Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Üreter Taşı Yeri ve Büyüklüğünün Semi-Rijit Üreteroskopi ve Pnömatik Litotripsi Başarısı Üzerine Etkisi
The Effect of Ureter Stone Size and Location on the Success of Semi-Rigid Ureteroscopy and Pneumatic Lithotripsy
Caner BARANa
aÇukurova Devlet Hastanesi, Üroloji Servisi, Adana, TÜRKİYE
J Reconstr Urol. 2021;11(2):84-9
doi: 10.5336/urology.2021-81300
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, üreter taşı nedeniyle semi-rijit üreteroskopi [semi-rigid ureteroscopy (S-URS)] ve pnömatik litotripsi uygulanan hastalarda, taşın büyüklüğü ve üreterdeki yerleşim seviyesinin, işlem başarısı üzerine etkisini araştırmaktır. Gereç ve Yöntemler: Nisan 2018 ve Mart 2020 tarihleri arasında Çukurova Devlet Hastanesinde, tek ürolog tarafından, üreter taşı endikasyonu ile S-URS ve pnömatik litotripsi uygulanan 140 hastaya ait veriler retrospektif olarak değerlendirildi. S-URS sonrası 1. ayda, direkt üriner sistem grafisi ve/veya tüm batın kontrastsız tomografi ile yapılan değerlendirmede, müdahale edilen taşın tamamen temizlenmesi başarılı işlem olarak kabul edildi. Üreter taşının büyüklüğünün ve yerinin cerrahi başarı üzerine etkisi istatistiksel olarak araştırıldı. Bulgular: Çalışmaya dâhil edilen 140 hastanın ortalama yaşı 44,2 yıl, ortalama taş büyüklüğü 7,27 mm olarak bulundu. Hastaların %77,1'inde taş tamamen temizlenirken, %15,7'sinde böbreğe 'push-back', %2,9'unde rest kalkül ve %4,3'ünde ise taşa ulaşılamama nedeniyle işlem başarısız olarak kabul edildi. İstatistiksel analizde, başarılı ve başarısız hastalar arasında, taş seviyesi, taş boyutu ve yaş arasında anlamlı fark tespit edildi. Bu değişkenlerin dâhil edildiği regresyon analizinde ise sadece taş seviyesinin işlem başarısına anlamlı şekilde etki ettiği ve taşın üst üreterde yerleşmesi hâlinde başarısızlık ihtimalini 7 kat artırdığı hesaplandı. Sonuç: S-URS ve pnömatik litotripsi, üreter taşının cerrahi tedavisinde önemli bir yere sahiptir. Fleksible cihazlar ve lazer litotripsi yöntemleri ile daha yüksek başarı oranları bildirilse de bu cihazların yüksek maliyeti ve hassas yapıları nedeniyle özellikle alt üreter taşlarında, S-URS ve pnömatik litotripsinin başarılı bir alternatif olduğunu düşünmekteyiz.

Anahtar Kelimeler: Üreter taşı; üreteroskopi; üreterolitiyazis; litotripsi
ABSTRACT
 Objective: To evaluate the effect of ureteric stone location and size on the success rate of the semi-rigid ureteroscopy (S-URS) and pneumatic lithotripsy. Material and Methods: The data belongs to 140 patients who underwent S-URS and pneumatic lithotripsy with an indication of ureteral calculi between April 2018-March 2020 at Çukurova State Hospital by a single urologist was evaluated retrospectively. After the first month of the procedure, patients whose stones were completely cleared were regarded as successful in the evaluation performed with kidney-ureter-bladder film and/or non-enhanced abdominal tomography. The effect of the size and location of the ureteral stone on surgical success was statistically investigated. Results: The mean age was 44.2 years, and the mean stone size was 7.27 mm for 140 patients included in the study. The successful procedure rate was 77.1% while, 15.7% of the patients had push-back of the stone to the kidney, 2.9% had rest calculus and 4.3% were considered unsuccessful procedure due to inability reach to stone. A statistically significant difference was found between successful and unsuccessful procedures, in terms of stone level, stone size, and age. The regression analysis showed that only the stone level had a statistically significant effect on the success rate and the probability of the unsuccessful procedure was 7-fold increased when the stone was located to the proximal ureter. Conclusion: S-URS and pneumatic lithotripsy have an important role in the surgical management of ureteric stones. Although higher success rates have been reported with flexible devices and laser lithotripsy methods, due to the high cost and delicate nature of these devices, S-URS and pneumatic lithotripsy could be successful alternatives, especially in lower ureteral stones.

Keywords: Ureteral calculi; ureteroscopy; ureterolithiasis; lithotripsy
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