Üst üriner sistem minimal invaziv taş cerrahisinde, perioperatif alınan taş tozu içeren sıvının kimyasal incelemesi ile taş protokollü kontrastsız abdominopelvik bilgisayarlı tomografi verilerinin taş analiz sonucunu öngörmedeki yeri
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Date
2018
Authors
Arslan, İbrahim Ethem
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Publisher
Uludağ Üniversitesi
Abstract
Giriş: Böbrek ve üreter taşları için üreterorenoskopik yaklaşım, son yıllarda artan sıklıkta, taş tedavisinde kullanılmaktadır ve hastaların büyük çoğunluğunda analiz yapılabilecek taş elde edilememektedir. Bu çalışmanın amacı; üreterorenoskopik yaklaşım ile tedavi edilen hastalarda, perioperatif alınan taş tozu içeren sıvının, taş öngörüsündeki yerini araştırmaktır. Ayrıca bilgisayarlı tomografi ile yapılacak preoperatif taş dansite ölçümünün, taşın yapısını göstermedeki yeri araştırılacaktır. Gereç ve Yöntem: Kliniğimizde, taş hastalığı için, üreterorenoskopik yaklaşımla tedavi edilen 109 hasta alındı. Perioperatif taş tozu içeren sıvı, 10ml'lik enjektör ile alındı, ameliyat sonunda üreterorenoskop çıkarılırken, 3mm'lik fragman basket kateter ile alındı. Taş tozu içeren sıvının kimyasal incelemesi yapıldı, taş fragmanı X-Işını Kırınımı (XRD) yöntemi ile ayrı bir merkezde incelendi. İki merkez de diğer merkezin sonuçlarını bilmiyordu. Testlerin duyarlılık, özgüllük, doğrulukları hesaplandı. XRD ile kimyasal analiz sonuçları arasındaki uyuma, Cohen'in Kappa Katsayısı ile bakıldı. Bulgular: 16 hasta, taş fragmanı elde edilemediği için, çalışma dışı bırakıldı. Kalan 93 hastanın tümünde karşılaştırmalı analizler yapılabildi. Strüvit taşları %100, kalsiyum oksalat taşları ve ürik asit taşları %99, "kalsiyum oksalat+ürik asit" taşları %98, "kalsiyum oksalat+kalsiyum fosfat" taşları %94 doğruluk oranı ile tespit edildi. Taşların, dansite değerlendirmesinde; "Kalsiyum oksalat+ürik asit" taşlarının dansitesi, "whewellite" grubundan anlamlı düşük çıktı. Bununla birlikte taş dansitesi, taş yapısı hakkında, kimyasal analize ek bilgi sağlayamadı. Tartışma ve Sonuç: Üst üriner sistem taş hastalığının, üreterorenoskopik lazer litotripsi tedavisi sonrasında, taş fragmanı elde edilemeyen hastalarda, perioperatif alınan sıvının kimyasal analizi, taş yapısını yüksek doğrulukta belirlemektedir. Taş tozu içeren sıvının, kolaylıkla ve tüm hastalardan, perioperatif elde edilebilmesi, kimyasal analizin, taş fragmanıyla yapılan analizlere üstünlüğünü oluşturmaktadır. Çalışmamızda, nonkontrast bilgisarlı tomografi verileri ile taş yapısını öngörme konusunda, anlamlı bir sonuç elde edilememiştir.
Introduction: The ureterorenoscopic approach for renal and ureteral stones has been used increasingly in recent years in the treatment of stone, and stone can not be obtained for analysis in the vast majority of patients. The purpose of this study is; investigate to fluid containing stone dust which obtained perioperativly for the role of predicting stone analysis results in patients treated with ureterorenoscopic approach. In addition, the role of stone density measurement with computed tomography preoperativly will be investigate to determine stone structure. Materials and Methods: In our clinic, 109 patients treated with ureterorenoscopic approach for stone disease were included. Perioperative fluid containing stone dust was taken with a 10 ml syringe. At the end of the operation, ureterorenoscope was removed while 3 mm fragment was taken by basket catheter. Chemical analysis of the fluid containing stone dust was performed, the stone fragment was examined at a separate center with X-Ray Diffaction (XRD) tecnique. Both centers did not know the results of the other center. The sensitivity, specificity, and accuracy of the tests were calculated. The consistency between XRD and chemical analysis results was measured with Cohen's Kappa Coefficient. Results: Sixteen patients were excluded from the study because no stone fragment could be obtained. Struvite stones were found 100%, calcium oxalate stones and uric acid stones 99%, "calcium oxalate + uric acid" stones 98%, "calcium oxalate + calcium phosphate stones" 94% accuracy. In evaluating the density of the stones; The density of "calcium oxalate + uric acid" stones was significantly lower than the "whewellite" group. However, stone densities did not provide additional information about the stone structure, apart from the information we obtained by chemical analysis. Discussion and Conclusion: After ureterorenoscopic laser lithotripsy treatment of upper urinary system stone disease, the chemical analysis of the fluid which obtained perioperativly in patients who can not obtain a stone fragment, determines stone structure with high accuracy. The fluid containing stone dust, can be easily and perioperatively obtained from all patients so chemical analysis is superior to analyzes made with stone fragments. In our study, no significant results were obtained, in predicting structure of stone, with noncontrast computed tomography data.
Introduction: The ureterorenoscopic approach for renal and ureteral stones has been used increasingly in recent years in the treatment of stone, and stone can not be obtained for analysis in the vast majority of patients. The purpose of this study is; investigate to fluid containing stone dust which obtained perioperativly for the role of predicting stone analysis results in patients treated with ureterorenoscopic approach. In addition, the role of stone density measurement with computed tomography preoperativly will be investigate to determine stone structure. Materials and Methods: In our clinic, 109 patients treated with ureterorenoscopic approach for stone disease were included. Perioperative fluid containing stone dust was taken with a 10 ml syringe. At the end of the operation, ureterorenoscope was removed while 3 mm fragment was taken by basket catheter. Chemical analysis of the fluid containing stone dust was performed, the stone fragment was examined at a separate center with X-Ray Diffaction (XRD) tecnique. Both centers did not know the results of the other center. The sensitivity, specificity, and accuracy of the tests were calculated. The consistency between XRD and chemical analysis results was measured with Cohen's Kappa Coefficient. Results: Sixteen patients were excluded from the study because no stone fragment could be obtained. Struvite stones were found 100%, calcium oxalate stones and uric acid stones 99%, "calcium oxalate + uric acid" stones 98%, "calcium oxalate + calcium phosphate stones" 94% accuracy. In evaluating the density of the stones; The density of "calcium oxalate + uric acid" stones was significantly lower than the "whewellite" group. However, stone densities did not provide additional information about the stone structure, apart from the information we obtained by chemical analysis. Discussion and Conclusion: After ureterorenoscopic laser lithotripsy treatment of upper urinary system stone disease, the chemical analysis of the fluid which obtained perioperativly in patients who can not obtain a stone fragment, determines stone structure with high accuracy. The fluid containing stone dust, can be easily and perioperatively obtained from all patients so chemical analysis is superior to analyzes made with stone fragments. In our study, no significant results were obtained, in predicting structure of stone, with noncontrast computed tomography data.
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Keywords
Kimyasal analiz, X-ışını kırınımı, Litotripsi, Lazer, Tomografi, Üriner sistem taşı, Chemical analysis, X-ray diffraction, Lithotripsy, Laser, Tomography, Urinary calculi
Citation
Arslan, İ. E. (2018). Üst üriner sistem minimal invaziv taş cerrahisinde, perioperatif alınan taş tozu içeren sıvının kimyasal incelemesi ile taş protokollü kontrastsız abdominopelvik bilgisayarlı tomografi verilerinin taş analiz sonucunu öngörmedeki yeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.