Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Mesane Kanserli Hastalarda Double J Stent Yerleştirme ve Perkütan Nefrostomi Drenaj Yöntemlerinin Metakron Üst Üriner Sistem Ürotelyal Hücreli Karsinom Gelişimi Açısından Karşılaştırılması: Retrospektif Klinik Çalışma
Comparison of Double J Stent Insertion and Percutaneous Nephrostomy Drainage Methods in Patients with Bladder Cancer in Terms of Metachronous Upper Urinary Tract Urothelial Cell Carcinoma Development: Retrospective Clinical Study
Özgür EKİCİa, Abdullah GÜLb, Salim ZENGİNb, Gökçe DÜNDARb, Sinan AVCIc, Metin KILIÇb
aNusaybin Devlet Hastanesi, Üroloji Kliniği, Mardin, Türkiye
bSağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Bursa, Türkiye
cBursa Şehir Hastanesi, Üroloji Kliniği, Bursa, Türkiye
J Reconstr Urol. 2022;12(2):48-55
doi: 10.5336/urology.2022-88011
Article Language: TR
Full Text
ÖZET
 Amaç: Hidronefroz, yüzeyel ve kas invaziv mesane kanseri (MK) hastalarında sırasıyla %7,5 ve %54'e varan oranlarda görülebilmektedir. MK hastalarında tıkalı bir böbreğin double J stentleme (DJS) yöntemiyle drenajının sağlanması, olası metakron üst üriner sistem tümörü (ÜÜST) gelişimi korkusu nedeniyle tartışmalıdır. MK hastalarında, transüretral rezeksiyon sırasında perkütan nefrostomi ya da DJS takma yöntemlerini, metakron ÜÜST gelişimi açısından karşılaştırmayı amaçladık. Gereç ve Yöntemler: Ocak 2016-Aralık 2021 tarihleri arasında eş zamanlı olarak mesane kanserinin transüretral rezeksiyonu ve retrograd/antegrad DJS veya perkütan nefrostomi yerleştirilmesi ile opere edilen MK hastalarının verileri geriye dönük olarak analiz edildi. Hastaların takiplerinde, metakron ÜÜST oluşumu açısından, tümör gelişen ve gelişmeyen olarak 2 gruba ayrıldı. Hastaların yaş, cinsiyet gibi demografik özellikleri ile tedavi öncesi hematolojik parametreleri ve serum biyokimyasal parametre seviyeleri, ameliyat öncesi görüntülemede hidronefroz derecesi, drenaj yöntemi ile ameliyat sonrası patoloji sonuçları kaydedildi ve gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 133 hastanın 8'inde (%6) metakron ÜÜST gelişti [perkütan nefrostomi (n=2), DJS (n=6)]. Nefrostomi takılan hastalar ile DJS takılan hastalar arasında metakron ÜÜST gelişim oranı istatistiksel olarak farklı saptanmadı (p=0,27). MK'nin yerleşimi, patolojisi, sayısı ve hidronefroz dereceleri her iki grup arasında benzerdi (p>0,05). Ameliyat öncesi nötrofil/lenfosit oranı, platelet/lenfosit oranı ve De Ritis oranında her iki grup arasında fark saptanmadı (p>0,05). Sonuç: Çalışmamızda, MK hastalarında perkütan nefrostomi ve DJS yerleştirilmesi yöntemleri, metakron ÜÜST gelişim riski açısından benzerdi.

Anahtar Kelimeler: Mesane neoplazileri; karsinom, değişici hücreli; nefrostomi, perkütan; stentler
ABSTRACT
 Objective: Hydronephrosis can be seen in up to 7.5% and 54% of non-muscle invasive and muscle invasive bladder cancer (BC) patients, respectively. Drainage of an obstructed kidney with double J stenting (DJS) method in BC patients is controversial due to the fear of possible metachronous upper urinary tract urothelial cancer (UUTUC) development. We aimed to compare the methods of percutaneous nephrostomy or DJS insertion during transurethral resection in BC patients in terms of metachronous UUTUC development. Material and Methods: Data of BC patients operated by concomitant transurethral resection of bladder tumor and retrograde/antegrade DJS or percutaneous nephrostomy placement between January 2016 and December 2021 were analyzed retrospectively. The patients were divided into 2 groups as UUTUC and non-UUTUC. Demographic features of the patients such as age, gender as well as pretreatment hematological and serum biochemical parameters, degree of hydronephrosis in preoperative imaging, drainage method, postoperative pathological findings were recorded and compared between groups. Results: Of the 133 eligible patients, 8 (6%) had metachronous UUTUC after the drainage of hydronephrosis by nephrostomy (n=2) or DJS (n=6). The rate of metachronous UUTUC development was not statistically different between patients treated with nephrostomy or with DJS (p=0.27). Location, pathological features and number of tumors along with hydronephrosis grades were similar between the two groups (p>0.05). There was no difference between the two groups in terms of the preoperative ratios of neutrophil/lymphocyte, platelet/lymphocyte and De Ritis (p>0.05). Conclusion: In our study, percutaneous nephrostomy or DJS insertion methods in BC patients were similar in terms of metachronous UUTUC development.

Keywords: Urinary bladder neoplasms; carcinoma, transitional cell; nephrostomy, percutaneous; stents
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