Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
The Effect of Passive Ureteral Dilatation on the Incidence of Ureteral Stricture in Retrograde Intrarenal Surgery of Renal Stone: Retrospective Observational Study
Böbrek Taşı Nedeniyle Retrograd İntrarenal Cerrahi Yapılan Hastalarda Pasif Üreteral Dilatasyonun Üreteral Darlık İnsidansına Etkisi: Retrospektif Gözlemsel Çalışma
Fatih AKKAŞa, Feyzi Arda ATARb, Ali İhsan TAŞÇIb
aClinic of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
bDepartment of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
J Reconstr Urol. 2022;12(2):39-47
doi: 10.5336/urology.2021-86492
Article Language: EN
Full Text
ABSTRACT
 Objective: To investigate the effect of passive dilatation (PD) on ureteral stricture (US) rates after retrograde intrarenal surgery (RIRS), and to determine the factors that predict US. Material and Methods: Patients who underwent RIRS (Group 1) and patients who could undergo RIRS after PD (Group 2) were compared in terms of demographic data, clinical characteristics, perioperative and postoperative complications. The primary end point was US rate at postoperative 1 year. The predictive factors for US was assessed with logistic regression analysis. Results: US was determined in 12 (4.61%) and in 1 (0.67%) patients for Group 1 and 2, respectively. When the study population was grouped according to the US, the rate of PD was observed to be lower (p=0.037), and stone volume, surgical duration were observed to be higher in the US group, statistically (p<0.001 and p=0.034 respectively). The rate of PD, Stone volume and surgical duration were detected as predictive factors for US. The cut-off value of stone volume for US was 2,408 mm3 in receiver- operating characteristic curve analysis. Above the cut-off value, it was observed that the surgical duration was higher in cases with US, and there was no difference between the groups in terms of PD statistically. Conclusion: We conclude that PD is protective against US. However it was observed that PD was not protective in patients with stone volume higher than the cut off value, and the most important risk factor for US was found to be prolonged surgical duration.

Keywords: Retrograde intrarenal surgery; passive dilatation; ureteral stent; ureteral stricture
ÖZET
 Amaç: Bu çalışmanın amacı, böbrek taşı tedavisi için retrograd intrarenal cerrahi (RİRC) yapılan hastalarda pasif dilatasyonun (PD) üreteral darlık (ÜD) insidansına olan etkisini ve ÜD gelişimini predikte eden faktörleri araştırmaktır. Gereç ve Yöntemler: PD uygulamaya gerek kalmadan RİRC uygulanan hastalar (Grup 1) ile PD sonrası RİRC uygulanabilen hastalar (Grup 2); demografik veriler, klinik özellikler, perioperatif ve postoperatif komplikasyonlar açısından karşılaştırıldı. Çalışmanın birincil sonlanım noktası, postop 1. yıl ÜD saptanma oranı olarak belirlendi. ÜD gelişimini predikte eden faktörler lojistik regresyon analizi kullanılarak belirlendi. Bulgular: ÜD 1. grupta 12 (%4,61) hastada, 2. grupta 1 (%0,67) hastada saptanmıştır. Çalışma popülasyonu, ÜD gelişimi açısından gruplandırıldığında ise ÜD grubunda PD oranı daha düşük (p=0,037), ortalama taş hacmi ve cerrahi süresi daha yüksek saptandı (p<0,001 ve p=0,034). PD, taş hacmi ve cerrahi süre ÜD için prediktif faktörler olarak saptandı. ÜD gelişimi için taş volümü kestirim değeri alıcı işletim karakteristiği eğrisi analizinde 2.408 mm3 olarak saptandı. Taş volümü saptanan kestirim değerinin üzerinde olan olgularda yapılan analizde, operasyon süresinin ÜD gelişen olgularda daha yüksek olduğu, PD açısından gruplar arasında fark olmadığı izlenmiştir. Sonuç: PD'nin ÜD gelişimi açısından koruyucu bir faktör olabileceği sonucuna varılmıştır. Bununla birlikte, yüksek taş hacmine sahip hastalarda, PD'nin koruyucu bir faktör olmadığı görülmüş, en önemli risk faktörünün uzamış operasyon süresi olduğu saptanmıştır.

Anahtar Kelimeler: Retrograd intrarenal cerrahi; pasif dilatasyon; üreteral stent; üreteral darlık
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