Factors affecting stone-free rates in retrograde intrarenal surgery

Yıl 2022, Cilt: 14 Sayı: 2, 42 - 48, 31.05.2022

Uğur Öztürk , Emrah Küçük , Mehmet Özen , Mustafa Koray Kırdağ , Turgut Serdaş , Varol Nalçacıoğlu , Mustafa Aydın , Mustafa Kemal Atilla

https://doi.org/10.54233/endouroloji.1091342

Öz

Objective: We aimed to determine the factors that are effective in achieving stone-free status (SFS) in patients who underwent retrograde intrarenal surgery for kidney stones.
Material and Methods: We retrospectively analyzed the data of 160 patients who underwent retrograde intrarenal surgery (RIRS) in our clinic between January 2021 and July 2021. Demographic characteristics of the patients, parameters related to stone and renal calyceal anatomy measured on computed tomography (CT) images, use of ureteral access sheath (UAS) and surgical time were analyzed. Surgery was considered successful if the residual stone on direct urinary system radiography (DUSG) or CT images at the postoperative 1st month was smaller than 2 mm or there was no stone at all. The patients were divided into two groups according to their stone free status (SFS), as stone free (Group 1) and with residual stone (Group 2). In addition, stones in the kidney were divided into lower poles (45 degrees and above and below) and non lower pole according to localization. The groups were compared according to the presence of postoperative residues.
Results: There was no difference for the distribution of gender, body mass index (BMI), side, UAS use, opacity status, infundibulopelvic angle (IPA) and infundibular length for Group 1 and Group 2 (p>0.05). Infundibular width was greater in Group 1 without stone (p>0.021). The residual in patients with more than one stone was higher than those with one stone (p>0.048). We did not find impressive results on stone-freeness for stone volume and stone density. According to the localization in the kidney, the residue was higher in those with lower poles (p>0.001). However, there was no difference between those with lower pole stones and those above and below 45 degrees (p>0.050).
Conclusion: In the treatment of retrograde intrarenal stone surgery, the presence of more than one stone, the presence of lower pole stones, and the small infundibular width can be predicted as factors that negatively affect stone clearance.

Anahtar Kelimeler

retrograd intrarenal cerrahi, böbrek taşı, taşsızlık

Retrograde intrarenal cerrahide taşsızlık oranlarını etkileyen faktörler

Öz

Amaç: Böbrek taşı nedeniyle retrograt intrarenal cerrahi uygulanan olgularda taşsızlık elde etmede etkili olan faktörleri saptamayı amaçladık.
Gereç ve Yöntemler: Ocak 2021- Temmuz 2021 tarihleri arasında kliniğimizde retrograt intrarenal cerrahi (RİRC) uygulanan 160 olgunun verilerini retrospektif olarak analiz ettik. Hastaların demografik özellikleri, bilgisayarlı tomografi (BT) görüntüleri üzerinden ölçümü yapılan taş ve böbrek kalisiyel anatomisi ile ilgili parametreleri, üreter erişim kılıfı (ÜEK) kullanılma durumu ve cerrahi süre analiz edildi. Postoperatif 1.ayda direkt üriner sistem grafisi (DÜSG) veya BT görüntülerindeki rezidü taşın 2 mm’den küçük olması veya hiç taş olmaması cerrahi için başarılı kabul edildi. Hastalar taşssızlık durumuna göre taşsız (Grup1) ve rezidü taşa sahip (Grup 2) olmak üzere iki gruba ayrıldı. Ayrıca böbrekteki taş lokalizasyona göre alt pol olan (45 derece ve üstü ile altı) ve olmayan diye alt grublara ayrıldı. Gruplar operasyon sonrası rezidü varlığına göre kıyaslandı.
Bulgular: Grup 1 ve Grup 2 için cinsiyetin dağılımları, vücut kitle indeksi (VKİ), taraf, ÜEK kullanımı, opasite durumu, infindibulopelvik açı (İPA) ve infundibuler uzunluk için fark yoktu (p>0,05). Taşssız olan Grup 1’de infundibuler genişlik daha fazla idi (p>0,021). Birden fazla taşı olanlarda rezidü, tek taşı olanlara göre fazla idi (p>0,048). Taş hacmi ve taş dansitesi için taşsızlık üzerine etkileyici sonuç bulmadık. Böbrekteki lokalizasyona göre alt pol olanlarda rezidü fazlaydı (p>0,001). Ancak alt pol taşları olanlarda 45 derece üstü ve altı olanlar arasında fark yoktu (p>0,050).
Sonuç: Retrograd intrarenal taş cerrahisi tedavisinde, birden fazla taşın olması, alt pol taşın olması, infundibüler genişliğin az olması taşsızlığı olumsuz etkileyen faktörler olarak öngörülebilir. 

Anahtar Kelimeler

retrograt intrarenal cerrahi, böbrek taşı, taşsızlık

Kaynakça

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