Journal of Reconstructive Urology

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Böbrek Alt Pol Taşlarında Perkütan Nefrolitotomi ve Retrograd İntrarenal Cerrahinin Etkinlik ve Güvenilirliğinin Karşılaştırılması: Retrospektif Klinik Çalışma
Comparison of Efficiency and Reliability of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Lower Pole Renal Stones: Retrospective Clinical Study
Murat ŞAHANa, Kağan Türker AKBABAa, Serkan YARIMOĞLUa, Özgür DEYİRMENCİa, İbrahim Halil BOZKURTa, Tansu DEĞİRMENCİa
aİzmir Bozyaka Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, İzmir, Türkiye
J Reconstr Urol. 2022;12(1):22-7
doi: 10.5336/urology.2022-88393
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmamızda, alt kaliks taşlarında retrograd intrarenal cerrahi [retrograde intrarenal surgery (RIRS)] ve perkütan nefrolitotominin [percutaneous nephrolithotomy (PCNL)] etkinlik ve güvenliğini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Nisan 2011-Ocak 2020 tarihleri arasında, Sağlık Bakanlığı Üniversitesi İzmir Bozyaka Eğitim ve Araştırma Hastanesinde alt pol yerleşimli böbrek taşı nedeniyle PCNL veya RIRS operasyonu uygulanan hastalar retrospektif olarak incelendi. Hastalar, uygulanan ameliyat prosedürüne göre PCNL grubu ve RIRS grubu olmak üzere 2 gruba ayrıldı. Bu 2 grup arasında demografik veriler, perioperatif ve postoperatif sonuçlar karşılaştırıldı. Bulgular: Alt pol taşı nedeniyle ameliyat olan toplam 148 hastanın 74'ü PCNL grubunda, geri kalan 74'ü ise RIRS grubunda idi. PCNL grubunda ortalama taş boyutu 22,9±5,0 mm iken, RIRS grubunda 22,1±4,7 mm idi (p=0,338). PCNL grubunda operasyon ve skopi süreleri anlamlı olarak daha uzun saptandı (p<0,001, p=0,001). Ortalama Görsel Analog Skala skoru, 1. saatte PCNL grubunda anlamlı olarak daha fazla iken, postoperatif 1. günde gruplar arasında benzer olarak saptandı (p<0,001, p=0,641). Başarı oranı PCNL'de %90,5 olarak saptanırken, RIRS grubunda bu oran %86,5 idi (p=0,439). Total komplikasyon oranları ise PCNL ve RIRS gruplarında sırasıyla %18,9 ve %8,1 olarak saptandı (p=0,034). Clavien skorlama sistemine göre komplikasyonların alt grupları incelendiğinde ise Grade II komplikasyon oranının PCNL grubunda anlamlı olarak daha fazla olduğu saptandı (p=0,09). Sonuç: Çalışmamızda, 1,5-3 cm arasındaki alt kaliks taşlarında PCNL ve RIRS benzer başarı oranına sahip olmasına rağmen PCNL grubunda operasyon ve skopi süresi daha uzun, total komplikasyon ve Clavien Grade II komplikasyon oranı anlamlı olarak daha yüksek bulundu.

Anahtar Kelimeler: Perkütan nefrolitotomi; retrograd intrarenal cerrahi; böbrek taşları; ürolitiyazis
ABSTRACT
 Objective: To compare the efficacy and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in lower calyceal stones. Material and Methods: Patients who underwent PCNL or RIRS operation due to kidney stones located in the lower pole at the Ministry of Health University Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020 were analyzed retrospectively. The patients were divided into 2 groups as PCNL group and RIRS group according to the surgical procedure performed. Demographic data, perioperative and postoperative results were compared between these 2 groups. Results: Of the 148 patients who treated for lower pole stones, 74 were in the PCNL group and the remaining 74 were in the RIRS group. The mean stone size was 22.9±5.0 mm in the PCNL group, while it was 22.1±4.7 mm in the RIRS group (p=0.338). Operation and fluoroscopy times were significantly longer in the PCNL group (p<0.001, p=0.001). While the mean Visual Analogue Scale score was significantly higher in the PCNL group at the 1st hour, it was found to be similar between the groups on the 1st postoperative day (p<0.001, p=0.641). While the success rate was 90.5% in PCNL, this rate was 86.5% in the RIRS group (p=0.439). Total complication rates were 18.9% and 8.1% in PCNL and RIRS groups, respectively (p=0.034). When the subgroups of complications were analyzed according to the Clavien scoring system, Grade II complications was found to be significantly higher in the PCNL group (p=0.09). Conclusion: In our study, although PCNL and RIRS had similar success rates in lower pole stones between 1.5-3 cm, in the PCNL group the operation and scopy time was longer, and the total complications rate and Clavien Grade II complications were found to be significantly higher.

Keywords: Percutaneous nephrolithotomy; retrograde intrarenal surgery; kidney calculi; urolithiasis
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