İki taraflı böbrek taşlarına eş zamanlı perkütan nefrolitotomi: İlk deneyimlerimiz
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Dosyalar
Tarih
2003
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Türk Üroloji Dergisi/Turkish Journal of Urology
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Öz: Aynı ameliyat seansında iki taraflı böbrek taşlarına perkutan nefrolitotomi yaptığımız hastalardaki cerrahi sonuçlarımızı değerlendirdik. Aynı zamanda hastalardaki erken dönem renal fonksiyon değişikliklerini inceledik. Bu ameliyatı yaptığımız altı hastanın başarı, komplikasyon, ek tedavi, kateterizasyon ve hospitalizasyon sürelerini değerlendirdik. Aynı zamanda, hastaların cerrahi öncesi ile cerrahi sonrası 6. ve 48. saatler arasında BUN ve kreatinin değişikliklerim saptadık. Dört hasta taşlanndan temizlendi veya klinik önemi olmayan parçalar kaldı. Bir hasta ek tedavi olarak ESWL ve sonra üreterorenoskopi ile taştan kurtuldu. Bir hastada rezidü taş kaldı. Cerrahi ortalama 225 dakika sürdü, hemoglobin ortalama 2,75 gr/dl azaldı. Bir hastada kan transfüzyonu gereği oldu. Ameliyattan sonra 6. saatte yapılan ölçümlerde üç hastanın BUN ve kreatinin değerlerinde ılımlı yükselme görüldü. Bu değişiklikler 48. saatte eski değerlerine döndü. Hastalar ortalama 5,5 gün hastanede kaldı. Aynı seansta iki taraflı perkutan nefrolitotomi, uygun endikasyonlu hastalarda etkin ve güvenli bir ameliyat tekniği olabilir. Başlık (İngilizce): Bilateral simultaneous percutaneous nephrolithotomy: Our initial experience Öz (İngilizce): Introduction: Percutaneous nephrolithotomy is a minimally invasive method of stone disease surgery, defined in 1976 and is being applied for a variety of indications since than. This surgery is à routine in our clinic for treatment of one kidney in a single session for adults and children since 1998. In May 2001, we have performed our first bilateral simultaneous percutaneous nephrolithotomy operation. In this manuscript, we have evaluated our surgical results in patients who underwent this operation, regarding surgical outcomes, success and complication rates and secondary methods of treatment for residual fragments. We have also investigated renal functional changes in early postoperative period by means of renal functional tests. Material and Methods: We have evaluated success, complication, auxiliary and secondary procedure rates, catheterization and hospitalization times in six patients who underwent this operation. At the same time, we noted BUN and creatinine changes between preoperative period and 6th and 48th postoperative hours. A fragment that is 4mm in largest diameter was rendered as "clinically insignificant". We have also summarized our experience in patients who underwent surgery for one kidney at a single session, with special emphasis on success and complications in a table. Since the data is not suitable, we did not perform any statistical tests for comparison. Results: Four of the 12 renal units had staghorn and another four had multiple stones initially. Mean stone surface area was 542 mm2 and 568 mm2 in right and left kidneys, respectively. Nine kidneys were operated via single nephrostomy tract while two and three tracts were created for two and one kidney units, respectively. In four renal units, at least one nephrostomy tract needed to be created between 11 and 12 ribs. " Of the six patients operated, four rendered stone free or with clinically insignificant stone fragments in both kidneys. Of the patients with residual stone fragments, one was cleared by ESWL followed by ureterorenoscopy. So, our initial success rate was 66,6% and success after secondary procedures was 83,3%. A residual stone fragment persisted in one patient. Mean time of surgery was 225 minutes and mean hemoglobin decrease was 2,75 mg/ml. The second side was operated at a mean of 80 minutes. Mean body temperature decrease was 1,7°C during the operation. One patient needed blood transfusion. Measurements at 6th postoperative hour revealed a mild increase in BUN and creatinine in three patients, but no clinical sign of renal insufficiency was ever realized in any patients. These changes returned to preoperative values at 48' hour. Mean time of urethral catheterization was 1 day and mean time to nephrostomy removal was 3,6 days. Patients were hospitalized for a mean of 5,5 days. Conclusion: Although we have experience in unilateral operations, bilateral simultaneous operation is a new and limited experience for us; larger series may be more suitable to derive strict knowledge on efficacy and safety. Our data reveals that bilateral simultaneous percutaneous nephrolithotomy may be a safe and efficient operation in patients with suitable indications and with experienced surgeons.
Açıklama
Anahtar Kelimeler
Üroloji ve nefroloji
Kaynak
Türk Üroloji Dergisi/Turkish Journal of Urology
WoS Q Değeri
Scopus Q Değeri
Cilt
29
Sayı
2
Künye
M. Y. UĞRAŞ , A. GÜNEŞ , U. YILMAZ , A. SOYLU , C. BAYDİNÇ (2003).İki taraflı böbrek taşlarına eş zamanlı perkütan nefrolitotomi: İlk deneyimlerimiz, Türk Üroloji Dergisi/Turkish Journal of Urology, İnönü Üniversitesi, Malatya.
