İKİ CM’DEN KÜÇÜK PROKSİMAL ÜRETER TAŞLARININ FLEKSİBLE ÜRETERORENOSKOPİ İLE TEDAVİSİ

Abstract

Ozet: Gunumuzde distal ureter taslarinin ilk basamak tedavisi rijid ureterenoskopidir. Ancak proksimal ureter taslarinin standart tedavisi halen tartismalidir. Son yillarda proksimal ureter taslarinda fleksibl ureterenoskopinin basari ile uygulanabilecegi literaturde yerini almaktadir. Bu calismada klinigimizde proksimal ureter taslarina uygulanan fleksibl ureterenoskopi sonuclari sunulmaktadir. Calismaya hastane kayitlari incelenen ve tum datalarina ulasilabilen 28 hasta dahil edildi. Tum hastalara preoperatif idrar kulturleri yapildi. Preoperatif diversiyonu olmayan hastalarin ureter orifislerine balon dilatasyon yapildi. Kilavuz tel uzerinden ilerletilen fleksibl ureterenoskop (Olympus URF-P5) esliginde sisteme girildi ve cerrahin tercihine gore farkli guc ayarlarinda ayni holmiyum lazer esliginde tas kirma islemi gerceklestirildi. Islem sonrasi hastalar direkt uriner sistem grafisi, ultrasonografi, intravenoz pyelografi gerektiginde bilgisayarli tomografi ile degerlendirildi. Hastalarin ortalama yasi 41 (22-84); 15’i (%53,6) erkek ve 13’u (%46,4) kadindi. 25 tas radyoopak, 1 tas semi-opak, 2 tas non-opak olmak uzere 16’si sag toplayici sisteme 12’si sol toplayici sisteme girisim yapildi. 13 (%53,6) hastaya islem oncesi swl uygulanmisti. Ortalama tas boyutu 105mm2 (49-400 mm2)’di. 11 (%39,3) hastada islem oncesi djs bulunmaktaydi. Ortalama ameliyat suresi 45 dakikaydi (35-80). Islem sirasinda 18 hastada (%64,3) anklave tas oldugu goruldu. Postoperatif 4 hastada (%14,3) diversiyon kullanilmazken yine 4 hastaya (%14,3) ureter kateteri konuldu ve birinci gun cekildi. 20 hastaya (%71,4) djs yerlestirildi. Islem sonrasi degerlendirmelerde tum hastalarda rezidu tas saptanmadi. Iki hastada (%7,1) erken donemde uriner enfeksiyon gozlenirken baska komplikasyona rastlanilmadi. Fleksibl ureterenoskopi, anklave taslar da dahil olmak uzere proksimal ureter taslarinda yuksek basari ve minimum komplikasyon orani ile uygulanabilir bir yontemdir. Anahtar Kelimeler: Ureterolitiazis, fleksible ureterenoskopi TREATMENT OF PROXIMAL URETER STONES LESS THAN TWO CENTIMETERS WITH FLEXIBLE URETERENOSCOPY Abstract: The first-line treatment of distal ureteral Stones is rigid ureterenoscopy. However, standard treatment of proximal ureteral stones is still controversial. In recent years, proximal ureteral stones can be managed with flexible ureterenoscopy (F-URS) successfully. This study presents results of F-URS due to the proximal ureteral stones in our clinic. 28 patients with accessible to all data were included in the study. Preoperative urine cultures were performed for all patients. Balloon dilatation of the ureteral orifice was done for patients without urinary diversion. Flexible ureterenoscope (Olympus URF- P5) was introduced over the wire and with different power settings of laser was applied according to the surgeon's preference. After the procedure, patients were evaluated x ray graphy, intravenous urography, ultrasonography and computed tomography when necessary. The average age of patients was 41 (22-84). 15 of patients (53.6%) were male and 13 of patients (46.4%) were female. 25 of stones were radiopaque, 1stone was semi-opaque, and 2 of stones were non-opaque while 16 of access was made on the patients’ right ureter and 12 of access was made on the patients’ left ureter. SWL was performed in 13 patients (%53,6) before the procedure. Mean stone size was 105mm2 (49-400 mm2). Eleven patients (%39,3) had double j stent before the procedure. Mean operative time was 45 minutes (35-80). During the operation, in 18 patients (64.3%) it was found to be completely obstructive stone. Postoperatively diversion was not use for 4 patients (14.3%), ureteral catheter placement was used for 4 patients (14.3%), which were pulled out on the first day. Double j stent was the choice of diversion on 20 patients (71.4%). There were no residual stones in all patients after the evaluation process. Urinary tract infection was the complication in two patients (7.1%) while other complications were not observed. Flexible ureterenoscopy is a reliable method with a high success rate and minimal complications in proximal ureteral stones. Key words: Ureter stone, Flexible ureterenoscopy