http___www.urology-today.com_lijecenje-ureteralnih-kamenaca-ureterorenoskopijom-iskustvo-referentnog-centra-za-urolitijazu-ministarstva-zdravstva-socijalne-skrbi-republike-hrvatske__1.xml
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Ureterorenoscopy in treating ureteral calculi: experience of Croatian Reference Center for Urolithiasis Radoja I, Sudarević B, Šimunović D, Kuveždić H. Department of Urology, University Hospital Center Osijek, Osijek, Croatia Introduction Initial treatment for patients with ureteral stones are extracorporeal shock-wave lithotripsy (SWL) and ureterorenoscopy (URS). The aim of this study was to present our results of URS in treating ureteral calculi and to analyze stone-free rate (SFR) and complications. Patients and Methods We have analyzed 210 out of 777 patients who had URS at our Department from 1987 to 2013. URS was performed with Storz semirigid ureterorenoscope, using electrokinetic and rarely ultrasonic lithotripsy. Mean age of the patients was 54 years (12-82 years). Male to female ratio was 0.93. Stones were located proximally in 21.9%, mid-ureteral in 29.5% and distally in 48.6%. Median stone size was 10 mm (2-90 mm). Comorbidities were present in 58% patients (arterial hypertension 74.6%). 51% of the patients had previous SWL treatment. SFR was determined as complete abscence of stone fragments on plain abdominal film and ultrasonography after URS treatment. Results Overall SFR was 77.14%, with 58.7% for proximal, 79% for mid-ureteric and 84.3% for distal calculi. 41% of the patients required JJ stent. In 58.3% of non stone-free patients additional SWL session was sufficient for complete stone clearance (modified overall SFR was 90.5%). The rest had clinically insignificant residual fragments and were monitored or they had several SWL sessions. Complications were noted in 23 patients: 13 had fever, 6 required percutaneous nephrostomy and 4 open surgery. Discussion URS is initial treatment option for younger patients and it is safe and effective in removing ureteral stones, because of low retreatment and complication rate.
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Liječenje ureteralnih kamenaca ureterorenoskopijom: iskustvo Referentnog centra za urolitijazu Ministarstva zdravstva i socijalne skrbi Republike Hrvatske Radoja I, Sudarević B, Šimunović D, Kuveždić H. Klinika za urologiju, Klinički bolnički centar Osijek, Osijek, Hrvatska Uvod Metode izbora liječenja ureteralnih kamenaca su ureterorenoskopija (URS) i izvantjelesna litotripsija udarnim valovima (SWL). Ovim retrospektivnim istraživanjem željeli smo prikazati naša iskustva u liječenju ureteralnih kamenaca URS-om i analizirati stone-free rate (SFR) i komplikacije. Bolesnici i metode Analizirali smo 210 od 777 bolesnika liječenih URS-om na Klinici od 1987. do 2013. godine. Koristili smo Storz-ov semirigidni ureterorenoskop s elektrokinetičkom, a u manjoj mjeri i ultrazvučnom litotripsijom. Prosječna dob bolesnika bila je 54 godine (raspon od 12-82), omjer muškaraca i žena bio je 0.93. Kamenci su bili u proksimalnom ureteru u 21.9%, u srednjem u 29,5% i u distalnom u 48.6% slučajeva. Prosječna veličina kamenca je bila 10 mm (raspon 2-90 mm). 58% bolesnika imalo je komorbiditete (arterijska hipertenzija 74.6%). U 51% bolesnika prethodno je urađen SWL. SFR je definiran kao odsutnost fragmenata na rentgenskoj snimci i ultrazvuku neposredno nakon URS-a. Rezultati SFR je sveukupno bio 77.14%, za kamence u proksimalnom ureteru 58.7%, u srednjem 79%, a u distalnom 84.3%. U 41% bolesnika postavljen je JJ stent. U 58.3% bolesnika s fragmentima nakon URS-a urađen je SWL koji je postigao potpuno uklanjanje kamenaca. Ostali bolesnici imali su klinički beznačajne ostatne fragmente, praćeni su tijekom kontrolnih pregleda ili su kasnije podvrgnuti SWL-u. Od komplikacija imali smo vrućicu u 13, perkutanu nefrostomiju u 6, otvoreni operativni zahvat u 4 bolesnika. Rasprava URS je metoda izbora liječenja ureteralnih kamenaca u bolesnika mlađe životne dobi, ima nisku stopu komplikacija i revizije. Dodatni SWL tretman urađen je kada nije došlo do spontanog izmokravanja rezidualnih fragmenata.