.: ORİJİNAL ARAŞTIRMA
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
J Reconstr Urol. 2022;12(1):22-7
doi: 10.5336/urology.2022-88393
Makale Dili: TR
Tam Metin
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
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
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
REFERANSLAR:
- Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69(3):468-74. [Crossref] [PubMed]
- Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69(3):475-82. [Crossref] [PubMed]
- Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, et al. Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol. 2015;194(1):137-43. [Crossref] [PubMed]
- Knoll T, Buchholz N, Wendt-Nordahl G. Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones. Arab J Urol. 2012;10(3):336-41. [Crossref] [PubMed] [PMC]
- Bozzini G, Verze P, Arcaniolo D, Dal Piaz O, Buffi NM, Guazzoni G, et al. A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal Stones less than 2 cm: a multicenter experience: a better understanding on the treatment options for lower pole stones. World J Urol. 2017;35(12):1967-75. [Crossref] [PubMed]
- Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis. 2018;46(1):87-97. [Crossref] [PubMed]
- Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki RA. A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol. 2012;26(1):52-7. [Crossref] [PubMed]
- de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25(1):11-7. [Crossref] [PubMed]
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. [Crossref] [PubMed] [PMC]
- Sari S, Ozok HU, Cakici MC, Ozdemir H, Bas O, Karakoyunlu N, et al. A comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for management of renal stones?2 CM. Urol J. 2017;14(1):2949-54. [PubMed]
- Zeng G, Zhu W, Li J, Zhao Z, Zeng T, Liu C, et al. The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol. 2015;33(8):1159-64. [Crossref] [PubMed]
- Shi X, Peng Y, Li X, Wang Q, Li L, Liu M, et al. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy for large stones in patients with a solitary kidney. J Endourol. 2018;32(3):198-204. [Crossref] [PubMed]
- Junbo L, Yugen L, Guo J, Jing H, Ruichao Y, Tao W. Retrograde intrarenal surgery vs. percutaneous nephrolithotomy vs. extracorporeal shock wave lithotripsy for lower pole renal stones 10-20 mm: a meta-analysis and systematic review. Urol J. 2019;16(2):97-106. [PubMed]
- Eryildirim B, Kucuk EV, Atis G, Ozturk M, Senkul T, Tuncer M, et al. Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: a critical comparative evaluation. Arch Ital Urol Androl. 2018;90(3):149-54. [Crossref] [PubMed]
- Kandemir A, Guven S, Balasar M, Sonmez MG, Taskapu H, Gurbuz R. A prospective randomized comparison of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones. World J Urol. 2017;35(11):1771-6. [Crossref] [PubMed]
- Armagan A, Karatag T, Buldu I, Tosun M, Basibuyuk I, Istanbulluoglu MO, et al. Comparison of flexible ureterorenoscopy and micropercutaneous nephrolithotomy in the treatment for moderately size lower-pole stones. World J Urol. 2015;33(11):1827-31. [Crossref] [PubMed]
- Cepeda M, Amón JH, Mainez JA, de la Cruz B, Rodríguez V, Alonso D, et al. Retrograde intrarenal surgery and micro-percutaneous nephrolithotomy for renal lithiasis smaller than 2 CM. Actas Urol Esp. 2017;41(8):516-521. [Crossref] [PubMed]
- Jung GH, Jung JH, Ahn TS, Lee JS, Cho SY, Jeong CW, et al. Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: a propensity score-matching study. Korean J Urol. 2015;56(7):525-32. [Crossref] [PubMed] [PMC]
- Koyuncu H, Yencilek F, Kalkan M, Bastug Y, Yencilek E, Ozdemir AT. Intrarenal surgery vs percutaneous nephrolithotomy in the management of lower pole stones greater than 2 cm. Int Braz J Urol. 2015;41(2):245-51. [Crossref] [PubMed] [PMC]
- Jin L, Yang B, Zhou Z, Li N. Comparative efficacy on flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of medium-sized lower-pole renal calculi. J Endourol. 2019;33(11):914-9. [Crossref] [PubMed]
- Ozayar E, Gulec H, Bayraktaroglu M, Tutal ZB, Kurtay A, Babayigit M, et al. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy: from the view of an anesthesiologist. J Endourol. 2016;30(2):184-8. [Crossref] [PubMed]
- Demirbas A, Resorlu B, Sunay MM, Karakan T, Karagöz MA, Doluoglu OG. Which should be preferred for moderate-size kidney stones? Ultramini percutaneous nephrolithotomy or retrograde intrarenal surgery? J Endourol. 2016;30(12):1285-9. [Crossref] [PubMed]
- Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol. 2011;25(7):1131-5. [Crossref] [PubMed]
- Akbulut F, Kucuktopcu O, Kandemir E, Sonmezay E, Simsek A, Ozgor F, et al. Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm. Ren Fail. 2016;38(1):163-7. [Crossref] [PubMed]
.: İşlem Listesi