Research Article
BibTex RIS Cite

30 mm’den Küçük Renal Pelvis Taşlarının Üreteroskopik Tedavisi

Year 2017, Volume: 12 Issue: 1, 11 - 16, 29.03.2017
https://doi.org/10.17517/ksutfd.302093

Abstract



Amaç: Bu çalışmanın amacı retrospektif olarak
renal pelvis taş tedavisinde semirigid üreterorenoskopi sonuçlarımızı ve
modifiye Clavien sınıflamasına göre komplikasyonlarımızı değerlendirmek ve
literatür eşliğinde tartışmaktır.



Gereç ve Yöntemler:30 mm’den küçük
renal pelvis taşı nedeniyle 2014-2015 yılları arasında semirigid
üreterorenoskopi uygulanan 23 hastanın tıbbi kayıtları geriye dönük olarak
değerlendirildi.



Hastalar yaş,
cinsiyet, taş boyutu, daha önce vücut dışı ses dalga tedavisi ve ürteral
kateter kullanımı, taşsızlık ve komplikasyon açısından incelendi. Taş kırma
işlemi için Holmium-Yag lazer ve/veya pneumotik lithotripsi kullanıldı.
Hastalar postoperatif birinci ayda kontrastsız batın tomografisi ile
değerlendirildi. Klinik başarı taşsızlık veya asemptomatik klinik önemsiz
reziduel fragmanlar (<4 mm) olarak tanımlandı.  Komplikasyonlar modifiye Clavien
sınıflamasına göre sınıflandırıldı.



Bulgular: Çalışma grubu yaş ortalaması 39.78 ± 19.48
yıl (3-76 yıl) olan 11 kadın ve 12 erkek hastadan oluştu. Ortalama taş boyutu
19.6 ± 5.76 mm (7-30 mm) idi. İlk semirigid üreterorenoskopik lithotripsi
sonrası taşsızlık yüzdesi % 78.3 idi. Taş boyutu, cinsiyet ve hidronefroz
derecesinin başarı oranı üzerine anlamlı etkisi olmadığı görüldü (p>0.05).
Clavien sınıflamasına göre bir hastada derece 1, iki hastada derece 2 olmak
üzere toplam üç hastada minör komplikasyonlar oluştu. Derece 3,4,5 komplikasyonlar
hiçbir hastada izlenmedi.



Sonuç: Semirigid üreterorenoskopik lithotripsi
30 mm’den küçük renal pelvis taş tedavisinde etkili ve güvenli bir yöntemdir.
Bu bulguların doğrulanması için ileriye dönük randomize kontrollü çalışmalara
ihtiyaç vardır.



 



References

  • 1. Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am 2007;34: 409–19.
  • 2. El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int 2012;110: 898–902.
  • 3. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol 1998;159: 1139–43.
  • 4. Resorlu B, Unsal A, Ziypak T, et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 2013; 31:1581-6.
  • 5. Pan J, Chen Q, Xue W, Chen Y, Xia L, Chen H, Huang Y. RIRS versus mPCNL for single renal stone of 2-3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis. 2013;41: 73-8.
  • 6. Giusti G, Proietti S, Luciani LG, et al. Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard? Canadian Journal of Urology. 2014;21: 7207–12.
  • 7. Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. 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: 52–7.
  • 8. Miernik A, Schoenthaler M, Wilhelm K, et al. Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2 cm: a bicentric prospective assessment. World J Urol. 2014,32: 697-702.
  • 9. Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK. Flexible Ureteroscopy and Laser Lithotripsy for Stones > 2 cm: A Systematic Review and Meta-Analysis. J Endourol 2012;26: 1257–63.
  • 10. Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int 2013;111: 127-31.
  • 11. Suer E, Gulpinar O, Ozcan C, Gogus C, Kerimov S, Safak M. Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm Korean J Urol 2015;56: 138-42.
  • 12. Sung JC, Springhart WP, Marguet CG, L'Esperance JO, Tan YH, Albala DM, Preminger GM.Location and etiology of flexible and semirigid ureteroscope damage. Urology 2005; 66: 958-63.
  • 13. Landman J, Lee DI, Lee C, et al. Evaluation of overall costs of currently available small flexible ureteroscopes. Urology 2003;62: 218–22.
  • 14. Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol 2009;182: 1012–7
  • 15. Gurbuz C, Atış G, Arikan O, Efilioglu O, Yıldırım A, Danacıoglu O, et al. The cost analysis of flexible ureteroscopic lithotripsy in 302 cases. Urolithiasis. 2014;42: 155-8.
  • 16. Carey RI, Gomez CS, Maurici G, Lynne CM, Leveillee RJ, Bird VG. Frequency of ureteroscope damage seen at a tertiary care center. J Urol. 2006;176: 607-10.
  • 17. Multescu R, Geavlete B, Geavlete P. A new era: performance and limitations of the latest models of flexible ureteroscopes. Urology. 2013;82: 1236-9.
  • 18. Mogilevkin Y, Sofer M, Margel D, Greenstein A, Lifshitz D. Predicting an effective ureteral access sheath insertion: a bicenter prospective study. J Endourol. 2014;28: 1414-7.
  • 19. Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexible ureteroscopic lithotripsy: the children’s hospital of Philadelphia experience. J Urol 2008; 180: 2616-9.
  • 20. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral accesss heath during retro grade intrarenal surgery. J Urol 2013;189: 580-4.
  • 21. Atis G, Gurbuz C, Arikan O, Canat L, Kilic M, Caskurlu T. Ureteroscopic management with laser lithotripsy of renal pelvic stones. J Endourol. 2012; 26: 983-7.
  • 22. Patel A. Lower calyceal occlusion by autologous blood clot to prevent stone fragment reaccumulation after retrograde intra-renal surgery for lower calyceal stones: first experience of a new technique. J Endourol. 2008;22: 2501-6.

Ureteroscopic Management of Renal Pelvic Stones Less Than 30 mm

Year 2017, Volume: 12 Issue: 1, 11 - 16, 29.03.2017
https://doi.org/10.17517/ksutfd.302093

Abstract

Objective: The aim of this study was to assess the
our outcomes of semirigid ureterorenoscopy for management of renal pelvic stones
and determine complications according to the modify Clavien classification
retrospectively and discuss with literature.

Material and Methods: Medical
records of 23 patients who underwent semirigid ureteroscopy due to renal pelvic
stones sized < 30 mm between 2014 and 2015 were retrospectively evaluated.

Patients were
investigated with regard to age, gender, stone size, history of previous
shockwave lithotripsy and ureteral catheterization, stone clearance and
complications. Holmium-Yag laser and/or pneumatic lithotripsy was used for
lithotripsy. Patients assessed using non-contrast computed tomography at one
month, postoperatively. Clinical success was defined as stone-free status or
asymptomatic insignificant residual fragments (<4 mm). Complications were
classified according to the modified Clavien classification.

Results: Study population consisted of 11 female
and 12 male patients with a mean±SD age of 39.78 ± 19.48 years (3-76 years).
The mean±SD stone size was 19.6 ± 5.76 mm (7-30 mm). The mean stone-free rate
was 78.3% after initial semirigid ureterorenoscopic lithotripsy. Success rates
did not differ significantly with respect to stone size, gender and grade of
hydronephrosis (p>0.05). Minor complications as classified by Clavien 1
(n:1) or 2 (n:2) occured in 3 (13%) patients. Grade 3, 4,5 complications were
not determined in any patient.









Conclusion: Semirigid ureterorenoscopic lithotripsy
is an effective and safe procedure in the treatment of < 30 mm renal pelvic
stones.  Prospective randomized
controlled trials are needed to confirm these findings.

References

  • 1. Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am 2007;34: 409–19.
  • 2. El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int 2012;110: 898–902.
  • 3. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol 1998;159: 1139–43.
  • 4. Resorlu B, Unsal A, Ziypak T, et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 2013; 31:1581-6.
  • 5. Pan J, Chen Q, Xue W, Chen Y, Xia L, Chen H, Huang Y. RIRS versus mPCNL for single renal stone of 2-3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis. 2013;41: 73-8.
  • 6. Giusti G, Proietti S, Luciani LG, et al. Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard? Canadian Journal of Urology. 2014;21: 7207–12.
  • 7. Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. 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: 52–7.
  • 8. Miernik A, Schoenthaler M, Wilhelm K, et al. Combined semirigid and flexible ureterorenoscopy via a large ureteral access sheath for kidney stones >2 cm: a bicentric prospective assessment. World J Urol. 2014,32: 697-702.
  • 9. Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK. Flexible Ureteroscopy and Laser Lithotripsy for Stones > 2 cm: A Systematic Review and Meta-Analysis. J Endourol 2012;26: 1257–63.
  • 10. Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int 2013;111: 127-31.
  • 11. Suer E, Gulpinar O, Ozcan C, Gogus C, Kerimov S, Safak M. Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm Korean J Urol 2015;56: 138-42.
  • 12. Sung JC, Springhart WP, Marguet CG, L'Esperance JO, Tan YH, Albala DM, Preminger GM.Location and etiology of flexible and semirigid ureteroscope damage. Urology 2005; 66: 958-63.
  • 13. Landman J, Lee DI, Lee C, et al. Evaluation of overall costs of currently available small flexible ureteroscopes. Urology 2003;62: 218–22.
  • 14. Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol 2009;182: 1012–7
  • 15. Gurbuz C, Atış G, Arikan O, Efilioglu O, Yıldırım A, Danacıoglu O, et al. The cost analysis of flexible ureteroscopic lithotripsy in 302 cases. Urolithiasis. 2014;42: 155-8.
  • 16. Carey RI, Gomez CS, Maurici G, Lynne CM, Leveillee RJ, Bird VG. Frequency of ureteroscope damage seen at a tertiary care center. J Urol. 2006;176: 607-10.
  • 17. Multescu R, Geavlete B, Geavlete P. A new era: performance and limitations of the latest models of flexible ureteroscopes. Urology. 2013;82: 1236-9.
  • 18. Mogilevkin Y, Sofer M, Margel D, Greenstein A, Lifshitz D. Predicting an effective ureteral access sheath insertion: a bicenter prospective study. J Endourol. 2014;28: 1414-7.
  • 19. Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexible ureteroscopic lithotripsy: the children’s hospital of Philadelphia experience. J Urol 2008; 180: 2616-9.
  • 20. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral accesss heath during retro grade intrarenal surgery. J Urol 2013;189: 580-4.
  • 21. Atis G, Gurbuz C, Arikan O, Canat L, Kilic M, Caskurlu T. Ureteroscopic management with laser lithotripsy of renal pelvic stones. J Endourol. 2012; 26: 983-7.
  • 22. Patel A. Lower calyceal occlusion by autologous blood clot to prevent stone fragment reaccumulation after retrograde intra-renal surgery for lower calyceal stones: first experience of a new technique. J Endourol. 2008;22: 2501-6.
There are 22 citations in total.

Details

Subjects Health Care Administration
Journal Section Makaleler
Authors

Tayfun Şahinkanat

Hasan Çetin Ekerbiçer

Publication Date March 29, 2017
Submission Date March 29, 2017
Acceptance Date October 31, 2016
Published in Issue Year 2017 Volume: 12 Issue: 1

Cite

AMA Şahinkanat T, Ekerbiçer HÇ. Ureteroscopic Management of Renal Pelvic Stones Less Than 30 mm. KSU Medical Journal. April 2017;12(1):11-16. doi:10.17517/ksutfd.302093