Optimal treatment in lithtripsy with miniureteroscope

Objective: To compare tlýe methods of "breakand leave" and in ureteroscopic lithotripsy. Material and Methods: The last 100 patients with urolithiasis were randomly treated with miniureteroscope using the method of ‘‘break and leave "or " break and clean". A pneumotic. lithotrite was used as the power source. URS procedure was done by 6,9 Fr. Ureteroscope and 3 Fr basket catheter or 3 Fr. grasping forceps was used for cleaning procedure. KUB and USG were performed for the patients at fifteenth day of spontaneous passage following the lithotripsy. All patients were treated with cephaperazone+sulbactam forprophylaxy.
Results: This procedure was achieved in 44 of 50 patients who underwent to lihotripsy and spontaneous passage. In 3 cases secondary ureteroscopic intervention was performed successfully following the primaiy procedure. The remaining 3 cases were subjected to an open ureterolithotomy due. to the hard, multiple and/or big stones. Therefore, the success rate of intervention was 94%, whereas the complication rate was %0. During the ureteroscopy, an open surgery was performed for one patient who was subjected to accessorial interventions in addition to the primary lithotripsy because the basket catheter was broke in two withip ureter. In. one patient, a severe narrowness of ureteral meatus was detected during the postoperative checks, and transurethral meatotomy was petfoimed. In one patient, a detachment in the form of mucosal flap occured during the extraction of stone, and was treated with peroperatiye cold section, In three patients, the basket catheter was affixed during the extraction. In two of our these patients, the basket catheter was removed together with the stone without traction during the 24-48 hours spontaneous passage period, while in one patient the basket catheter was removed together with the stone using the method of peroperative unroofing. Jn 20 out of 50 patients, a 24-hour ureteral catheter was placed to avoid any possible trauma. Our inteiventional success rate was 98%, and the complication rate was 12%, Although using the "break and leave” method combined with cm accessorial tool for cleaning the pieces of stone operation seems to reach a similar success rate, both the high possibility of complications and additional cost of 150$per case should be reconsideved.

Miniüreteroskopla Litotripside Optimal Tedavi Yöntemi

Amaç: Üreteroskopik litotripside ‘kýr-býrak‘ ile ‘kýr-arýndýr‘ yöntemlerini karþýlaþtýrmak
Hastalar ve Yöntem: Son 100 üreter taþý olgusu birebir sýralanarak çalýþmaya alýndý. Üreteroskopik giriþim 6,9 Fr. üreteroskop ile litotripsi ise pnömotik litotriptör ile yapýldý. Taþ arýndýrmada 3 Fr. Basket kaleter veya 3 Fr. Graspitýgforceps kullanýldý. 50 olguda litotripsi sonrasý fragmanlar spontan pasaja býrakýlýrken 50 olguda litotripsi sonrasý aksesuar giriþimlerle arýndýrma iþlemi basket kateter veya grasping forceps ile yapýldý. Litotripsi grubunda olgularýn kontrolü 15. günde DÜS grafisi ve USG ile yapýlýrken, arýndýmýa uyguladýðýmýz olgularda postoperatuar 1. Günde DÜS grafisi ve 15. günde USG gerekli olgularda ise ÝVP ile yapýldý.
Sonuçlar: Litotripsi yapýlýp spontan pasaja býrakýlan grupta, T. 50 n vakanýn 44‘ünde iþlem baþarý ile tamamlandý. 3 vakada sekonder üreteroskopik giriþim ile baþarýlý olundu. 3 vakada ise taþýn sert, mültipl ve/veya büyük olmasý, gibi sebeplerle açýk cerrahi uygulandý. Bu grupta giriþinýsel baþarý oraný %94 olup,: komplikasyon oraný %0‘dýý: Litotripsi yapýlýp arýndýrma uygulanan 50 vakanýn 49‘unda arýndýrma saðlandý. 1 vakada basket kateteriýý iireter içinde kopmasý sonucu açýk cerrahi uygulandý. Aýýçak 3 vakada basket kateter, çýkartýlmasý sýrasýnda ürelerde takýldý. 2 vakada 24/48 saat bekleme periyodu espasýnda traksiyonsuz olarak taþla birlikte çýktý. 1 vakada peroperatuar sýcak kesi yapýlarak kateter taþla birlikte kurtarýldý. 1 vakada üreteral meadan flep kalkmasý, peroperatuar soðuk kesi. ile, 1 vakada? postoperatuar saptanan üreteral mea darlýðý. ise transiüetral meatotomi ile tedavi edildi. Bu grupta ise giriþimsel baþarý oranýmýz %98 olup komplikasyon oraný % 12‘dir.
Yorum: Kýr-býrak ile kýr-arýndýr yöntemlerinin sonuçlarýnda baþarý oranlarý benzer görülmektedir, ancak hastayý ayný seansta stone-free hale getirme kaygýsý ile uyguladýðýmýz aksesuar giriþimler hem komplikasyon oranýný arttýrmakta hem de 150 ABD dolan ilave maliyet getirmektedir.