Yıl: 2006 Cilt: 32 Sayı: 2 Sayfa Aralığı: 225 - 229 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?

Öz:
Bu çalışmada komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilen ve yerleştirilmeyen hastaların sonuçlarını karşılaştırdık. Bu çalışmada 1996 ile 2004 yılları arasında üreteroskopik litotripsi uygulanan 367 hasta retrospektif olarak değerlendirilmiştir. Hastalar iki gruba ayrıldı; ilk grupta stent takılan (4.8 F çift J stent) 236 hasta, ikinci grupta ise stent takılmayan 131 hasta, üreteroskopi sonuçları ve taşsızlık oranları açısından incelendi. Üreteroskopi işlemi standart olarak 8.5 F rigid üreteroskop ile yapıldı. Litotripsi işleminde ise pnömotik litotriptör kullanıldı. Hastaların ortalama yaşı stent takılan grupta 40.1 yıl (22-76) ve stent takılmayan grupta ise 37.8 yıl (19-65) olarak saptandı. Ortalama taş boyutu ise sırasıyla 9.1 mm (4-21) ve 7.8 mm (3-17) olarak saptandı. Ameliyat sonrası yapılan kontrollerde hastalar taşsızlık oranları açısından incelendiğinde stent takılan grupta %92.4, takılmayan grupta %90.8 olarak saptandı. Ameliyat süresi stent takılan grupta (ort 51.4, dk:30-110), takılmayanlara (ort 40.2, dk: 25-70) göre daha uzun olarak saptandı. Hastalar sık idrara çıkma, göğüs ağrısı, sıkışma hissi, disüri gibi şikayetler açısından incelendiğinde, stent takılan grupta şikayetlerin belirgin olarak artmış olduğu saptandı. Pnömotik litotripsi uygulanan komplike olmayan üreteroskopilerden sonra stent takılması gerekli olmadığını düşünmekteyiz. İstenmeyen yan etki olmayan litotripsilerden sonra rutin olarak stent yerleştirilmesi ameliyat süresini uzatmakta, maliyeti arttırmakta ve hasta morbiditesini arttırmaktadır.
Anahtar Kelime: Üreteroskopi Litotripsi Stentler Geriyedönük çalışma

Konular: Üroloji ve Nefroloji

Is it necessary to place ureteral stenting after uncomplication ureteroscopic litrotripsy?

Öz:
Introduction: The routine placement of ureteral stents after ureteroscopic lithotripsy procedure is controversial. The main aim of placing a ureteral stent is to prevent ureteral obstruction and renal colic which may develop as a result of uretral edema. Additionally, stents are thought to assist the passage of residual fragments after lithotripsy through passive ureteral dilatation. However, the placement of a ureteral stent is associated with complications including stent migration, breakage, encrustation, stone formation, urinary tract infections and patient discomfort. Therefore numerous studies have been questioned the routine use of ureteral stents after uncomplicated uretroscopic lithotripsy. In this study we compared the results and stone free rates of patients with and without ureteral stenting after uncomplicated ureteroscopic lithotripsy. Materials and Methods: In this study, 367 patients who underwent ureteroscopic lithotripsy between 1996 and 2004 were evaluated retrospectively. Patients were divided into two groups. The first group consisted of 236 stented patients and the second group consisted of 132 non-stented patients. In both groups, patients were evaluated for results and stone free rates. Only uncomplicated ureteroscopy patients were included to the study. Patients with solitary kidney, history of renal failure, transplant kidney and a significant perforation or injury to ureter, high grade hydronephrosis, urinary tract infections and patients with impacted stones were excluded from the study. Additionally, patients with retrogarde stone migration were excluded from the study. The operation was performed under general anesthesia with 8.5 F rigid ureteroscope and stones were fragmented with pneumatic lithotriptor. In stented patients a double-J stent was placed in the treated ureter under fluoroscopic monitoring. In the non-stented group the safety wire was removed from the ureter and then the procedure was terminated. In stented patients, stents were removed cystoscopically under local or general anesthesia. Results: The mean age of patients was 40.1 years (range 22 to 76) in the stented group and 37.8 (range 19 to 65) in the non-stented group. The mean stone size was 9.1 mm (range 4 to 21) and 7.8 mm (range 3 to 17) in the in the stented and nonstented patients, respectively. There was no statistical difference between stone free rates in both groups. The stone free rate was %92.4 in stented group and %90.8 in the non-stented group (p>0.05). However, there was statistically significant difference for operative times between the two groups. The mean operative time was 51.4 min (range 30 to 110) in the stented group and 40.2 min. in the non-stented group (range 25 to 70) (p<0.05). The mean operative times increased 28% in the stented group. The symptoms of urinary frequency, flank pain, urgency and dysuria were more common and severe in the stented group. Additionally, hematuria was more severe and prolonged in stented patients when compared to non-stented patients. Conclusion: Our results demonstrate that it is not necessary to place uretral stent after uncomplicated ureteroscopic pneumatic lithotripsy. There was no difference between nonstented and stented patients with respect to stone free status. Ureteral stent placement following uncomplicated lithotripsy augments the operation time, surgical cost and increases patient morbidity.
Anahtar Kelime: Stents Retrospective Studies Ureteroscopy Lithotripsy

Konular: Üroloji ve Nefroloji
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA ATUĞ F, AKAY F, AKKUŞ Z, ÖRGEN S, ALAR S, ŞAHİN H (2006). Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. , 225 - 229.
Chicago ATUĞ Fatih,AKAY Ferruh,AKKUŞ Zeki,ÖRGEN Sait,ALAR Salih,ŞAHİN Hayrettin Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. (2006): 225 - 229.
MLA ATUĞ Fatih,AKAY Ferruh,AKKUŞ Zeki,ÖRGEN Sait,ALAR Salih,ŞAHİN Hayrettin Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. , 2006, ss.225 - 229.
AMA ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. . 2006; 225 - 229.
Vancouver ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. . 2006; 225 - 229.
IEEE ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H "Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?." , ss.225 - 229, 2006.
ISNAD ATUĞ, Fatih vd. "Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?". (2006), 225-229.
APA ATUĞ F, AKAY F, AKKUŞ Z, ÖRGEN S, ALAR S, ŞAHİN H (2006). Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. Türk Üroloji Dergisi/Turkish Journal of Urology, 32(2), 225 - 229.
Chicago ATUĞ Fatih,AKAY Ferruh,AKKUŞ Zeki,ÖRGEN Sait,ALAR Salih,ŞAHİN Hayrettin Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. Türk Üroloji Dergisi/Turkish Journal of Urology 32, no.2 (2006): 225 - 229.
MLA ATUĞ Fatih,AKAY Ferruh,AKKUŞ Zeki,ÖRGEN Sait,ALAR Salih,ŞAHİN Hayrettin Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. Türk Üroloji Dergisi/Turkish Journal of Urology, vol.32, no.2, 2006, ss.225 - 229.
AMA ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. Türk Üroloji Dergisi/Turkish Journal of Urology. 2006; 32(2): 225 - 229.
Vancouver ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?. Türk Üroloji Dergisi/Turkish Journal of Urology. 2006; 32(2): 225 - 229.
IEEE ATUĞ F,AKAY F,AKKUŞ Z,ÖRGEN S,ALAR S,ŞAHİN H "Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?." Türk Üroloji Dergisi/Turkish Journal of Urology, 32, ss.225 - 229, 2006.
ISNAD ATUĞ, Fatih vd. "Komplike olmayan üreteroskopik litotripsilerden sonra üreteral stent yerleştirilmesi gerekli midir?". Türk Üroloji Dergisi/Turkish Journal of Urology 32/2 (2006), 225-229.