Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 4
Böbrek nakli sonrası çift J stent kullanımının etkileri
- Sayfa
- 585–588
- DOI
- —
Özet
Böbrek nakli yapılan alıcılarda görülen üreteral istenmeyen yan etkilerin, idrar yolu enfeksiyonunun ve kreatinin seviyelerinin DJ stenti ile ilişkisini prospektif olarak araştırmayı amaçladık Ocak 2002-Mart 2005 tarihleri arasında Çukurova Üniversitesi'nde canlı akrabadan böbrek nakli yapılan erişkin 60 alıcı prospektif olarak değerlendirildi. Otuz alıcıya (grup I) 4.8 French 12 cm çift J stent konuldu, 30 alıcıya (grup II) ise çift J stent konmadı. Çift J stent 14. günde çekildi. İki grup arasında yaş, cinsiyet, donör yaşı, operasyon süreleri ve soğuk iskemi süreleri açısından fark yoktu. Çift J stent konan alıcılarda herhangi bir üreteral istenmeyen yan etki görülmezken, Çift J stent konmayan 6 alıcıda üreteral istenmeyen yan etki görüldü (p=0.024). Çift J stent konan alıcıların 6'sında idrar yolu enfeksiyonu görülürken, çift J stent konmayan alıcıların 3'ünde idrar yolu enfeksiyonu görüldü (p=0.72). İki grup arasındaki operasyon öncesi ortalama kreatinin değerleri arasında fark yokken (p=0.688), ameliyat sonrası 1., 2. ve 3. günlerde Grup I'deki kreatinin düzeylerinin daha düşük olduğu görüldü (p=0.024, p=0.029 ve p=0.041). Dördüncü günden sonra kreatinin düzeylerinde ise farkın kaybolduğu görüldü (p>0.05). Ameliyat sonrası 1. gün idrar miktarının grup I'de daha fazla olduğu görüldü (p=0.017). Üreteral istenmeyen yan etkilerin önlenmesinde ve üreterovezikal anastomozun yeterli bir çapta güvenle oluşturulması açısından çift J stentlerin önemli bir role sahip olduğu kanaatindeyiz. Bunun yanında, yoğun immünsupresif tedavi altındaki böbrek nakli alıcılarında çift J stentin mümkün olan en kısa zamanda çekilmesi uygun olacaktır.
Abstract
Introduction: In modern urology, ureteral stents are playing significant role in avoiding complications after endoscopic or open surgery. In this study, the association between double J stent and ureteral complications, urinary tract infections and creatinine levels in renal transplant recipients after renal transplantation was prospectively assessed. Materials and Methods: Between January 2002 and March 2005, 60 recipients after renal transplantation from relative living donors in Cukurova University were observed prospectively. Lich-Gregoir reimplantation was used as ureteroneocystostomy technique. 4.8 French 12 cm double J stent was placed in 30 recipients (Group I). No double J stent was placed in 30 recipients (Group II). Double J stents were removed 14 days after renal transplantation. More than 105 colonies of bacteria in urine culture were considered as urinary tract infection. The creatinine levels and urine volumes of recipients were documented for 7 days postoperatively. Results: There was no difference between two groups according to age, sex, donor's age, operation time and cold ischemia time. Ureteral complications were seen in 6 recipients in group II (no double J) while no complication was seen in group I (p=0.024). Urinary tract infection occurred in 6 recipients in group I and in 3 recipients in group II (p=0.72). The average creatinine level in group I was lower than group II in postoperative 1st, 2nd and 3 rd days (p=0.024, p=0.029 and p=0.041) while there was no significant difference preoperatively (p=0.688). There was no significant difference between two groups in after postoperative 4th, 5th, 6th and 7 th days (all p>0.05). The average urine volume in group I was more than group II in postoperative 1 stday (p=0.017). Conclusion: Ureteral complications after renal transplantation may cause graft loss and mortality. The ureteral stents were used successfully to avoid and reduce the complications. Some centers have suggested that brief stenting could stop minor leakage due to partial disruption of the ureterovesical anastomosis and prevent early obstruction secondary to anastomotic edema or small tunnel hematoma. However, using double J stent routinely was not suggested in some centers because of the stent complications like urinary tract infection, hematuria, stent migration, stone formation, frequency, flank pain, suprapubic pain, dysuria, reflux, stent fracture. As a result, we believe that the double J stents have a significant role in avoiding the ureteral complication and in forming the ureterovesical anastomosis. However, double J stents have to be removed as soon as possible in the recipients who are under serious immunosupressive treatment. Further studies with larger series are necessary to confirm these results.