Retrograt intrarenal cerrahi uygulanan erişkin ve çocuk hastaların etkinlik ve sonuçlarının karşılaştırılması
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Tarih
2019
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info:eu-repo/semantics/openAccess
Özet
Taş hastalığı yüzyıllardan beri biliniyor olmasına rağmen günümüzde yaygınlığı çocuk ve erişkinlerde gittikçe artmaktadır. Teknolojik gelişmeler, endoskopik aletlerin minyatürizasyonu böbrek taşlarının tedavisinde retrograt intrarenal cerrahinin etkin şekilde kullanımına olanak sağlamıştır. Çocuk hastalarda bu konuda kısıtlı sayıda çalışma vardır. Çalışmamızda, retrograt intrarenal cerrahi ile tedavi edilen çocuk ve erişkin hastalardaki tam taşsızlık oranları ile komplikasyon oranlarını karşılaştırarak retrograt intrarenal cerrahinin çocuk hastalardaki etkinliğini ve güvenirliğini değerlendirmeyi amaçladık. MATERYAL-METOD: Çalışmamızda 01.01.2010 ile 01.03.2018 tarihleri arasında böbrek taşı tanısı konulup retrograt intrarenal cerrahi ile tedavi edilen hastaların dosyaları incelendi. Hastalar çocuk (18 yaş altı) (grup 1) ve erişkin (18 yaş ve üzeri) (grup2) yaş gruplarına ayrıldı. Gruplar; taş yükü, taş boyutu, taş lokalizasyonu, operasyon süresi, üreteral erişim kılıf kullanımı, intraoperatif komplikasyon oranları, tam taşsızlık oranları, postoperatif komplikasyon oranları, hastane yatış süreleri, DJ katater kullanımı açısından karşılaştırıldı. BULGULAR: Grup 1 içerisinde 55 hasta ve grup 2 içerisinde 220 hasta olmak üzere toplam 275 hasta değerlendirilmeye alındı. Hastaların ortalama yaşı 36,5 ± 20,1 (8 ay- 89 yıl) yıl olarak izlendi. Ortalama taş boyutu 14,6 ± 6,7 mm (5-47 mm) idi. Ortalama operasyon süresinin 62,9 ± 24,4 (25-170 dk) dakika (dk) olduğu görüldü. Hastanede yatış süresi 1,9 ± 2,4 (1-15 gün) gün olarak tespit edildi. Her iki grupta taş yükü, taş sayısı (tek-multipl), taş opasitesi, taraf, işlem öncesi hidroüreteronefroz derecesi ve operasyon sürelerinin benzer olduğu tespit edildi. Gruplar arasında ilk seans cerrahi sonrası tam taşsızlık oranları (grup 1 %81,8, grup 2 78,2, p: 0,554) benzer olarak bulundu. Toplam komplikasyon oranı %13,8 (grup 1 %16,4, grup 2 13,2) olup iki grup arasında fark izlenmedi. SONUÇ: Çalışmamızda böbrek taşı olan çocuk hastalarda RIRS'ın etkin ve güvenle kullanılabilecek minimal invazif cerrahi prosedür olduğunu tespit ettik. Alt pol taşı varlığının, artan taş yükünün ve birden fazla taş mevcudiyetinin hem çocuk hem de erişkin hastalar için cerrahi sonrası başarıyı etkileyen en önemli faktörler olduğunu gördük.
Stone disease has been known for centruies, in recent decads its prevalence is increasing in children and adults. Technological developments, miniaturization of endoscopic instruments have enabled the effective use of retrograde intrarenal surgery in the treatment of kidney stones. There are limited number of studies in pediatric patients. In our study, we aimed to evaluate the efficacy and safety of retrograde intrarenal surgery in pediatric patients by comparing the exact stone-free rates and complication rates in children and adults treated with retrograde intrarenal surgery. METHODS: In our study, the files of patients who were diagnosed with kidney stones and treated with retrograde intrarenal surgery between 01.01.2010 and 01.03.2018 were retrospectively reviewed. The patients were divided into children (under 18 years) (group 1) and adult (18 years of age and older) (group 2) age groups. The stone load, stone size, stone localization, operation time, use of ureteral access sheath, intraoperative complication rates, complete stone-free rates, postoperative complication rates, hospitalization duration, preoperatve and postoperative stenting were compared between in both groups. RESULTS: A total of 275 patients (55 patients in group 1 and 220 patients in group 2) were included in the study. The mean age of the patients was 36.5 ± 20.1 (8 months-89 years) years. The mean stone size was 14.6 ± 6.7 mm (5-47 mm). The mean operation time was 62.9 ± 24.4 (25-170 min) minutes (min). The hospitalization period was 1.9 ± 2.4 (1-15 days) days. In both groups, stone load, number of stones (single-multiple), stone opacity, side, degree of hydroureteronephrosis and duration of operation were similar. The exact stone-free rate between the groups (group 1 81.8%, group 2 78.2%, p: 0.554) was similar after the first session. Total complication rate was 13.8% (group 1 16.4%, group 2 13.2%) and no difference was observed between the two groups. CONCLUSION: In our study, we found that RIRS is a minimally invasive surgical procedure that can be used effective and safely in pediatric patients with kidney stones. We found that the presence of lower pole stone, increased stone burden and presence of more than one stone were the most important factors affecting postoperative success for both child and adult patients.
Stone disease has been known for centruies, in recent decads its prevalence is increasing in children and adults. Technological developments, miniaturization of endoscopic instruments have enabled the effective use of retrograde intrarenal surgery in the treatment of kidney stones. There are limited number of studies in pediatric patients. In our study, we aimed to evaluate the efficacy and safety of retrograde intrarenal surgery in pediatric patients by comparing the exact stone-free rates and complication rates in children and adults treated with retrograde intrarenal surgery. METHODS: In our study, the files of patients who were diagnosed with kidney stones and treated with retrograde intrarenal surgery between 01.01.2010 and 01.03.2018 were retrospectively reviewed. The patients were divided into children (under 18 years) (group 1) and adult (18 years of age and older) (group 2) age groups. The stone load, stone size, stone localization, operation time, use of ureteral access sheath, intraoperative complication rates, complete stone-free rates, postoperative complication rates, hospitalization duration, preoperatve and postoperative stenting were compared between in both groups. RESULTS: A total of 275 patients (55 patients in group 1 and 220 patients in group 2) were included in the study. The mean age of the patients was 36.5 ± 20.1 (8 months-89 years) years. The mean stone size was 14.6 ± 6.7 mm (5-47 mm). The mean operation time was 62.9 ± 24.4 (25-170 min) minutes (min). The hospitalization period was 1.9 ± 2.4 (1-15 days) days. In both groups, stone load, number of stones (single-multiple), stone opacity, side, degree of hydroureteronephrosis and duration of operation were similar. The exact stone-free rate between the groups (group 1 81.8%, group 2 78.2%, p: 0.554) was similar after the first session. Total complication rate was 13.8% (group 1 16.4%, group 2 13.2%) and no difference was observed between the two groups. CONCLUSION: In our study, we found that RIRS is a minimally invasive surgical procedure that can be used effective and safely in pediatric patients with kidney stones. We found that the presence of lower pole stone, increased stone burden and presence of more than one stone were the most important factors affecting postoperative success for both child and adult patients.
Açıklama
Anahtar Kelimeler
Böbrek hastalıkları, Kidney diseases, Böbrek taşları, Kidney calculi, Cerrahi-ürolojik, Surgery-urologic
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Özkent, M. S. (2019). Retrograt intrarenal cerrahi uygulanan erişkin ve çocuk hastaların etkinlik ve sonuçlarının karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
