Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

KARA, Cengiz; ÜNSAL, Ali; REŞORLU, Berkan; BAYINDIR, Mirze

Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

Cengiz KARA, (Sağlık Bakanlığı, Keçiören Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Ankara, Türkiye)

Berkan REŞORLU, (Sağlık Bakanlığı, Keçiören Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Ankara, Türkiye)

Mirze BAYINDIR, (Sağlık Bakanlığı, Keçiören Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Ankara, Türkiye)

Ali ÜNSAL (Sağlık Bakanlığı, Keçiören Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Ankara, Türkiye)

Türk Üroloji Dergisi/Turkish Journal of Urology

0 0

Yıl: 2011 Cilt: 37 Sayı: 3 Sayfa Aralığı: 210 - 216 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

Öz:

Amaç: Büyük üreter taşlarının (≥1.5 cm) tedavisinde antegrad perkütan yaklaşımın (PCNL) etkinlik ve güvenliliğini değerlendirmek. Gereç ve yöntem: Bu çalışmada Kasım 2006-Mayıs 2009 tarihleri arasında üst üreter taşı nedeniyle kliniğimizde tedavi edilen 44 hasta değerlendirildi. Tüm hastalarda taşlar üreteropelvik bileşkede (UPB) veya proksimal üreterin 5 cm’lik bölümünde olup, taş boyutu 1.5 cm’den büyüktü. Girişimden önce tüm hastalar üriner ultrasonografi (USG) ve intravenöz piyelografi (IVP) ile değerlendirildi. Operasyon sonrası direk üriner sistem grafisi, USG ve IVP yapıldı. Taşsızlık oranı, ortalama operasyon ve floroskopi zamanı, komplikasyonlar ve hastanede kalış zamanı değerlendirildi. Bulgular: Ortalama hasta yaşı 41.2 ve ortalama taş boyutu 2.3 cm (dağılım 1.5-3.0 cm) idi. Girişim sonunda taşsızlık oranı %81.8 olup, 4 mm’den küçük klinik önemsiz rezidü taşları olan 4 hasta göz önüne alındığında toplam taşsızlık oranı %90.9’a ulaşmıştır. İki (%4.4) hastada açık cerrahi girişime geçilmiş, rezidü taşları olan 1 (%2.2) hasta şok dalga litotripsi, 1 (%2.2) hasta ise üreterorenoskopi ile tedavi edilmiştir. Altı (%9.5) hastaya toplayıcı sistemdeki küçük mukozal perforasyonlar ya da rezidü taş nedeniyle double-J stent yerleştirilmiştir. Ortalama ameliyat süresi 47 dakika, floroskopi zamanı 2.4 dakika ve hastanede kalış zamanı 2.8 gün olarak bulunmuştur. Sonuç: PCNL, 1.5 cm’den büyük üst üreter taşlarının tedavisinde yüksek taşsızlık oranları sağlayan etkin ve güvenli bir yöntemdir.

Anahtar Kelime:

Konular: Üroloji ve Nefroloji

Büyük üst üreter taşlarının tedavisinde antegrad perkütan yaklaşımın etkinliği:Tek merkezin deneyimi

Öz:

Objective: To evaluate the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) in patients with upper ureteral calculi ≥1.5 cm. Materials and methods: From November 2006 to May 2009, 44 consecutive patients with upper ureteral stones who were treated in our center were evaluated. In all cases, stones were located in the ureteropelvic junction (UPJ) or in 5 cm of proximal ureter and had greatest diameter ≥1.5 cm. Ultrasonography (USG) and intravenous urography (IVU) were performed in all patients before surgery. After the operation, radiography, USG, and IVU were conducted. The stone-free rate, mean operative and fluoroscopy time, complications, and hospital stay were assessed. Results: Mean patient age was 41.2 years, and mean stone size was 2.3 cm (range 1.5-3.0 cm). The stone-free rate was 81.8% at the end of the procedure. When 4 patients with clinically insignificant residual fragments <4 mm were considered, the success rate reached to 90.9%. Open surgery was performed in 2 (4.4%) patients. One (2.2%) patient underwent shock wave lithotripsy, and one (2.2%) patient was treated with ureterorenoscopy postoperatively for residual stones. A double-J stent was intraoperatively inserted into 6 (9.5%) patients because of small mucosal perforations in the pelvicaliceal system and presence of residual stones. The mean operating time, fluoroscopy time, and hospital stay were 47 min, 2.4 min, and 2.8 days, respectively. Conclusion: PCNL is a safe and effective option for upper ureteral calculi larger than 1.5 cm, providing a high stone-free rate.

Anahtar Kelime:

Konular: Üroloji ve Nefroloji

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Drach GW, Dretler S, Fair W, Finlayson B, Gillenwater J, Griffith D, et al. Report of the United States Cooperative Study of Extracorporeal Shock Wave Lithotripsy. J Urol 1986; 135: 1127-33.
2. Grasso M, Bagley D. A 7.5/8.2F actively deflectable, flexible ureteroscope: a new device for both diagnostic and therapeutic upper urinary tract endoscopy. Urology 1994; 43: 435-41.
3. 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.
4. Sun X, Xia S, Lu J, Liu H, Han B, Li W. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol 2008;22:913-7.
5. Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol 1996; 155: 38-42.
6. Hemal AK, Goel A, Goel R. Minimally invasive retroperitoneoscopic ureterolithotomy. J Urol 2003; 169: 480-2.
7. Geol R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 2005; 19: 54-7.
8. Karami H, Arbab AHMM, Hosseini SJ, Razzaghi MR, Simael NR. Impacted upper-ureteral calculi >1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach? J Endourol 2006; 20: 616-9.
9. Basiri A, Simforoosh N, Ziaee A, Shayaninasab H, Moghaddam SM, Zare S. Retrograde, antegrade, and laparoscopic approaches for the management of large proximal ureteral stones: a randomized clinical trial. J Endourol 2008; 22: 2677-80.
10. Bellman GC, Huang S, Tebyani N, et al. Lumbar notch: a technique in percutaneous renal access. Presented at the 16th World Congress on Endourology and SWL, New York, September 1998.
11. Chien GW, Bellman GC. Blind percutaneous renal access. J Endourol 2002; 16: 93-6.
12. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol 1997; 158: 1915-21.
13. Chen CS, Wu CF, Shee JJ, Lin WY. Holmium:YAG lasertripsy with semirigid ureterorenoscope for upper-ureteral stones >2 cm. J Endourol 2005; 19: 780-4.
14. Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 2004; 172: 1899-902.
15. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 2002; 167: 31-4.
16. Shah OD, Matlaga BR, Assimos DG. Selecting treatment for distal ureteral calculi: shock wave lithotripsy versus ureteroscopy. Rev Urol 2003; 5: 40-4.
17. Yagisawa T, Kobayashi C, Ishikawa N, Kobayashi H, Toma H. Benefits of ureteroscopic pneumatic lithotripsy for the treatment of impacted ureteral stones. J Endourol 2001; 15: 697-9.
18. Park H, Park M, Park T. Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol 1998; 12: 501-4.
19. Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM, Bansal M. Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi? J Endourol 1999; 13: 441-4.
20. Kumar V, Ahlawat R, Banjeree GK, Bhaduria RP, Elhence A, Bhandari M. Percutaneous ureterolitholopaxy: the best bet to clear large bulky impacted upper ureteral calculi. Arch Esp Urol 1996; 49: 86-91.

APA	KARA C, REŞORLU B, BAYINDIR M, ÜNSAL A (2011). Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. , 210 - 216.
Chicago	KARA Cengiz,REŞORLU Berkan,BAYINDIR Mirze,ÜNSAL Ali Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. (2011): 210 - 216.
MLA	KARA Cengiz,REŞORLU Berkan,BAYINDIR Mirze,ÜNSAL Ali Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. , 2011, ss.210 - 216.
AMA	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. . 2011; 210 - 216.
Vancouver	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. . 2011; 210 - 216.
IEEE	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A "Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience." , ss.210 - 216, 2011.
ISNAD	KARA, Cengiz vd. "Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience". (2011), 210-216.

APA	KARA C, REŞORLU B, BAYINDIR M, ÜNSAL A (2011). Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. Türk Üroloji Dergisi/Turkish Journal of Urology, 37(3), 210 - 216.
Chicago	KARA Cengiz,REŞORLU Berkan,BAYINDIR Mirze,ÜNSAL Ali Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. Türk Üroloji Dergisi/Turkish Journal of Urology 37, no.3 (2011): 210 - 216.
MLA	KARA Cengiz,REŞORLU Berkan,BAYINDIR Mirze,ÜNSAL Ali Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. Türk Üroloji Dergisi/Turkish Journal of Urology, vol.37, no.3, 2011, ss.210 - 216.
AMA	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. Türk Üroloji Dergisi/Turkish Journal of Urology. 2011; 37(3): 210 - 216.
Vancouver	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience. Türk Üroloji Dergisi/Turkish Journal of Urology. 2011; 37(3): 210 - 216.
IEEE	KARA C,REŞORLU B,BAYINDIR M,ÜNSAL A "Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience." Türk Üroloji Dergisi/Turkish Journal of Urology, 37, ss.210 - 216, 2011.
ISNAD	KARA, Cengiz vd. "Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience". Türk Üroloji Dergisi/Turkish Journal of Urology 37/3 (2011), 210-216.