Üreter Taşlarında Ekstrakorporeal Şok Dalga Litotripsisinin Başarısını Öngörmede Belirleyici Faktörler: Geniş Hasta Katılımlı Retrospektif Değerlendirme

Year 2024, Volume: 16 Issue: 1, 1 - 7, 31.01.2024

Ali Haydar Yılmaz , Şaban Oğuz Demirdöğen , Hüseyin Koçakgöl , Bakytbek Kozubaev , Salih Al

https://doi.org/10.54233/endourologybull-1345899

Abstract

Amaç: Retrospektif olarak planladığımız çalışmamızda; ekstrakorporeal şok dalga litotripsisi (ESWL) yöntemi ile tedavi edilen, üreter taşı olan hastalarımızda ESWL başarısını öngören faktörleri ve güvenirliğini araştırmayı amaçladık.
Gereç ve Yöntemler: Çalışma 2008-2013 yılları arasında Atatürk Üniversitesi Üroloji Kliniği’nde üreter taşı nedeniyle tedavi edilen 489 hastayı kapsamaktadır. Hastalara en fazla üç seans ESWL uygulandı. İki seansa kadar kırılanlar başarılı kabul edildi. Üreter taşı nedeniyle ESWL uygulanan hastalar hastane kayıtlarından retrospektif olarak incelendi. ESWL başarısını öngörmede, cinsiyet, yaş, opasitesi, taraf ile komplikasyon oranları, ek prosedür gerekliliği gibi parametreler değerlendirildi. ESWL sonrası taşsız olan ya da kontrol görüntülemede 4 mm’den küçük rezidü taşı olan hastalarda ESWL başarılı olarak kabul edilip taşsızlık sağlandı olarak değerlendirildi. Sedoanaljezi sadece çocuk hastalara uygulandı.
Bulgular: Üreter taşlarından ESWL’ye alınan toplam 486 hasta çalışmaya dahil edildi. Hastalar da yaş gruplarına göre 3 gruba ayrıldı.1- 18 yaşa kadar birinci grup 20-40 arası ikinci grup ve 40 üstü üçüncü grubu oluşturuyordu. Yaş grupları ve cinsiyet parametreleri açısından taşsızlık istatiksel olarak anlamlı değildi. Komplikasyon olarak 3 hastada taş yolu, 2 hastada hematüri gelişti. Komplikasyonlar ile taşların lokalizasyonu arasında anlamlılık saptanmadı (p=0.531). Taş boyutu ile taşsızlık sağlanması ve komplikasyon gelişmesi açısından anlamlılık saptanmıştır (sırası ile p=0.016, p=0.0001).
Sonuç: ESWL’de tedavi başarısını öngörmek, hastaları gereksiz tedavi ve işlemden kaynaklanabilecek komplikasyonlardan, zaman kaybından ve morbiditeden korumak esastır. Geniş hasta katılımlı çalışmamızda ESWL’nin üreter taşlarında güvenle tercih edilebilecek bir yöntem olduğunu yüksek başarı ve düşük komplikasyon oranları ile gösterdik. Bizim çalışmamızda taş boyutu başarıyı ön görmede önemli bir prediktif değer olarak saptanmıştır.

Keywords

ekstrakorporeal şok dalga litotripsisi, üreter taşı, komplikasyon, taşsızlık

Predicting Factors of the Success Rate of Extracorporeal Shock Wave Lithotripsy in Ureteral Stones: A Retrospective Evaluation with Large Patient Participiant

Abstract

Objective: In our retrospectively planned study; treated with ESWL method; we aimed to investigate the factors that predict the success of Extracorporeal Shock Wave Lithotripsy (ESWL) and its reliability in our patients with ureteral stones.
Material and Methods: The study includes 489 patients treated for ureteral stones at Atatürk University Urology Clinic between 2008 and 2013. Patients underwent a maximum of three sessions of ESWL. Those who had fractures within two sessions were considered successful. Patients who underwent ESWL due to ureteral stones were retrospectively examined from hospital records. In predicting ESWL success, parameters such as gender, age, opacity, side and complication rates, and the need for additional procedures were evaluated. In patients who were stone-free after ESWL or had residual stones smaller than 4 mm on control imaging, ESWL was considered successful and stone-free was achieved. Sedoanalgesia was applied only to pediatric patients.
Results: A total of 486 patients who underwent ESWL for ureteral stones were included in the study. The patients were divided into 3 groups according to age groups. Ages 1-18 were the first group, ages 20-40 were the second group, and people over 40 were the third group. Stone-free status was not statistically significant in terms of age groups and gender parameters. As a complication, stone street developed in 3 patients and hematuria developed in 2 patients. No significance was found between complications and the location of the stones (p=0.531). There was a significance between stone size and stone-free status and the development of complications (p=0.016, p=0.0001, respectively).
Conclusion: It is essential to predict treatment success in ESWL and to protect patients from complications, time loss and morbidity that may arise from unnecessary treatment and procedures. In our study with large patient participation, we showed that ESWL is a method that can be safely preferred in ureteral stones with high success and low complication rates. In our study, stone size was found to be an important predictive value in predicting success.

Keywords

extracorporeal shock wave lithotripsy, ureteral stones, complication, stone free

References

• 1.Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2(8207):1265-1268. https://doi.org/10.1016/S0140-6736(80)92335-1
• 2.Bach C, Buchholz N. Shock wave lithotripsy for renal an ureteric stones. Eur Urol Suppl. 2011;10:423-432. https://doi.org/10.1016/j.eursup.2011.07.004
• 3. Akal HR. The role of extracorporeal shock wave lithotripsy in the treatment of upper ureteral stone disease. Thi-Qar Medical Journal. 2011;5(3):16-27. http://jmed.utq.edu.iq/index.php/main/article/view/263/344
• 4. Abe T, Akakura K, Kawaguchi M. et al. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol. 2005;19(7):768-773. https://doi.org/10.1089/end.2005.19.768
• 5. Shinde S, Al Balushi Y, Hossny M, Jose S, Al Busaidy S. Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment. Oman Med J. 2018;33(3):209-217. https://doi.org/10.5001/omj.2018.39
• 6. Albala DM, Assimos DG, Clayman RV. et al. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol. 2001;166(6):2072-2080. https://doi.org/10.1016/S0022-5347(05)65508-5
• 7. Coz F, Orvieto M, Bustos M. et al. Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith SL-20: success and failureaccording to size and location of stones. J Endourol. 2000;14(3):239-246. https://doi.org/10.1089/end.2000.14.239
• 8. Turna B, Akbay K, Ekren F, et al. Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones. Int Urol Nephrol. 2008;40:23-9. https://doi.org/10.1007/s11255-007-9214-x
• 9.Alsmadi J. Role of Patient Age and Stone Density in Predicting Outcomes of Shockwave Lithotripsy in Lower Ureteral Stones. Med Arch. 2023;77(3):222-226. https://doi.org/10.5455/medarh.2023.77.222-226
• 10. Lu Y, Tianyong F, Ping H, Liangren L, Haichao Y, Qiang W. Antibiotic prophylaxis for shock wave lithotripsy in patients with sterile urine before treatment may be unnecessary: a systematic review and meta-analysis. J Urol. 2012;188:441. https://doi.org/10.1016/j.juro.2012.04.014
• 11. Lee YH, Tsai JY, Jiaan BP, Wu T, Yu CC. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology. 2006;67:480-4. https://doi.org/10.1016/j.urology.2005.09.067
• 12. Karlsen SJ, Renkel J, Tahir AR, Angelsen A, Diep LM. Extracorporeal shockwave lithotripsy versus ureteroscopy for 5-to 10-mm Stones in the proximal ureter: prospective effectiveness patient-preference trial. J Endourol. 2007;21:28-33. https://doi.org/10.1089/end.2006.0153
• 13. Cui Y, Cao W, Shen H, et al. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones. PLoS One. 2014;9:e87634. https://doi.org/10.1371/journal.pone.0087634
• 14. Zhang J, Shi Q, Wang GZ, Wang F, Jiang N. Cost-effectiveness analysis of ureteroscopic laser lithotripsy and shock wave lithotripsy in the management of ureteral calculi in eastern China. Urol Int. 2011;86:470-5. https://doi.org/10.1159/000324479
• 15. Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. Part I J Urol. 2016;196:1153-60. https://doi.org/10.1016/j.juro.2016.05.090
• 16. Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. Part II. J Urol. 2016;196:1161-9. https://doi.org/10.1016/j.juro.2016.05.090
• 17. Aboumarzouk OM, Kata SG, Keeley FX, McClinton S, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2012:Cd006029. https://doi.org/10.1002/14651858.CD006029.pub3
• 18. Perks AE, Schuler TD, Lee J, et al.Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology. 2008;72:765-9. https://doi.org/10.1016/j.urology.2008.05.046
• 19.Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT. A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi J Urol. 2011;186:556-62. https://doi.org/10.1016/j.juro.2011.03.109
• 20.Kanao K, Nakashima J, Nakagawa K,et al. Preoperative nomograms for predicting stone-free rate after extracorporeal shock wave lithotripsy. J Urol. 2006;176:1453-6. https://doi.org/10.1016/j.juro.2006.06.089
• 21. El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol. 2007;51:1688-93. https://doi.org/10.1590/1806-9282.61.01.065
• 22.Efiloğlu Ö. , Çakıcı M. Ç. , Kazan H. Ö. , Keser F. , Yıldırım A. , Atis G. Böbrek ve üreter taşlarında ESWL başarısını öngörmede radyografik ve litotriptör parametrelerinin klinik önemi. Endourology Bulletin. 2021;13(3):78-8422.
• 23.Picozzi SC, Ricci C, Gaeta M, et al. Urgent shock wave lithotripsy as first-line treatment for ureteral stones: a metaanalysis of 570 patients. Urol Res. 2012;40:725-31. https://doi.org/10.1007/s00240-012-0484-0