ÖZER BARAN, Ali ATAN, AYKUT AYKAÇ, MEHMET MELİH SUNAY, Fatih YALÇINKAYA, Memduh Nurettin SERTÇELİK

Üst üriner sistem taşlarında taş büyüklüğüne göre fleksibl üreterorenoskopinin etkinliği

renal cerrahi RIRS uygulanan 280 olgunun sonuçları taş boyutlarına göre retrospektif olarak değerlendirildi. Gereç ve Yöntem: Eylül 2014 ve Şubat 2016 tarihleri arasında üst üriner sistem taş hastalığı olan 280 hastada fleksibl üreterorenoskopi ile taş kırma işlemi yapıldı. Görüş altında taş veya taşlar 3 mm’den küçük hale gelinceye kadar kırıldı. Üç mm’den büyük taşlar klinik anlamlı rezidü parçalar olarak kabul edildi. Bulgular: Fleksibl üreterorenoskopi ile taş tedavisi 197 erkek, 83 kadın toplam 280 hastaya uygulandı. Hastaların yaş ortalaması 45.8 yıl ve ortalama taş boyutu 16,9 mm 7 - 40 mm idi. Ortalama işlem süresi 47.6 dk 30 - 90 dk idi. İkizyüz oniki hastaya %75.7 işlem sonrası double J stent takılırken, işlem süresinin çok kısa sürdüğü, rezidüel taşı kalmayan ve üreter hasarı gelişmeyen 68 hastaya %24.2 double J stent takılmadı. Üreteral kılıf 256 hastada ilk seansta yerleştirildi, 17 hastada ise 3 haftalık double j stent sonrası yerleştirilebildi. 229 %81.7 hastada tek seansta tüm taşlar kırılmış iken 51 %18.2 hastada rezidü taşlar nedeniyle ikincil işlem gerekti. Fleksibl üreterorenoskopi esnasında ciddi kanama meydana gelmedi. Bir hastada üreteral hasar gelişmesi ve double J stent takılamaması nedeniyle açık cerrahiye dönüldü. Sonuç: Üst üriner sistem taş hastalığında fleksibl URS yüksek taşsızlık ve düşük morbidite oranları ile güvenilir ve etkin bir cerrahi yöntemdir.

Anahtar Kelimeler:

ürolithiasis, retrograd intrarenal cerrahi, fleksible ureterorenoskopi

Efficacy of flexible ureterorenoscopy in the upper urinary tract stones according to stone size

Aim: The results of retrograde intrarenal surgery in 280 cases according to stone size were retrospectively evaluated. Material and Methods: Between September 2014 and February 2016, flexible ureterorenoscopy was performed in 280 cases with upper urinary tract stone disease. Stone or stones were fragmented until smaller than 3 mm under vision. Larger than 3 mm stones were accepted as the clinical significance residual stones. Results: Stone treatment with flexible ureterorenoscopy was performed in 197 male and 83 female patients. Median age was 45.8 years and median stone size was 16.9 mm 7- 40mm . Median operation time was 47.6 min 30-90 min . Double J stent was placed in 212 patient 75.7% after the operation while 68 patients 24.2% who has a very short operation time, without residual stone and ureteral damage was not placed. Ureteral access sheath was inserted at first procedure in 256 patient, 17 patient was inserted after the 3 week double J stent period. 229 81.7% patient stones were fragmented at first procedure but 51 18.2% patient had seconder procedure for residual stones. Severe bleeding did not occur during flexible ureterorenoscopy. In one patient developed ureteral injury inserting double J stent was unsuccesfully and was converted to open surgery. Conclusion: Flexible ureterorenoscopy is effective and reliable surgical procedure with high stone free rates and low morbidity in upper urinary system stone treatment.

Keywords:

urolithiasis, retrograde intrarenal surgery, flexible ureterorenoscopy,

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