Perkütan Nefrolitotomi Ameliyatında Taşsızlığın İntraoperatif Değerlendirilmesi: Cerrahın Gözü

Year 2023, Volume: 15 Issue: 2, 52 - 60, 31.05.2023

Mehmet Yiğit Yalçın , Batuhan Ergani , Taha Çetin , Mustafa Karabıçak , Mert Hamza Özbilen , Çağdaş Bildirici , Erkin Karaca , Mehmet Yoldaş , Erdem Kısa , Tufan Suel Özgen , Gökhan Koç , Özgür Çakmak , Hayal Boyacıoğlu , Yusuf Özlem İlbey

https://doi.org/10.54233/endouroloji.20231502-1282074

Abstract

Amaç: Perkütan nefrolitotomi (PNL) uygulanan hastalarda cerrahın intraoperatif taşsızlık kanısının doğruluğunu,
bunu etkileyen faktörleri, yanlış tahminine sebep olan prediktörleri saptamak ve sonuç olarak “cerrah gözü” ‘nün
güvenilirliğini değerlendirmek amaçlandı.

Gereç ve Yöntemler: PNL uygulanan ve dahil etme kriterlerine uyan 1025 hastanın verileri retrospektif olarak incelendi.
Çalışmamızın temeli cerrahın taşşsızlığı değerlendirmesi üzerine olması sebebiyle, cerrahın intraoperatif
rezidü taş (RT) kalmadığı kanaatini belirttiği ancak postoperatif bilgisayarlı tomografi görüntülemede RT olan ve
olmayan hasta grupları değişkenlere göre karşılaştırıldı.

Bulgular: Cerrah gözü‘nün sensitivitesi %67,87, spesifitesi %96,23, pozitif prediktif değeri %91,67 ve negatif prediktif
değeri %83,04 bulundu. Çalışmamızda “cerrahın gözü” ‘nün %16,9 oranında yanlış taşsızlık tahmin ettiği
saptandı. Her iki grup arasında cinsiyet, taşın tarafı, taşın yoğunluğu ve hemoglobin düşüşü arasında istatistiksel
anlamlı ilişki saptanmadı. Taş boyutu, operasyon süresi, floroskopi süresi, taşın konumu, kaliks taşlarının sayısı
ve GUY’s nefrolitometri skoru (GSS) cerrahın gözü ile istatistiksel anlamlı ilişkili saptandı. Cerrahın gözü ile istatistiksel
anlamlı ilişki saptanan parametrelerin çok değişkenli (multivariate) lojistik regresyon analizi sonucunda
sırasıyla taş boyutu, kaliks taşlarının sayısı ve GSS anlamlı prediktörler olarak bulundu.

Sonuç: PNL’ de “cerrah gözü” nün en önemli prediktörleri taş boyutu, kaliks taş sayısı ve GSS idi. Bu prediktörler
taşsızlık öngörülen hastaların postoperatif görüntülemelerinde, radyasyon maruziyetini azaltacak yöntemlerin
kullanılmasında etkili bir kriter olarak kullanılabilir.

Keywords

böbrek taşları, perkütan nefrolitotomi, taşsızlık durumu, intraoperatif değerlendirme, cerrahın gözü

Intraoperative Assessment of Stone Free Status for Percutaneous Nephrolithotomy Surgery: Surgeon’s Eye

Abstract

Objective: In patients who underwent percutaneous nephrolithotomy (PNL),it was aimed to determine
the accuracy of the surgeon’s intraoperative stone-free status (SFS) prediction, the factors affecting it, the
predictors that cause incorrect estimation, and finally to evaluate the reliability of the “surgeon’s eye”.

Material and Methods: The data of 1025 patients who underwent PNL and met the inclusion criteria
were evaluated retrospectively. Since the basis of our study was based on the evaluation of the surgeon’s
stone-free prediction, patients identified as “absence of residual stone fragment (RF)” by the surgeon were
grouped and compared with postoperative computed tomography imaging according to the presence of RF.

Results: Sensitivity, specificity, positive predictive value and negative predictive value were calculated as
67.87%, 96.23%, 91.67% and 83.04%, respectively. In our study, it was found that the “surgeon’s eye” predicted
SFS incorrectly at a rate of 16.9%. There was no statistically significant relationship between gender,-
stone side,stone density and hemoglobin decrease between the two groups. Stone size,operation time,
fluoroscopy time, location of the stone,number of stones in the calyces and GUY’s stone score (GSS) were
found to be statistically significant in relation to the “surgeon’s eye”. As a result of multivariate logistic regression
analysis stone size, number of stones in the calyces and GSS were significant predictors of the
parameters that had a statistically significant relationship with the surgeon’s eye.

Conclusion: The most important determinants of “surgeon’s eye” in PNL were stone size,number of stones
in the calyces and GSS. These predictors can be used as an effective criterion in the use of methods to reduce
radiation exposure in postoperative imaging of patients who are predicted to be stone-free.

Keywords

stones, percutaneous nephrolithotomy, stone-free status, intraoperative evaluation, surgeon’s eye

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