Kalis taşlarında beden dışı şok dalga ile taş kırmanın taş yerleşimine göre etkinliği

Sedat SOYUPEK,Abdullah ARMAĞAN,M. Burak HOŞCAN,Alim KOŞAR,Hakkı PERK,T. Ahmet SEREL

Özet

Çalışmamızda izole alt, orta ve üst kalis taşlarında beden dışı şok dalga ile taş kırma (ESWL) monoterapisinin etkinliğini değerlendirmeyi amaçladık. İzole kalis taşı olan 284 hastaya Stonelith V3 lithotripter (PCK, Türkiye) kullanarak ESWL tedavisi uygulandı. Alt, orta ve üst kaliste taşı olan hastaların sayısı sırasıyla 155, 76 ve 53 idi. Hastalar ayrıca taş boyutuna bağlı olarak 3 gruba ayrıldı; grup 1: 1 cm'den küçük, grup 2: 1.1-2.0 cm, grup 3: 2 cm' den büyük taşlar. Olgular tedavi sonucu açısından taşsız (stone-free), klinik olarak önemsiz rezidüel fragmanlar ve başarısız olarak ayrıldı. Klinik olarak önemsiz rezidüel fragmanlar; 4 mm veya daha küçük boyutta, obstrüksiyon veya enfeksiyona yol açmayan taş parçaları olarak kabul edildi. Alt, orta ve üst kalis taşları için taşsızlık oranı sırasıyla %59.35, %76.3 ve %77.35 idi. Alt kalis taşı olan hastalardaki taşsızlık oranı orta ve üst kalis taşı olan hastalara göre istatistiksel olarak anlamlı bir şekilde düşüktü (p=0.01, p= 0.02 sırasıyla). Ortalama yaş, tedavi seanslarının sayısı, şok dalgalarının sayısı ve taş çapları açısından gruplar arasında istatistiksel anlamlı fark saptanmadı (sırasıyla p= 0.9, p= 0.5, p= 0.1 ve p= 0.5). Taşyolu gelişen 20 (%7.04) hastanın alt, orta ve üst kalis gruplarına dağılımı ise sırasıyla 10, 4 ve 6 idi. ESWL'nin izole kalis taşlarının tedavisinde başarılı olduğu gözükmektedir. ESWL, alt kalis taşlarıyla karşılaştırıldığında özellikle üst ve orta kalis taşlarında daha etkili olmaktadır.

Abstract

Introduction: Treatment of patients with urinary calculi has undergone a dramatic change since the introduction of extracorporeal shock wave lithotripsy (ESWL) that proved to be highly effective with little morbidity. ESWL has become established as the preferred treatment for most upper urinary tract calculi. We assessed the efficacy of ESWL monotherapy for isolated lower pole nephrolithiasis and compare it to that for isolated middle and upper calyceal calculi. Materials and Methods: Patients with symptomatic urinary calculi who underwent ESWL as monotherapy were included in the study. Patients were evaluated with a plain film of the kidneys, ureters and bladder, excretory urography (IVP) and/or ultrasonography, urinalysis, urine culture, serum biochemistry and coagulation tests before the procedure. We treated 284 patients with isolated calyceal stones using a Stonelith V3 lithotripter (PCK, Turkey). The stones were localized in the lower, mid and upper calices in 155, 76 and 53 patients, respectively. The patients were further stratified into three groups based on stone diameter and included group 1- less than 1 cm., group 2- 1.1 to 2.0 cm. and group 3- greater than 2.0 cm. Results were classified as stone-free, clinically insignificant residual fragments, and failure. Clinically insignificant residual fragments were nonobstructive and non-infectious stone fragments and 4 mm. or less in size. Treatment was initiated with 9 kV, and energy was gradually increased by 0.5 kV to the maximum level (23 kV) that the patient could tolerate. The energy and shock waves, use of anaesthesia, number of treatment sessions, auxiliary measures and complications were noted. Results regarding calyceal localization were compared. Statistical analysis was performed by chi-square and Fisher's exact test. Results: The overall stone free rate was 59.35%, 76.3% and 77.35% for lower, middle and upper calyceal stones, respectively. There was no statistically significant difference between groups in mean age, number of treatment sessions, number of shock waves and stone diameters (p: 0.9, p: 0.5, p: 0.1, and p: 0.5, respectively). There was statistically significant difference between calyx groups and stone-free rate (p: 0.007). Stone-free rate in patients with lower calyceal stones was significantly lower than patients with middle and upper calyceal stones (p: 0.01, p: 0.02, respectively). The difference in stone-free rates among the middle and upper calyceal stones did not reach statistical significance. Steinstrasse developed in 20 (7.04%) patients in whom stones were localized in the lower, middle and upper calices in 10, 4 and 6, respectively. Temporary percutaneous nephrostomy tube placement for Steinstrasse was performed in 2 patients and double J catheter in 2 patients. Conclusion: ESWL appears to be successful for management of isolated calyceal stone disease. ESWL is effective, especially, in patients with upper and middle calyceal stones compared to lower calyceal stones.