Giriş kılıfı kullanılmadan retrograd intrarenal cerrahi planlanan erişkin hastalarda pasif dilatasyon gerekliliğini etkileyen faktörler: Üreter çapı önemli mi? Retrospektif çalışma
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Retrograd intrarenal cerrahi (RİRS) öncesi çift j (JJ) stent ilepasif dilatasyon uygulaması rutin olarak uygulanması önerilmemekle birlikte erişkin hastaların yaklaşık %10’unda ihtiyaç olduğu bildirilmiştir. Bu durumda %10 hastada rutin pasif dilatasyon yapılmayan ve genel anestezi altında RİRS planlanan hastada litotripsi uygulanamadan JJ stent takılarak işlemin sonlanmasına neden olur. Erişkinde lokal anestezi altında JJ stent takılabilmesi bu hasta grubunda fazladan genel anestezi almasını gerektirecektir. Bu nedenle pasif dilatasyon gereken hastaların işlem öncesi öngörülmesi önemlidir. Bu çalışmadaki amacımız hastalardaki pasif dilatasyon ihtiyacını öngörmektir. H1 hipotez: İşlem öncesi çekilen kontrastsız bilgisayarlı tomografi (NKBT)’de üreter çapı küçük ölçülen üreter orenal ünitelerde pasif dilatasyon ihtiyacı fazladır. Gereç-Yöntem: Bu çalışmada 02.09.2010 ile 30.10.2022 tarihleri arasında kliniğimizde RİRS yapılan 1610 hasta verileri retrospektifdeğerlendirildi. Vaka kontrol çalışması olarak planlandı. Dışlama kriterleri sağlandıktan sonra pasif dilatasyon yapılan 52 hasta çalışmaya alındı. Yaş, cinsiyet benzer pasif dilatasyon uygulanmayan 52 hastadan kontrol grubu oluşturuldu. Bilgisayarlı tomografide üreter çapları 3 farklı odaktan ölçüldü. Üreterleri NKBT’de ölçülemeyen hastalar üreter çapı ölçülemeyen olarak değerlendirildi. Gruplar demografik özellikler, taş özellikleri, proksimal, orta ve distal üreter çap ölçümleri ile karşılaştırıldı. Bulgular: Pasif dilatasyon grubu ile kontrol grubu arasında yaş, taraf, VKİ ve preoperatif SWL uygulanması açısından fark yoktu. Pasif dilatasyon grubunun üreter çapları her üç odakta da daha küçüktü (p<0,001). Proksimal üreterde 5 mm ve altı, orta ve distal üreterde 4 mm ve altı pasif dilatasyon ihtiyacı için anlamlı saptandı. Üreter çaplarının pasif dilatasyonu öngörmede doğruluğu en yüksek %77,88 ile distal üreterdi. Pasif dilatasyon grubunda taş boyutu daha küçük saptandı (p=0,005). Taş yerleşimi ele alındığında, pasif dilatasyon grubunda en çok alt pol, kontrol grubunda ise en yüksek oranda pelvis yerleşimli izlendi (p=0,035). Sonuç: H1 hipotezimiz doğrulandı. RİRS planlanan hastaların cerrahi öncesi çekilen NKBT’lerinde üreter çapı ölçülerek pasif dilatasyon gerekliliği öngörülebilir.
Objective: It has been reported that passive dilation with a double j (JJ) stent before retrograde intrarenal surgery (RIRS) is needed in approximately 10% of patients although it is not recommended routinely. In that 10% of cases, whom RIRS is planned under general anesthesia and routine passive dilatation is not performed, the procedure results as termination with insertinga JJ stent before lithotripsy. JJ stent can be inserted under local anesthesia in adults but in those situations cases will require additional general anesthesia. Therefore, it is important to predict patients who require passive dilation before the procedure. Our aim in this study is to predict the requirement of passive dilatation in patients. H1 hypothesis: The need for passive dilatation is high in ureterorenal units whose ureteral diameter is measured to be small in the non-contrastcomputed tomography (NCCT) taken before the procedure. Materials-Methods: In this study, the data of 1610 patients whounderwent RIRS in our clinic between 02.09.2010 and 30.10.2022 were evaluated retrospectively. This study planned as a case-control study. In this study 52 patients were included who underwent passive dilation after exclusion criteria was met. A control group was created from 52 patients of similar age and gender who did not undergo passive dilatation. Ureter diameters were measured from 3 different centers on computed tomography. Patients whose ureters could not be measured on NCCT were considered as patients with unmeasurable ureter diameter. The groups were compared according to demographics, stone characteristics and number of the SWL application performed. Proximal, middle and distal ureter diameter measurements were compared. Results: There was no difference between the passive dilation and control groups in terms of age, side, BMI and preoperative SWL application. Ureter diameters of the passive dilation group were smaller in all three centers (p<0,001). Stones which measured 5 mm or less in the proximal ureter and 4mm or less in the middle and distal ureter were found to be significant for the requirement of passive dilatation. The highest accuracy of predicting ureteral diameters that requires passive dilatation was in the distal ureter with %77,88. Stone size was found to be smaller in the passive dilation group (p = 0.005). When stone location was considered, it was observed that the stone location was mostly located in the lower pole in the passive dilation group while in the control group it was located in the pelvis (p = 0,035). Conclusion: Our H1 hypothesis was confirmed. The requirement of passive dilatation can be predicted by measuring the ureter diameter in the preoperative NCCT’s of patients which planned RIRS procedure.
Objective: It has been reported that passive dilation with a double j (JJ) stent before retrograde intrarenal surgery (RIRS) is needed in approximately 10% of patients although it is not recommended routinely. In that 10% of cases, whom RIRS is planned under general anesthesia and routine passive dilatation is not performed, the procedure results as termination with insertinga JJ stent before lithotripsy. JJ stent can be inserted under local anesthesia in adults but in those situations cases will require additional general anesthesia. Therefore, it is important to predict patients who require passive dilation before the procedure. Our aim in this study is to predict the requirement of passive dilatation in patients. H1 hypothesis: The need for passive dilatation is high in ureterorenal units whose ureteral diameter is measured to be small in the non-contrastcomputed tomography (NCCT) taken before the procedure. Materials-Methods: In this study, the data of 1610 patients whounderwent RIRS in our clinic between 02.09.2010 and 30.10.2022 were evaluated retrospectively. This study planned as a case-control study. In this study 52 patients were included who underwent passive dilation after exclusion criteria was met. A control group was created from 52 patients of similar age and gender who did not undergo passive dilatation. Ureter diameters were measured from 3 different centers on computed tomography. Patients whose ureters could not be measured on NCCT were considered as patients with unmeasurable ureter diameter. The groups were compared according to demographics, stone characteristics and number of the SWL application performed. Proximal, middle and distal ureter diameter measurements were compared. Results: There was no difference between the passive dilation and control groups in terms of age, side, BMI and preoperative SWL application. Ureter diameters of the passive dilation group were smaller in all three centers (p<0,001). Stones which measured 5 mm or less in the proximal ureter and 4mm or less in the middle and distal ureter were found to be significant for the requirement of passive dilatation. The highest accuracy of predicting ureteral diameters that requires passive dilatation was in the distal ureter with %77,88. Stone size was found to be smaller in the passive dilation group (p = 0.005). When stone location was considered, it was observed that the stone location was mostly located in the lower pole in the passive dilation group while in the control group it was located in the pelvis (p = 0,035). Conclusion: Our H1 hypothesis was confirmed. The requirement of passive dilatation can be predicted by measuring the ureter diameter in the preoperative NCCT’s of patients which planned RIRS procedure.
Description
Keywords
Böbrek taşı, Fleksibl üreterorenoskop, Pasif dilatasyon, JJ stent, Kidney stone, Flexible ureterorenoscope, Prestenting
Citation
Turan, L. (2023). Giriş kılıfı kullanılmadan retrograd intrarenal cerrahi planlanan erişkin hastalarda pasif dilatasyon gerekliliğini etkileyen faktörler: Üreter çapı önemli mi? Retrospektif çalışma. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.