Üreter taşları tedavisinde pnömatik ve holmium lazer taş kırıcıların karşılaştırılması: retrospektif gözlemsel çalışma

Yıl 2022, Cilt: 15 Sayı: 4, 648 - 655, 01.10.2022

Tuncer Bahçeci , Aykut Başer

https://doi.org/10.31362/patd.1055563

Öz

Amaç: Üreter taşlarının endoskopik tedavisinde en sık kullanılan taş kırıcılar olan holmium lazer ve pnömatik taş kırıcıların tüm üreter seviyelerinde etkinlik ve komplikasyonlarını karşılaştırmak.
Gereç ve yöntem: Ocak 2018-2021 tarihleri arasında, tek cerrah tarafından üreterorenoskopik taş kırma uygulanan 510 hastanın verileri retrospektif olarak incelendi. Taş kırıcı cinsine göre lazer taş kırıcı (Grup 1) ve pnömatik taş kırıcı (Grup 2) olarak iki gruba ayrıldı. Taşın üreter içerisindeki lokalizasyonuna göre üreter proksimal, mid ve distal olmak üzere 3 bölüme ayrıldı. Demografik veriler, tam taşsızlık oranları, double-j (JJ) stent kullanımı, JJ stent çıkarılma süresi, anestezi yöntemi, operasyon süresi, hastanede kalış süresi ve komplikasyon oranları araştırıldı.
Bulgular: Hasta sayısı sırasıyla Grup 1’de 265, Grup 2’de 245 saptandı. Genel başarı oranı Grup 1'de %98,5, Grup 2’de %93,9 saptandı ve Grup 1’de istatiksel olarak daha başarılı bulundu (p=0,006). Proksimal üreter taşlarında başarı oranı Grup 1'de anlamlı olarak daha yüksek bulundu (%94,4’e karşı %68,9; p=0,001). Stent kullanılmadan sonlandırılan vaka sayısı Grup 1'de istatiksel olarak daha yüksek saptandı (%29,8’e karşı %17,6; p<0,001). Orta üreter ve distal üreter taşları, anestezi tipi, ameliyat süresi, hastanede kalış süresi, JJ stent çıkarma süresi ve komplikasyonlar açısından iki grup arasında fark bulunmadı.
Sonuç: Üreter taşları tedavisinde en sık tercih edilen yaklaşım üreterorenoskopik taş kırma yöntemidir. Taşın üreter içerisindeki lokalizasyonu ve taş kırıcının cinsi başarıyı etkilemektedir. Proksimal üreter taşları tedavisinde, yüksek etkinlik ve daha az üreteral stent ihityacı nedeniyle holmium lazer taş kırıcı tercih edilebilir.

Anahtar Kelimeler

Holmium lazer, pnömatik taş kırıcı, üreter taşları

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Comparison the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for the treatment of ureteral stones: a retrospective observational study

Öz

Purpose: To compare the efficacy and complications of holmium laser lithotripters and pneumatic lithotripters, the two most commonly used lithotripters in the endoscopic treatment of ureteral stones, at all ureteral levels.
Material and method: Retrospective data on 510 patients who had ureterorenoscopic lithotripsy performed by a single surgeon between January 2018 and 2021 were studied. Patients were divided into two groups: those who received a holmium laser lithotripter and those who received a pneumatic lithotripter. Demographic information, stone-free rates, double-j (JJ) stent usage, JJ stent removal time, type of anesthesia, operation time, hospital stay, and complication rates were all examined.
Results: The patient numbers in the holmium laser and pneumatic groups were 265 and 245, respectively. The overall success rate in group 1 was found to be significantly higher than in group 2 (98.5 percent vs 93.9 percent; p=0.006). Group 1 had a significantly higher success rate in proximal ureteral stones (94.4 percent vs 68.9 percent; p=0.001). Patients in group 1 had a significantly higher rate of not using any ureteral stent (29.8 percent vs 17.6 percent; p<0.001). There was no difference between the two groups in terms of mid-ureter and distal ureter stones, anesthesia type, operation time, hospital stay, JJ stent removal time, and complications.
Conclusion: For ureteral stones, ureterorenoscopic lithotripsy is the chosen therapeutic approach. The location of the stone in the ureter as well as the type of lithotripters used can have an impact on the outcome. Because of its great efficiency and lack of need for ureteral stents, holmium laser lithotripsy may be preferred for the treatment of proximal ureteral stones.

Anahtar Kelimeler

Holmium laser, pneumatic lithotripsy, ureteral stones

Proje Numarası

yok

Kaynakça

• Romero V, Akpinar H, Assimos D.G. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in urology 2010;12(2-3), e86.
• Rabani SM , Rabani S, Rashidi N. Laser Versus Pneumatic Lithotripsy With Semi-Rigid Ureteroscope; A Comparative Randomized Study. J Lasers Med Sci. 2019;10(3):185-188. doi: 10.15171/jlms.2019.29.
• Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Tepeler A, Esen T, et al. Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urol Res. 2011;39(4):309-14. doi: 10.1007/s00240-010-0346-6.
• Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Urolithiasis. European Association of Urology Guidelines 2013.
• Hong YK., Park DS, Ureteroscopic lithotripsy using Swiss Lithoclast for treatment of ureteral calculi: 12-years experience. Journal of Korean medical science. 2009;24.4: 690-694. doi: 10.3346/jkms.2009.24.4.690.
• Torricelli FC, Mazzucchi E, Danilovic A, Coelho RF, Srougi M. Surgical management of bladder stones: literature review. Rev Col Bras Cir. 2013;40:227-233. doi: 10.1590/s0100-69912013000300011.
• Razzaghi MR, Razi A, Mazloomfard MM, Taklimi GA, Valipour R, Razzaghi Z. Safety and efficacy of pneumatic lithotripters versus holmium laser in management of ureteral calculi: a randomized clinical trial. Urol J 2013;10:762-6.
• Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, et al. Guideline for the management of ureteral calculi. Eur Urol 2007;52(6):1610-31. doi: 10.1016/j.eururo.2007.09.039.
• Khoder WY, Bader M, Sroka R, Stief C, Waidelich R. Efficacy and safety of Ho: YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi. BMC urology. 2014;14.1:1-7. doi 10.1186/1471-2490-14-62.
• Leone NT, Garcia-Roig M, Bagley DH. Changing Trends in the Use of Ureteroscopic Instruments from 1996 to 2008. J Endourol. 2010;24: p.361-5. doi: 10.1089/end.2009.0222
• Rosemary F. Ureteroscopy Overtakes SWL for Ureteral Stone Treatment. Renal & Urology News. 2012;02:cover articles.
• Eisner BH, K.M, Dretler SP. Ureteroscopy for the management of stone disease. Nat Rev Urol, 2010;7: p. 40-5. doi: 10.1038/nrurol.2009.233.
• Denstedt JD, Eberwein PM, Singh RR. The Swiss Lithoclast: a new device for intracorporeal lithotripsy. J Urol 1992;148:1088-90. doi:10.1016/s0022-5347(17)36827-1.
• Schock J, Barsky RI, Pietras JR. Urolithiasis update: clinical experience with the Swiss LithoClast. J Am Osteopath Assoc. 2001;101:437-40
• Piergiovanni M, Desgrandchamps F, Cochand-Priollet B, Janssen T, Colomer S, Teillac P, et al. Ureteral and bladder lesions after ballistic, ultrasonic, electrohydraulic, or laser lithotripsy. J Endourol 1994;8:293-9. 29. doi: 10.1089/end.1994.8.293.
• Menezes P, Kumar PV, Tımoney AG. A randomized trial comparing lithoclast with an electrokinetic lithotripter in the management of ureteric stones. BJU international. 2000;85.1: 22-5. doi:10.1046/j.1464-410x.2000.00428.x
• Lee J, Gianduzzo TRJ: Advances in laser technology in urology. Urol Clin North Am 2009; 36:189–198. doi: 10.1016/j.ucl.2009.02.004
• Zarrabi A, Gross AJ. The evolution of lasers in urology. Ther Adv Urol 2011;3:81-9. doi: 10.1177/1756287211400494.
• Akdeniz E, İrkılata L, Demirel HC, Saylık A, Bolat MS, Şahinkaya N, et al. A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones. Turkish journal of urology. 2014;40(3),138. doi: 10.5152/tud.2014.46548.
• Yucel S, Akin Y, Kol A, Danisman A, Guntekin E. Experience on semi-rigid ureteroscopy and pneumatic lithotripsy in children at a single center. World J Urol. 2011;29:719–23. doi: 10.1007/s00345-010-0599.
• Manohar T, Ganpule A, Desai M. Comparative evaluation of Swiss LithoClast 2 and holmium:YAG laser lithotripsy for impacted upper-ureteral stones. J Endourol. 2008;22:443–6. doi:10.1089/end.2007.0288.
• Gunlusoy B, Degirmenci T, Arslan M, Kozacioglu Z, Nergiz N, Minareci S, et al. Ureteroscopic pneumatic lithotripsy: is the location of the stone important in decision making? Analysis of 1296 patients. J Endourol 2008;22:291-294. doi: 10.1089/end.2007.0160.
• Kassem A, Elfayoumy H, Elsaied W, Elgammal M, Bedair A. Laser and pneumatic lithotripsy in the endoscopic management of large ureteric stones: a comparative study. Urol Int. 2012;88:311-315. doi: 10.1159/000336254.
• Sözen S, Küpeli B, Tunc L, Senocak C, Alkibay T, Karaoğlan U, et al. Management of ureteral stones with pneumatic lithotripsy: report of 500 patients. J Endourol 2003;17:721-724. doi: 10.1089/089277903770802236.
• Aydemir H, Budak S, Hirik E, Kumsar Ş, Çelik O, Adsan Ö. Upper Ureteral Stone Treatment: Effectiveness and Complications of Holmium Laser and Pneumatic Lithotripsy. J Clin Anal Med 2016;7:46-49. doi: 10.4328/JCAM.3230.
• Irer B, Şen V, Erbatu O, Yıldız A, Ongün Ş, Çınar Ö, et al. Comparison of efficacy and complications of holmium laser and pneumatic lithotripters used in the ureterorenoscopic treatment of proximal ureter stones, a multi-center study of society of urological surgery aegean study group. Journal of Urological Surgery. 2018;5(3), 158-163. doi: 10.4274/jus.214.
• Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Koras O, Arslan B, et al. Comparison of Ho: YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: an analysis of risk factors. Kaohsiung J Med Sci 2014;30:153-158 doi: 10.1016/j.kjms.2013.08.007
• Ilker Y, Ozgür A, Yazici C. Treatment of ureteral stones using Holmium:YAG laser. Int Urol Nephrol 2005;37:31-34. doi: 10.1007/s11255-004-6084-3.
• Bagley DH. Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi. Curr Opin Urol 2002;12:277-280. doi: 10.1097/00042307-200207000-00003.
• Jeon SS, Lee KS, Won HS, Park KH, Lee SW, Choi HY, et al. A comparison of Holmium: YAG laser with lithoclast lithotripsy in ureteral calculi fragmentation. Korean Journal of Urology. 2000; 41(3), 375-380. doi: 10.1111/j.1442-2042.2005.01087.x.
• Tipu SA, Malik HA, Mohhayuddin N, Sultan G, Hussain M, Hashmi A, et al. Treatment of ureteric calculi--use of Holmium: YAG laser lithotripsy versus pneu-matic lithoclast. J Park Med Assoc 2007;57:440-443
• Eisner BH, Dretler SP. Use of the Stone Cone for prevention of calculus retropulsion during holmium:YAG laser lithotripsy: case series and review of the literature. Urol Int 2009;82:356-60. doi: 10.1159/000209372.
• Bastawisy M, Gameel T, Radwan M, Ramadan A, Alkathiri M, Omar A. A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy. Ther Adv Urol 2011;3:203-10. doi: 10.1177/1756287211419551.
• Salvadó JA, Mandujano R, Saez I, Saavedra A, Dell’oro A, Dominguez J, et al. Ureteroscopic lithotripsy for distal ureteral calculi: comparative evaluation of three different lithotriptors. J Endourol 2012;26:343-6. doi.org/10.1089/end.2011.0416.
• Rashid AO, Attar A, Mohammed KS, Fakhralddin SS, Abdulla LN, Buchholz N. Direct Comparison of Pneumatic and Ho: YAG Laser Lithotripsy in the Management of Lower Ureteric Stones. Urologia Internationalis, 2020; 104(9-10), 765-768. doi: 10.1159/000508419.
• De la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, et al. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol. 2014;28:131–139. doi: 10.1089/end.2013.0436.
• Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-centre experience. J Endourol 2006;20:179. doi: 10.1089/end.2006.20.179.
• Nour HH, Kamel AI, Elmansy H, Badawy MH, Shabana W, Abdelwahab A, et al. Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country. Arab Journal of Urology. 2020;18.3: 181-186. doi: 10.1080/2090598X.2020.1749800.
• Bapat SS, Pai KV, Purnapatre SS, Yadav PB, Padye AS. Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones. J Endourol. 2007;21:1425–1427. doi: 10.1089/end.2006.0350.