Retrograd intrarenal cerrahi'de intrapelvik basınç düşürücü üreteral access sheat kullanımının etkinliğinin; Renal hasarı gösteren kim-1 biyobelirteci ile değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Üriner sistem taş hastalığı ülkemizde sık görülen ve üroloji pratiğinde her zaman önemini koruyan bir hastalıktır. Zaman içerisinde endoskopik aletlerin gelişimi nedeniyle minimal invaziv tedavi seçenekleri ön plana çıkmıştır. Bu minimal invaziv tedavi seçenekleri içinde en populer yöntemlerden birisi Retrograd Intrarenal Cerrahi (RIRS)'dir. RIRS esnasında intrapelvik basıncı düşürmek için 'Üreteral erişim kılıfı' (UAS) sıklıkla kullanılmaktadır. Çalışmamızda RIRS operasyonu sırasında ve sonrasında; UAS kullanılmayan, standart UAS kullanılan ve çift lümenli intrapelvik basıncı düşüren UAS (DLUAS) kullanılan hastalardaki böbrek hasarlanmasını KİM-1 (Kidney Injury Molecule 1) biyobelirteç değerlerini ölçerek karşılaştırmayı amaçladık. MATERYAL-METOD: Çalışmamızda hastanemiz üroloji kliniğine Temmuz 2019-Aralık 2019 tarihleri arasında başvuran, böbrek taşı tanısı konulup RIRS ile tedavi edilen toplam 60 hasta dahil edilmiştir. Hastalar randomize prospektif olarak UAS kullanılmayan (Grup 1), Standart UAS kullanılan (Grup 2), DLUAS kullanılan (Grup 3) olmak üzere üç gruba ayrılmıştır. Her bir grupta 20 hasta olacak şekilde gruplar randomize edilmiştir. Hastalardan preoperatif, postoperatif 4. saat ve postoperatif 14. gün kan ve idrar numuneleri alınarak idrar KİM-1 düzeyleri ölçülmüştür. Daha sonra idrar KİM-1/Cr oranları hesaplanmıştır. Araştırmada elde edilen veriler SPSS programı yardımıyla değerlendirilmiştir. BULGULAR: Çalışmamıza dahil edilen hastaların yaş ortalaması 48,2 iken, Grup 1'de 50,5; Grup 2'de 47,95; Grup 3'de 46,35 olarak bulunmuştur (p=0,68). Tüm hastaların 42'si (%70) erkek, 18'i (%30) kadındır. Ortalama operasyon süresinin 62,8 dk olduğu ve gruplar arasında istatistiksel anlamlı fark olmadığı bulunmuştur (p=0,55). Ortalama taş boyutu 14.08 mm iken, Grup 1'de 14,95 mm; Grup 2'de 14,65 mm, Grup 3'te 12,65 mm olarak ölçülmüştür (p=0,48). Taş dansiteleri ölçüldüğünde ortalama 950 HU olup, gruplarda sırasıyla 1002, 919, 929 HU olarak ölçülmüştür (p=0,57). 39 hastanın taşı sağ tarafta iken, 21 hastanın taşı sol tarafta olup gruplar arasında istatistiksel anlamlı fark izlenmemiştir (p=0,41). Hastaların preoperatif KİM-1/Cr düzeyleri arasında istatistiksel anlamlı farklılık bulunmamıştır (p=0,57). Hastalardan postoperatif 4. saat alınan idrar KİM-1/Cr düzeylerini incelediğimizde ise Grup 1'de 1,86; Grup 2'de 0,67 ve Grup 3'te 0,63 tespit edilmiş olup Grup 1'de yüksek olduğu izlenmiştir (p=0,021). Ayrıca Grup 1 ile Grup 2'yi ve Grup 1 ile Grup 3'ü karşılaştırdığımızda Grup 1'in istatistiksel anlamlı olarak daha yüksek olduğu izlenmiştir (p=0,002 ve p=0,001). Grup 2 ve Grup 3 arasında ise anlamlı farklılık bulunmamıştır (p=0,7). SONUÇ: Çalışmamız sonucunda UAS kullanılan 2 grupta, UAS kullanılmayan gruba göre KİM-1/Cr düzeylerinin belirgin olarak daha düşük olduğunu saptadık. UAS kullanımı RIRS cerrahisi sırasında intrapelvik basıncı düşürerek böbrekteki hasarlanmayı azaltmaktadır. Ancak DLUAS grubunda KİM-1/Cr değerleri standart UAS ile kıyaslandığında daha düşük olmakla birlikte iki grup arasında istatistiksel anlamlılık saptamadık.
Urinary system stone disease is a common disease in our country and always maintains its importance in urological practice. Due to the development of endoscopic instruments over time, minimally invasive treatment options have come to the fore. One of the most popular methods among these minimally invasive treatment options is Retrograde Intrarenal Surgery (RIRS). Ureteral access sheath (UAS) is frequently used to decrease intrapelvic pressure during RIRS. In our study, during and after RIRS operation; We aimed to compare kidney damage by measuring the biomarker values of Kidney Injury Molecule 1 (KIM-1) in patients without UAS, with standart UAS and Dual lumen ureteral Access sheat). MATERIAL-METHOD: In our study, 60 patients who were admitted to the urology clinic of our hospital between July 2019 and December 2019, who were diagnosed with kidney stones and treated with RIRS were included. The patients were randomized prospectively divided into three groups: UAS (Group 1), Standard UAS (Group 2), DLUAS (Group 3). The groups were randomized, with 20 patients in each group. Urine KIM-1 levels were measured by taking blood and urine samples from the patients on the preoperative, postoperative 4th hour and on the 14th postoperative day. Then urine KIM-1/Cr ratios were calculated. The data obtained in the study were evaluated with the help of SPSS program. RESULTS: The average age of the patients in our study was 48,2 years; 50,5 years in Group 1; 47,95 years in Group 2; and 46,35 years in Group 3 (p=0,68). 42 (70%) of all patients are male and 18 (30%) are female. The average operation time was 62,8 minutes and there was no statistically significant difference between the groups. When we examine the average stone sizes, while the average size was 14.08 mm in all groups, 14.95 mm in Group 1; 14.65 mm in Group 2 and 12.65 mm in Group 3 (p=0.48). The mean stone density was 950 HU, and the groups were measured as 1002, 919, 929 HU, respectively. (p=0,57) While the stones of 39 patients were on the right side, 21 patients were on the left side and there was no statistically significant difference between the groups (p=0.41). There was no statistically significant difference between the preoperative KIM-1/Cr levels of the patients (P=0.57). When we analyzed the urine KIM-1/Cr levels taken from patients at the 4th postoperative hour, 1.86 in Group 1, 0.67 in Group 2, and 0.63 in Group 3 were detected (p=0.021). In addition, when we compared Group 1 vs 2 and Group 1 vs 3, it was observed that Group 1 was statistically significantly higher (p=0,002 ve p=0,001). No significant difference was found between Groups 2 and 3 (p=0,7) CONCLUSION: As a result of our study, we determined that the KIM-1/Cr levels were significantly lower in the 2 groups using UAS compared to the group without UAS. UAS use reduces intrapelvic pressure during RIRS surgery, thus reducing kidney damage. However, in the DLUAS group, the KIM-1/Cr values were lower compared to the standard UAS, but we did not find statistical significance between the two groups.
Urinary system stone disease is a common disease in our country and always maintains its importance in urological practice. Due to the development of endoscopic instruments over time, minimally invasive treatment options have come to the fore. One of the most popular methods among these minimally invasive treatment options is Retrograde Intrarenal Surgery (RIRS). Ureteral access sheath (UAS) is frequently used to decrease intrapelvic pressure during RIRS. In our study, during and after RIRS operation; We aimed to compare kidney damage by measuring the biomarker values of Kidney Injury Molecule 1 (KIM-1) in patients without UAS, with standart UAS and Dual lumen ureteral Access sheat). MATERIAL-METHOD: In our study, 60 patients who were admitted to the urology clinic of our hospital between July 2019 and December 2019, who were diagnosed with kidney stones and treated with RIRS were included. The patients were randomized prospectively divided into three groups: UAS (Group 1), Standard UAS (Group 2), DLUAS (Group 3). The groups were randomized, with 20 patients in each group. Urine KIM-1 levels were measured by taking blood and urine samples from the patients on the preoperative, postoperative 4th hour and on the 14th postoperative day. Then urine KIM-1/Cr ratios were calculated. The data obtained in the study were evaluated with the help of SPSS program. RESULTS: The average age of the patients in our study was 48,2 years; 50,5 years in Group 1; 47,95 years in Group 2; and 46,35 years in Group 3 (p=0,68). 42 (70%) of all patients are male and 18 (30%) are female. The average operation time was 62,8 minutes and there was no statistically significant difference between the groups. When we examine the average stone sizes, while the average size was 14.08 mm in all groups, 14.95 mm in Group 1; 14.65 mm in Group 2 and 12.65 mm in Group 3 (p=0.48). The mean stone density was 950 HU, and the groups were measured as 1002, 919, 929 HU, respectively. (p=0,57) While the stones of 39 patients were on the right side, 21 patients were on the left side and there was no statistically significant difference between the groups (p=0.41). There was no statistically significant difference between the preoperative KIM-1/Cr levels of the patients (P=0.57). When we analyzed the urine KIM-1/Cr levels taken from patients at the 4th postoperative hour, 1.86 in Group 1, 0.67 in Group 2, and 0.63 in Group 3 were detected (p=0.021). In addition, when we compared Group 1 vs 2 and Group 1 vs 3, it was observed that Group 1 was statistically significantly higher (p=0,002 ve p=0,001). No significant difference was found between Groups 2 and 3 (p=0,7) CONCLUSION: As a result of our study, we determined that the KIM-1/Cr levels were significantly lower in the 2 groups using UAS compared to the group without UAS. UAS use reduces intrapelvic pressure during RIRS surgery, thus reducing kidney damage. However, in the DLUAS group, the KIM-1/Cr values were lower compared to the standard UAS, but we did not find statistical significance between the two groups.
Açıklama
Anahtar Kelimeler
Retrograd intrarenal cerrahi, İntrapelvik basınç düşürücü, Üreteral access sheat, Retrograde intrarenal surgery, Intrapelvic pressure reducer, Ureteral access sheat
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Ecer, G. (2020). Effectiveness of using dual lumen ureteral access sheat in retrograde intrarenal surgery; Evaluation of kim-1 indicator showing renal damage. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
