Supin ve pron perkütan nefrolitotomi: obez hastalarda etkinlik ve güvenlik karşılaştırması

Year 2022, Volume: 14 Issue: 3, 49 - 56, 30.09.2022

Taner Kargı , Mithat Ekşi , Ubeyd Sungur , Osman Özdemir , Serdar Karadağ , İsmail Evren , Ahmet Haciislamoğlu , Hakan Polat , Feyzi Arda Atar , Alper Bitkin , Ali İhsan Taşçı

https://doi.org/10.54233/endouroloji.1135843

Abstract

Amaç: Obez hastalarda supin ve pron perkütan nefrolitotomiyi (PNL) etkinlik ve güvenlik açısından karşılaştırmak.
Gereç ve Yöntemler: Ocak 2011 ile Eylül 2020 tarihleri arasında Dünya Sağlık Örgütü (WHO) vücut kitle indeksi (VKİ) ≥30 kg/m2 sınıflamasına göre 2 cm’den büyük böbrek taşı olan, supin veya pron pozisyonda PNL uygulanan hastalar retrospektif olarak çalışmaya dahil edildi. Demografik özellikler, intraoperatif, postoperatif veriler ile birlikte Modifiye Clavien Derecelendirme Sistemine göre komplikasyonlar listelendi. Hastalar taşsızlık durumu belgelenerek 3 ay boyunca takip edildi.
Bulgular: Toplam 156 obez hastanın 74’üne (%47,4) supin PNL (grup 1) ve 82’sine (%52,6) pron PNL (grup 2) uygulandı. Hemoglobin düşüşü pelvikalisiyel akses sayısı, kan transfüzyonu, hastanede kalış süresi, komplikasyon oranları, taşsızlık durumu açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Pelvikalisiyel akses yeri (üst, orta, alt kaliksler) iki grup arasında anlamlı olarak farklıydı (grup 1’de sırasıyla %18,9, %32,4, %42,6, grup 2’de %3,2, %19,3, %77,5) (p<0,001). Ortalama ameliyat süreleri gruplar arasında istatistiksel olarak farklı saptandı (sırasıyla grup 1’de 97,2 ± 18,1 dakika, grup 2’de 119,5 ± 18,9 dakika) (p<0,001).
Sonuç: PNL, hem supin hem de pron pozisyonda uygulanabilen obez hastalarda böbrek taşlarının tedavisinde güvenli ve etkili bir yöntemdir. Hasta karakteristiği göz önünde bulundurularak, supin pozisyonda üst kaliksten erişim de tercih edilebilir. Ek olarak, supin pozisyonun pron pozisyona göre en büyük avantajı daha kısa ameliyat süresine sahip olmasıdır.

Keywords

perkütan nefrolitotomi, obez, supin, pron

Supine versus prone percutaneous nephrolithotomy: A comparison of efficacy and safety in obese patients

Abstract

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.
Material and Methods:  Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status. 
Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p>0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p<0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p<0.001).
Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

Keywords

percutaneous nephrolithotomy, obese, supine, prone

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