Laparoskopik üreterolitotomi; siz hangi yolu tercih ediyorsunuz?

Year 2020, Volume: 12 Issue: 2, 92 - 98, 23.07.2020

Cemil Aydın , Ali Akkoç

Abstract

Amaç: Minimal invaziv üroloji prosedürlerinin gelişmesiyle, üreter taşlarının tedavisinde açık cerrahi girişimler daha az kullanılmaktadır. Laparoskopik üreterolitotomi (LU) endikasyonları şok dalgası litotripsi veya üreterorenoskopi ile tedavi edilemeyen büyük, çoklu ve / veya impakte üreter taşlarıdır. Bu çalışmada laparoskopik retroperitoneal ve transperitoneal üreterolitotomi tekniklerini karşılaştırmayı ve hangi prosedürün daha etkili olduğunu saptamayı amaçladık.

Gereç ve Yöntemler: Ocak 2012-Aralık 2017 tarihleri arasında büyük ve impakte üst üreter taş nedeniyle transperitoneal ve retroperitoneal LU uygulanan 45 hastayı değerlendirdik. Retroperitoneal ve transperitoneal yöntemler sırasıyla grup 1 ve grup 2 olarak sınıflandırıldı. Gruplar preoperatif, intraoperatif ve postoperatif klinik bulgulara göre karşılaştırıldı.

Bulgular: Gruplar arasında yaş, cinsiyet, taş büyüklüğü, kan kaybı ve vücut kitle indeksi açısından istatistiksel olarak anlamlı bir farklılık bulunmadı. Taşsızlık oranı her 2 grupta da %100 idi. VAS skorları grup 1'de istatistiksel olarak daha yüksek saptandı (p <0.05). Ortalama ameliyat süresi grup 2'de istatistiksel olarak daha kısa bulundu (p: 0.022). İntraoperatif hiçbir hastaya rutin double J stent konulmadı.

Sonuç: Transperitoneal yöntemle karşılaştırıldığında, retroperitoneal teknik, büyük ve impakte proksimal üreter taşlarının tedavisinde anlamlı olarak daha kısa ameliyat süresine ve daha az postoperatif ağrı oranına sahiptir.

Keywords

Laparoskopi, Transperitoneal, Retroperitoneal

Supporting Institution

Yok

Project Number

Yok

Laparoscopic ureterolithotomy; which approach do you prefer?

Abstract

Objectives: With the improvement of minimally invasive urology procedures, open surgical interventions are less common to treat ureteral calculus. Laparoscopic ureterolithotomy (LU) indications are large multiple and/or impacted ureteral calculus that may not be treated with shock-wave lithotripsy or ureterorenoscopy approaches. We aimed to collate laparoscopic retroperitoneal and transperitoneal ureterolithotomy techniques and to identify which procedure is more effective.

Material and Methods: We reviewed 45 patients with large and impacted upper ureter calculus who underwent transperitoneal or retroperitoneal LU between January 2012 and December 2017. The retroperitoneal and transperitoneal routes were grouped as group 1 and 2, respectively. Groups were crosschecked according to preoperative, intraoperative, and postoperative clinical datum.

Results: We did not find statistically meaningful disparity between groups with regards to age, gender, stone size, blood loss and body mass index. The stone free accomplishment ratio was 100% in group 1 and 2. VAS scores were higher and statistically meaningful in group 1 (p<0.05). The mean operative time was statistically shorter in group 2 (p:0.022). No double J stent inserted routinely intraoperatively.

Conclusion: Compared to those obtained with the transperitoneal technique, the retroperitoneal technique has a significantly shorter operating time and less postoperative pain for large and impacted proximal ureteral calculus. More randomized, controlled and prospective studies on large samples are needed.

Keywords

Laparoscopy, Transperitoneal, Retroperitoneal

Project Number

Yok

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