “smash and go” strategy 1.3% vs. 7.6 % p=0.001 . Mean patient age, gender, side, experience of the urologist, application of balloon dilatation at beginning of intervention, power supply used for lithotripsy were not predictive factors for the development of complications. Conclusions: Localization of the stone in the upper ureter and stone size larger than 10 mm were detected to increase complication rate whereas application of “smash and go” strategy decreased complication rate in ureteroscopy and stone lithotripsy

Keywords:

Ureteroscopy, complication, impacted stone,

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