Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Evaluation of the Stone Analysis Results of the Patients Who Underwent Ureterolithotomy
Üreterolitotomi Operasyonu Geçiren Hastaların Taş Analizi Sonuçlarının Değerlendirilmesi
Ekrem GÜNERa, Kamil Gökhan ŞEKERa
aDepartment of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, TURKEY
J Reconstr Urol. 2020;10(2):44-8
doi: 10.5336/urology.2020-75509
Article Language: EN
Full Text
ABSTRACT
 Objective: We aimed to evaluate the results of stone analysis of the patients with ureter stone and to determine the role of stone analysis in treatment and prevention of recurrence. Material and Methods: The data of the patients who underwent ureterolithotomy for ureter stone between 2003 and 2018 were evaluated retrospectively. X-Ray Diffraction (XRD) method was used in the analysis of the stones. The examined parameters included demographic data, body mass index (BMI), operation type, operative time and stone analysis result. Results: A total of 31 patients (21 male and 10 female) were included in the study. The mean age of the patients was 37.2±12.6 years. The mean stone size was 20.6±6 mm. Ureterolithotomy was performed in 16 (51.6%) patients for right ureter stone and in 15 (48.4%) patients for left ureter stone. Ureterolithotomy was performed laparoscopically in 10 (32.3%) patients and open in 21 (67.7%) patients. The most common stone chemical structure was mix calcium oxalate monohydrate (COMH) and calcium oxalate dihydrate (CODH) with a rate of 32.3%. Uric acid stone was more frequent in patients with diabetes mellitus and hypertension, and the rate of struvite stones was higher in patients with a history of recurrent urinary tract infection (p <0.001). The mean BMI of the patients with uric acid stone was higher than that of the patients with COMH, CODH and struvite stones, but there was no statistically significant difference, 27.8±0.9 kg/m2 versus 24.3±2.4 kg/m2, 22 ±1.4 kg/m2 and 25.2 ±3.3 kg/m2 (p=0.102). Conclusion: Uric acid stone was observed more frequently in patients with metabolic syndrome which ncludes obesity, diabetes mellitus and hypertension components. Stone analysis should be requested from each patient whose stone sample is obtained. In this way, metaphylaxis, which is a set of measures to prevent stone recurrence, can be meaningful.

Keywords: Urolithiasis; ureter stone; ureterolithotomy; stone analysis; x-ray diffraction
ÖZET
 Amaç: Üreter taşı nedeniyle üreterolitotomi operasyonu geçiren hastaların taş analizi sonuçlarını değerlendirerek tedavide ve rekürrensin önlenmesinde taş analizinin nasıl bir yeri olabileceğini ortaya koymaya çalıştık. Gereç ve Yöntemler: 2003-2018 yılları arasında üreter taşı nedeniyle üreterolitotomi operasyonu geçiren hastaların verileri retrospektif olarak değerlendirildi. Taşların analizinde X-Ray Difraksiyon (XRD) yöntemi kullanıldı. İncelenen parametreler; hastaların demografik verileri, beden kitle indeksleri (BKİ), operasyon türü, süresi ve taş analizi sonuçlarından oluşmakta idi. Bulgular: Çalışmaya 21'i erkek, 10'u kadın olmak üzere toplam 31 hasta dahil edildi. Hastaların ortalama yaşı 37,2±12,6 yıl idi. Ortalama taş boyutu 20,6±6 mm idi. On altı (%51,6) hastaya sağ üreter taşı, 15 (%48,4) hastaya ise sol üreter taşı sebebiyle üreterolitotomi operasyonu uygulandı. Üreterolitotomi operasyonları 10 (%32,3) hastada laparoskopik, 21 (%67,7) hastada ise açık olarak gerçekleştirildi. En sık saptanan taş kimyasal yapısı %32.3 ile kalsiyum oksalat monohidrat (KOMH) ve kalsiyum oksalat dihidrat (KODH) bileşimi idi. Ürik asit taşı, diabetes mellitus ve hipertansiyonu olan hastalarda daha sık gözlenirken tekrarlayan idrar yolu enfeksiyonu (İYE) hikayesi olan hastalarda strüvit taşı oranı daha fazla idi (p<0,001). Ürik asit taşına sahip olan hastaların ortalama VKİ değeri KOMH, KODH ve strüvit taşı olan hastalardan yüksek olmakla birlikte istatistiksel olarak anlamlı farklılık saptanmamıştır, 27,8±0,9 kg/m2'ye karşı sırasıyla 24,3±2,4 kg/m2, 22 ±1.4 kg/m2 ve 25,2 ±3,3 kg/m2 (p=0,102). Sonuç: Obezite, diyabet ve hipertansiyon bileşenlerinden oluşan metabolik sendromu olan hastalarda ürik asit taşı daha sık gözlenmiştir. Taş numunesi elde edilen her hastadan taş analizi istenmelidir. Bu sayede taş rekürrensini önleyecek önlemler bütünü olan metaflaksi anlam kazanabilir.

Anahtar Kelimeler: Ürolitiyazis; üreter taşı; üreterolitotomi; taş analizi; x ışını difraksiyon
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