2 cm'den büyük ürik asit taşlarında oral kemoliz

Süleyman ATAUS, Bülent ÖNAL, Armağan ÖNER, Burçin TUNÇ, Veli YALÇIN, Cabir ALAN

Özet

Medikal kemoliz ile ürik asit taşları eritilebilir tekrarlaması engellenebilir. Bu bilgiler ışığında kliniğimize 2000 ile 2004 tarihleri arasında 2 cm'den büyük ürik taşı ile başvuran 12 hastaya yeterli hidrasyon ve potasyum sitrat (1 mEq/kg/gün) tedavisi başladık. Potasyum sitrati tolere edemeyen hastalarda sodyum (650 mgr günde 3-4 kez) bikarbonat tedavisine geçildi ve bu hastalar prospektif olarak takip edildi. İdrar pH'ları kontrol edilerek 7,0 olacak şekilde doz ayarlaması yapıldı. Hiperürisemisi saptanan 3 hastaya ise Allopurinol (300 mgr/ gün) başlanıldı. Ortalama taş yükü 29 mm (20-40) olan hastaların hepsinin aşları ortalama 3.7 (2-6) ayda eritildi. Anüri ile başvuran soliter böbrekli 1 hasta dışında hiçbir hastaya kateter takıldı.Sonuç olarak oral kemoliz 2 cm'den büyük ürik asit taşlarında da güvenle,kullanılabilecek bir yöntemdir.

Abstract

Background and Design.- By medical chemolysis, uric acid calculus can be dissolved and their recurrences can be avoided. Between 2000 and 2004, 12 patients applied to our clinics with uric acid calculus larger than 2 cm. We treated these patients with adequate hydration and potassium citrate (1 mEq/kg/day). For those who can not tolerate potassium citrate, sodium bicarbonate (650 mgr 3-4 times a day) was started. Each patient was given a pH paper to record urinary pH, and drug dozes' were titrated until urinary pH 7.0 was reached. Allopurinol (300mgr/day) was given to the ones with hyperurisemia. Patients were followed-up with urinary sediment, urinary culture, and ultrasonography and/or computerized tomography. Results.- Mean age of the patients were found to be 51 (34-70). Eight patients had left, 4 had right kidney stone. One patient had solitary kidney. Mean stone size were 29 mm (20-40). All of the stones were dissolved in 3.7 (2-6) months. None of the patients had urinary infection through out of the treatment. Conclusion.- Even for the uric acid stones larger than 2 cm, oral chemolysis can be the treatment of choice. It is simple, safe and inexpensive. However, "it requires rigid compliance by the patient and strict follow-up.