RIRS’ta tam taşsızlık için prediktif faktörler; güncel bir retrospektif analiz

Year 2020, Volume: 12 Issue: 3, 210 - 216, 31.12.2020

Gökhan Ecer , Mehmet Giray Sönmez , Mehmet Balasar , Arif Aydın , Ahmet Öztürk

Abstract

Amaç: Üriner sistem taş hastalığı ülkemizde sık görülen ve cerrahi nedeni olan bir hastalıktır. Günümüzde taş hastalığı için Retrograd intrarenal cerrahi (RIRS) en önde gelen minimal invaziv tedavi seçeneklerinden birisidir. Bu çalışmada böbrek taşı nedeniyle RIRS cerrahisi yaptığımız hastalarda başarı ve komplikasyonları etkileyen faktörleri belirlemeyi amaçladık.

Gereç ve Yntemler: Haziran 2019-Temmuz 2020 tarihleri arasında böbrek taşı tanısı konulan ve RIRS operasyonu yapılan toplam 106 hasta çalışmaya dahil edilmiştir. Hastaların demografik, radyolojik ve cerrahi ilişkili verileri hasta kayıtlarından retrospektif olarak incelenmiştir. Veriler SPSS programı yardımıyla analiz edilerek yorumlanmıştır.

Bulgular: Yaş, cinsiyet, ek hastalık varlığı, Beden Kitle indeksi (BKİ) gibi demografik veriler açısından grupların birbirine benzediği görülmüştür. (Tablo 1)
Taş lokalizasyonlarını değerlendirdiğimizde ise RIRS başarısının sağlandığı Grup 1’de üst polde, RIRS başarısızlığı olan Grup 2’de ise alt polde daha fazla taş olduğu izlendi. (p=0,027) Çalışmamızdaki hastaların ortalama taş boyutu 12,7 mm olup, Grup 1’de 12.02, Grup 2’de 18,3 mm olarak tespit edilmiştir.(p=0,004)
Hastaların alt pol infindübulopelvik açıları BT görüntülerinden ölçüldüğünde Grup 1’de 55,8°, Grup 2’de 48,2° olarak ölçüldü. Grup 1’in istatistiksel anlamlı olarak daha yüksek olduğu belirlendi (p=0,02).
Ortalama operasyon süresi, taş dansitesi, floroskopi süresi ve preoperatif serum kreatinin seviyeleri arasında istatistiksel anlamlı farklılık saptanmadı.

Sonuç: Çalışmamızda RIRS başarısını etkileyen faktörler taş lokalizasyonu, taş boyutu ve alt pol infindibulopelvik açı olarak bulunmuştur. Uygun hastalarda kullanıldığında düşük komplikasyon oranları ve yüksek taşsızlık oranları elde edilebilmektedir. Böbreğe ulaşım açısından anatomik problemi olmayan daha küçük boyutta ve daha az sayıda böbrek taşı olan hastalarda etkin olarak kullanılabilen bir yöntem olarak seçilebilmektedir.

Keywords

Böbrek taşı, Fleksibl üreterorenoskopi, Retrograd intrarenal cerrahi, Taşsızlık

Predictive factors for achieving stone-free in RIRS; a current retrospective analysis

Abstract

Objective: Urinary system stone disease is a common disease in our country. Retrograde intrarenal surgery (RIRS) is currently one of the leading minimally invasive treatment options for stone disease. In this study, we aimed to determine the factors affecting success and complications in patients undergoing RIRS surgery for kidney stones.

Material and Methods: A total of 106 patients who were diagnosed with kidney stones and underwent RIRS operation between June 2019 and July 2020 were included in the study. Demographic, radiological, and surgical data of the patients were analyzed retrospectively from the hospital archive. The data were analyzed and interpreted with the SPSS program.

Results: It was observed that the groups were similar in terms of demographic data such as age, gender, presence of comorbidities, Body Mass Index (BMI). (Table 1)
When we evaluated the stone localizations, it was observed that there were more stones in the upper pole in Group 1, where RIRS success was achieved, and in the lower pole in Group 2 with RIRS failure. (p = 0.027) The average stone size of the patients in our study was 12.7 mm, and it was found as 12.02 mm in Group 1 and 18.3 mm in Group 2. (p = 0.004)
When the lower pole infundibulopelvic angles of the patients were measured from CT images, it was measured as 55.8 ° in Group 1 and 48.2 ° in Group 2. It was determined that group 1 was statistically significantly higher (p = 0.02).
There was no statistically significant difference between the mean operation time, stone density, fluoroscopy time, and preoperative serum creatinine levels.

Conclusion: In our study, the factors affecting the success of RIRS were stone location, stone size, and lower pole infundibulopelvic angle. Low complication rates and high stone-free rates can be obtained when used in appropriate patients. It can be chosen as a method that can be used effectively in patients with smaller sizes and fewer kidney stones, who do not have anatomical problems in terms of access to the kidney.

Keywords

Kidney stones, Flexible ureterorenoscopy, Retrograde intrarenal surgery, Stone free

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