.: ORİJİNAL ARAŞTIRMA
Retrograd İntrarenal Cerrahide Üreteral Erişim Kılıfı Kullanımının Postoperatif Sonuçlara Etkisi: Retrospektif Kohort Çalışması
Effect of Ureteral Access Sheath Use on Postoperative Outcomes in Retrograde Intrarenal Surgery: Retrospective Cohort Study
J Reconstr Urol. 2023;13(3):102-8
doi: 10.5336/urology.2023-99131
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmada, fleksibl üreterorenoskopi (f-URS) sırasında yaygın olarak kullanılan üreteral erişim kılıfının (ÜEK) postoperatif enfektif komplikasyonlar ve böbrek fonksiyonları üzerine etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Retrospektif yöntem ile Ocak 2021-Temmuz 2023 tarihleri arasında böbrek ya da proksimal üreter taşı nedeniyle f-URS yapılmış olan hastaların verileri tarandı. Hastaların ameliyat süreleri ve erişim kılıfı kullanım durumları, preoperatif görüntüleri ve postoperatif ateş, sepsis, üriner sistem enfeksiyonu (ÜSE) durumları ve periferik kandan ve idrar tetkikinden bakılan inflamasyon belirteçleri kaydedildi. Hastaların kreatinin ve glomerüler filtrasyon hız (GFH) değişimleri ile taburcu olduktan sonra ilk 2 haftadaki acil servis başvuruları kaydedildi. Hastalar ÜEK kullanılmayanlar ve kullanılanlar olarak 2 gruba ayrıldı. Gruplar arasında kaydedilen veriler karşılaştırıldı. Bulgular: Çalışmaya toplamda 124 hasta dâhil edildi. Hastaların ortalama yaşı 48,15±17,06 yıl idi. Hastalar ÜEK kullanılmayan (Grup 1, n=70) ve kullanılan (Grup 2, n=54) olarak 2 gruba ayrıldı. Her iki grup arasında cinsiyet, taş tarafı, double J stent (DJS) takılması, postoperatif sepsis, postoperatif ÜSE, postoperatif lökosit esteraz pozitifliği, postoperatif hematüri ve postoperatif acil servise başvuru açısından istatistiksel olarak anlamlı farklılık izlenmedi. Postoperatif ateş, idrar tetkikinde nitrit pozitifliği, beyaz kan hücresi ve Creaktif protein erişim kılıfı kullanılmayan hasta grubunda istatistiksel olarak anlamlı yüksek bulundu. Her iki grup arasında ortalama yaş, ameliyat süresi, postoperatif DJS çekim günü, kreatinin ve GFH değişimleri açısından istatistiksel olarak anlamlı farklılık izlenmedi. Sonuç: Böbrek taşı hastalarında erişim kılıfı kullanmanın böbrek fonksiyonları üzerinde koruyucu etkisi gözlenmemekle birlikte, postoperatif enfektif komplikasyonları bir miktar azaltabilir.
Anahtar Kelimeler: Ateş; üreteroskopi; üreteroskopik cerrahi; üreteral erişim kılıfı; sepsis
Amaç: Bu çalışmada, fleksibl üreterorenoskopi (f-URS) sırasında yaygın olarak kullanılan üreteral erişim kılıfının (ÜEK) postoperatif enfektif komplikasyonlar ve böbrek fonksiyonları üzerine etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Retrospektif yöntem ile Ocak 2021-Temmuz 2023 tarihleri arasında böbrek ya da proksimal üreter taşı nedeniyle f-URS yapılmış olan hastaların verileri tarandı. Hastaların ameliyat süreleri ve erişim kılıfı kullanım durumları, preoperatif görüntüleri ve postoperatif ateş, sepsis, üriner sistem enfeksiyonu (ÜSE) durumları ve periferik kandan ve idrar tetkikinden bakılan inflamasyon belirteçleri kaydedildi. Hastaların kreatinin ve glomerüler filtrasyon hız (GFH) değişimleri ile taburcu olduktan sonra ilk 2 haftadaki acil servis başvuruları kaydedildi. Hastalar ÜEK kullanılmayanlar ve kullanılanlar olarak 2 gruba ayrıldı. Gruplar arasında kaydedilen veriler karşılaştırıldı. Bulgular: Çalışmaya toplamda 124 hasta dâhil edildi. Hastaların ortalama yaşı 48,15±17,06 yıl idi. Hastalar ÜEK kullanılmayan (Grup 1, n=70) ve kullanılan (Grup 2, n=54) olarak 2 gruba ayrıldı. Her iki grup arasında cinsiyet, taş tarafı, double J stent (DJS) takılması, postoperatif sepsis, postoperatif ÜSE, postoperatif lökosit esteraz pozitifliği, postoperatif hematüri ve postoperatif acil servise başvuru açısından istatistiksel olarak anlamlı farklılık izlenmedi. Postoperatif ateş, idrar tetkikinde nitrit pozitifliği, beyaz kan hücresi ve Creaktif protein erişim kılıfı kullanılmayan hasta grubunda istatistiksel olarak anlamlı yüksek bulundu. Her iki grup arasında ortalama yaş, ameliyat süresi, postoperatif DJS çekim günü, kreatinin ve GFH değişimleri açısından istatistiksel olarak anlamlı farklılık izlenmedi. Sonuç: Böbrek taşı hastalarında erişim kılıfı kullanmanın böbrek fonksiyonları üzerinde koruyucu etkisi gözlenmemekle birlikte, postoperatif enfektif komplikasyonları bir miktar azaltabilir.
Anahtar Kelimeler: Ateş; üreteroskopi; üreteroskopik cerrahi; üreteral erişim kılıfı; sepsis
ABSTRACT
Objective: We aimed to investigate the effects of the ureteral access sheath (UEC), which is commonly used during flexible ureterorenoscopy (f-URS), on postoperative infective complications and renal functions. Material and Methods: The data of patients who underwent f-URS for kidney or proximal ureteral stones between January 2021 and July 2023 were reviewed using the retrospective method. The duration of surgery and access sheath usage status, preoperative images and postoperative fever, sepsis, urinary tract infection (UTI) status, and inflammation markers from peripheral blood and urinalysis were recorded. The creatinine and glomerular filtration rate (GFR) changes of the patients and their admissions to the emergency department in the first 2 weeks after discharge were recorded. The patients were divided into 2 groups as those who did not use UEC and those who were used. Data recorded between groups were compared. Results: A total of 124 patients were included in the study. The mean age of the patients was 48.15±17.06 years. The patients were divided into 2 groups as non-UEC (Group 1, n=70) and used (Group 2, n=54). There was no statistically significant difference between the 2 groups in terms of gender, stone side, double J stent (DJS) insertion, postoperative sepsis, postoperative UTI, postoperative leukocyte esterase positivity, postoperative hematuria, and postoperative emergency department admission. Postoperative fever, nitrite positivity in urinalysis, white blood cell and C-reactive protein access sheath were found to be statistically significantly higher in the patient group. There was no statistically significant difference between the 2 groups in terms of mean age, duration of surgery, postoperative DJS shooting day, creatinine and GFR changes. Conclusion: Although there is no protective effect of using an access sheath on kidney functions in kidney stone patients, it may slightly reduce postoperative infective complications.
Keywords: Fever; ureteroscopy; ureteroscopic surgery; ureteral access sheath; sepsis
Objective: We aimed to investigate the effects of the ureteral access sheath (UEC), which is commonly used during flexible ureterorenoscopy (f-URS), on postoperative infective complications and renal functions. Material and Methods: The data of patients who underwent f-URS for kidney or proximal ureteral stones between January 2021 and July 2023 were reviewed using the retrospective method. The duration of surgery and access sheath usage status, preoperative images and postoperative fever, sepsis, urinary tract infection (UTI) status, and inflammation markers from peripheral blood and urinalysis were recorded. The creatinine and glomerular filtration rate (GFR) changes of the patients and their admissions to the emergency department in the first 2 weeks after discharge were recorded. The patients were divided into 2 groups as those who did not use UEC and those who were used. Data recorded between groups were compared. Results: A total of 124 patients were included in the study. The mean age of the patients was 48.15±17.06 years. The patients were divided into 2 groups as non-UEC (Group 1, n=70) and used (Group 2, n=54). There was no statistically significant difference between the 2 groups in terms of gender, stone side, double J stent (DJS) insertion, postoperative sepsis, postoperative UTI, postoperative leukocyte esterase positivity, postoperative hematuria, and postoperative emergency department admission. Postoperative fever, nitrite positivity in urinalysis, white blood cell and C-reactive protein access sheath were found to be statistically significantly higher in the patient group. There was no statistically significant difference between the 2 groups in terms of mean age, duration of surgery, postoperative DJS shooting day, creatinine and GFR changes. Conclusion: Although there is no protective effect of using an access sheath on kidney functions in kidney stone patients, it may slightly reduce postoperative infective complications.
Keywords: Fever; ureteroscopy; ureteroscopic surgery; ureteral access sheath; sepsis
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