Öz
Amaç: Perkütan nefrolitotomi (PNL) uygulanan hastalarda cerrahın intraoperatif taşsızlık kanısının doğruluğunu,
bunu etkileyen faktörleri, yanlış tahminine sebep olan prediktörleri saptamak ve sonuç olarak “cerrah gözü” ‘nün
güvenilirliğini değerlendirmek amaçlandı.
Gereç ve Yöntemler: PNL uygulanan ve dahil etme kriterlerine uyan 1025 hastanın verileri retrospektif olarak incelendi.
Çalışmamızın temeli cerrahın taşşsızlığı değerlendirmesi üzerine olması sebebiyle, cerrahın intraoperatif
rezidü taş (RT) kalmadığı kanaatini belirttiği ancak postoperatif bilgisayarlı tomografi görüntülemede RT olan ve
olmayan hasta grupları değişkenlere göre karşılaştırıldı.
Bulgular: Cerrah gözü‘nün sensitivitesi %67,87, spesifitesi %96,23, pozitif prediktif değeri %91,67 ve negatif prediktif
değeri %83,04 bulundu. Çalışmamızda “cerrahın gözü” ‘nün %16,9 oranında yanlış taşsızlık tahmin ettiği
saptandı. Her iki grup arasında cinsiyet, taşın tarafı, taşın yoğunluğu ve hemoglobin düşüşü arasında istatistiksel
anlamlı ilişki saptanmadı. Taş boyutu, operasyon süresi, floroskopi süresi, taşın konumu, kaliks taşlarının sayısı
ve GUY’s nefrolitometri skoru (GSS) cerrahın gözü ile istatistiksel anlamlı ilişkili saptandı. Cerrahın gözü ile istatistiksel
anlamlı ilişki saptanan parametrelerin çok değişkenli (multivariate) lojistik regresyon analizi sonucunda
sırasıyla taş boyutu, kaliks taşlarının sayısı ve GSS anlamlı prediktörler olarak bulundu.
Sonuç: PNL’ de “cerrah gözü” nün en önemli prediktörleri taş boyutu, kaliks taş sayısı ve GSS idi. Bu prediktörler
taşsızlık öngörülen hastaların postoperatif görüntülemelerinde, radyasyon maruziyetini azaltacak yöntemlerin
kullanılmasında etkili bir kriter olarak kullanılabilir.
Anahtar Kelimeler
böbrek taşları perkütan nefrolitotomi taşsızlık durumu intraoperatif değerlendirme cerrahın gözü
Kaynakça
- 1. Turk C, Petřik A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69:475-82
- 2. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score—Grading the complexity of percutaneous nephrolithotomy procedures. Urology 2011;78: 277–81. https://doi:10.1016/j.urology.2010.12.026
- 3. Smith A, Averch TD, Shahrour K, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. Journal of Urology 2013;190: 149– 56. https://doi.org/10.1016/j.juro.2013.01.047
- 4. Lehtoranta K, Mankinen P, Taari K, et al. Residual stones after percutaneous nephrolithotomy: sensitivities of different imaging methods in renal stone detection. Ann Chir Gynaecol 1995;84: 43–49.
- 5. Gokce MI, Ozden E, Suer E, et al. Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy. Int Braz J Urol 2015;41: 86-90. https://doi.org/10.1590/S1677- 5538.IBJU.2015.01.12
- 6. Emmott AS, Brotherhood HL, Paterson RF, Lange D, Chew B.H. Complications, Re- Intervention Rates, and Natural History of Residual Stone Fragments After Percutaneous Nephrolithotomy. J Endourol 2018;32:28-32. https://doi.org/10.1089/end.2017.0618
- 7. Wong, VKF, Que J, Kong EK, et al. The Fate of Residual Fragments after PCNL: Results from the EDGE Research Consortium. Journal of Endourology ja. (2023). https://doi.org/10.1089/end.2022.0561
- 8. Harraz AM, Osman Y, El-Nahas AR, et al. Residual stones after percutaneous nephrolithotomy: Comparison of intraoperative assessment and postoperative non- contrast computerized tomography. World J Urol 2017;35:1241–46. https://doi.org/10.1007/s00345-016-1990-4
- 9. Portis AJ, Laliberte MA, Holtz C, et al. Confident intraoperative decision making during percutaneous nephrolithotomy: Does this patient need a second look? Urology 2008;71: 218–22. doi:10.1016/j. urology.2007.08.063
- 10. Gokce MI, Gulpınar O, İbisA, et al. Retrograde vs. antegrade fl exible nephroscopy for detection of residual fragments following PnL: A prospective study with computerized tomography control. Int Braz J Urol 2019;45: 581-7. https://doi.org/10.1590/S1677- 5538.IBJU.2018.0695
- 11. Perez-Fentes DA, Gude F, Blanco M, Novoa R, Freire CG. Predictive analysis of factors associated with percutaneous stone surgery outcomes. Can J Urol 2013;20: 7050–59. PMID: 24331348
- 12. Nevo A, Holland R, Schreter E, et al. How Reliable Is the Intraoperative Assessment of Residual Fragments During Percutaneous Nephrolithotomy? A Prospective Study. J Endourol 2018;32:471-75. https://doi.org/10.1089/end.2018.0005
- 13. Noureldin YA, Elkoushy MA, Andonian S. Which is better? Guy’s versus S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy. World J Urol 2015;33: 1821-25. doi:10.1007/s00345-015-1508-5
- 14. Vicentini FC, Marchini GS, Mazzucchi E, Claro JF, Srougi M. Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 2014;83: 1248–53. doi:10.1016/j. urology.2013.12.041
Intraoperative Assessment of Stone Free Status for Percutaneous Nephrolithotomy Surgery: Surgeon’s Eye
Öz
Objective: In patients who underwent percutaneous nephrolithotomy (PNL),it was aimed to determine
the accuracy of the surgeon’s intraoperative stone-free status (SFS) prediction, the factors affecting it, the
predictors that cause incorrect estimation, and finally to evaluate the reliability of the “surgeon’s eye”.
Material and Methods: The data of 1025 patients who underwent PNL and met the inclusion criteria
were evaluated retrospectively. Since the basis of our study was based on the evaluation of the surgeon’s
stone-free prediction, patients identified as “absence of residual stone fragment (RF)” by the surgeon were
grouped and compared with postoperative computed tomography imaging according to the presence of RF.
Results: Sensitivity, specificity, positive predictive value and negative predictive value were calculated as
67.87%, 96.23%, 91.67% and 83.04%, respectively. In our study, it was found that the “surgeon’s eye” predicted
SFS incorrectly at a rate of 16.9%. There was no statistically significant relationship between gender,-
stone side,stone density and hemoglobin decrease between the two groups. Stone size,operation time,
fluoroscopy time, location of the stone,number of stones in the calyces and GUY’s stone score (GSS) were
found to be statistically significant in relation to the “surgeon’s eye”. As a result of multivariate logistic regression
analysis stone size, number of stones in the calyces and GSS were significant predictors of the
parameters that had a statistically significant relationship with the surgeon’s eye.
Conclusion: The most important determinants of “surgeon’s eye” in PNL were stone size,number of stones
in the calyces and GSS. These predictors can be used as an effective criterion in the use of methods to reduce
radiation exposure in postoperative imaging of patients who are predicted to be stone-free.
Anahtar Kelimeler
stones percutaneous nephrolithotomy stone-free status intraoperative evaluation surgeon’s eye
Kaynakça
- 1. Turk C, Petřik A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69:475-82
- 2. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score—Grading the complexity of percutaneous nephrolithotomy procedures. Urology 2011;78: 277–81. https://doi:10.1016/j.urology.2010.12.026
- 3. Smith A, Averch TD, Shahrour K, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. Journal of Urology 2013;190: 149– 56. https://doi.org/10.1016/j.juro.2013.01.047
- 4. Lehtoranta K, Mankinen P, Taari K, et al. Residual stones after percutaneous nephrolithotomy: sensitivities of different imaging methods in renal stone detection. Ann Chir Gynaecol 1995;84: 43–49.
- 5. Gokce MI, Ozden E, Suer E, et al. Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy. Int Braz J Urol 2015;41: 86-90. https://doi.org/10.1590/S1677- 5538.IBJU.2015.01.12
- 6. Emmott AS, Brotherhood HL, Paterson RF, Lange D, Chew B.H. Complications, Re- Intervention Rates, and Natural History of Residual Stone Fragments After Percutaneous Nephrolithotomy. J Endourol 2018;32:28-32. https://doi.org/10.1089/end.2017.0618
- 7. Wong, VKF, Que J, Kong EK, et al. The Fate of Residual Fragments after PCNL: Results from the EDGE Research Consortium. Journal of Endourology ja. (2023). https://doi.org/10.1089/end.2022.0561
- 8. Harraz AM, Osman Y, El-Nahas AR, et al. Residual stones after percutaneous nephrolithotomy: Comparison of intraoperative assessment and postoperative non- contrast computerized tomography. World J Urol 2017;35:1241–46. https://doi.org/10.1007/s00345-016-1990-4
- 9. Portis AJ, Laliberte MA, Holtz C, et al. Confident intraoperative decision making during percutaneous nephrolithotomy: Does this patient need a second look? Urology 2008;71: 218–22. doi:10.1016/j. urology.2007.08.063
- 10. Gokce MI, Gulpınar O, İbisA, et al. Retrograde vs. antegrade fl exible nephroscopy for detection of residual fragments following PnL: A prospective study with computerized tomography control. Int Braz J Urol 2019;45: 581-7. https://doi.org/10.1590/S1677- 5538.IBJU.2018.0695
- 11. Perez-Fentes DA, Gude F, Blanco M, Novoa R, Freire CG. Predictive analysis of factors associated with percutaneous stone surgery outcomes. Can J Urol 2013;20: 7050–59. PMID: 24331348
- 12. Nevo A, Holland R, Schreter E, et al. How Reliable Is the Intraoperative Assessment of Residual Fragments During Percutaneous Nephrolithotomy? A Prospective Study. J Endourol 2018;32:471-75. https://doi.org/10.1089/end.2018.0005
- 13. Noureldin YA, Elkoushy MA, Andonian S. Which is better? Guy’s versus S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy. World J Urol 2015;33: 1821-25. doi:10.1007/s00345-015-1508-5
- 14. Vicentini FC, Marchini GS, Mazzucchi E, Claro JF, Srougi M. Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 2014;83: 1248–53. doi:10.1016/j. urology.2013.12.041
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Üroloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 15 Sayı: 2 |
