Cemil AYDIN, Ramazan TOPAKTAŞ, Selçuk ALTIN, Ali AKKOÇ, Zeynep Banu AYDIN, AYKUT AYKAÇ

Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği

Amaç: Perkütan nefrolitotomi (PNL) büyük ve kompleks böbrek taşı tedavisinde ilk seçenek tedavidir. Bu çalışmada tam tüpsüz PNL ile standart PNL yapılan hastaları iş- lemlerin etkinlik ve güvenilirlikleri yönünden karşılaştırmayı amaçladık. Yöntemler: Kliniğimizde, Ocak 2012 - Temmuz 2013 tarihleri arasında 73 hastaya standart ve tam tüpsüz PNL uygulandı, 35 (%39,7) tanesine işlem sonunda nefrostomi tüpü ve üreteral stent yerleştirilmedi, 38 (%43,1) tanesine ise standart PNL yapıldı. Taşlar pnömatik litotriptor ile kırıldı. Geriye dönük hasta ve taş verileri, operasyon süreleri, hastanede kalış süreleri, analjezi ihtiyaçları, taşsızlık oranları, operasyon bulguları, kan kaybı ve perioperatif komplikasyonlar her iki grupta karşılaştırıldı. Bulgular: Hazırlık süresi hariç ortalama operasyon süresi ve floroskopi süresi Grup 1 için 38,3±15,4 dakika, Grup 2 için 51,2±12,9 dakika iken, floroskopi süreleri Grup 1 ve Grup 2 için sırasıyla 4,5±2,4 dakika ve 4,8±2,1 dakika olarak saptandı. Her iki grupta intraoperatif önemli komplikasyon yada artık taş nedeniyle ikinci bir PNL işlemi gerekmedi. Her iki grupta hiçbir hastada postoperatif birinci günde yapılan ultrasonografide ve direk üriner sistem grafisinde, ürinom, kanama ya da rezidü taşa rastlanmadı. Grup 1de sadece 1 hastada, Grup 2de ise 2 hastada kan transfüzyonu ihtiyacı oldu. İki grup arasında preoperatif hasta verileri ve postoperatif komplikasyonlar açısından anlamlı bir farklılık yoktu, fakat tam tüpsüz grubun hastanede kalış süresi daha kısa ve analjezik ihtiyacı daha az idi. Sonuç: Nefrostomi tüpü ve üreteral stentin konulmaması ameliyat sonrası hasta konforunu arttırır, analjezik ihtiyacını ve hastanede kalış süresini azaltır. Tam tüpsüz PNL operasyonunun seçilmiş uygun vakalarda güvenilir ve etkin bir tedavi yöntemi olduğunu düşünmekteyiz.

Efficacy and safety of totally tubeless standard percutaneous nephrolithotomy in patients with kidney stones

Objective: Percutaneous nephrolithotomy (PNL) is the firstline treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods: Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7%) (Group 1) of them and 38 (43.1%) (Group 2) patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results: The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases.

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