Mogućnosti retrogradne intrarenalne hirurgije u lečenju kalkulusa u donjem polu bubrega kod dece

  • Predrag Ilić Institut za zdravstvenu zaštitu majke i deteta Srbije "Dr Vukan Čupić", Klinika za dečiju hirurgiju, odeljenje urologije
  • Dejan Kostić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
  • Slobodan Džambasanović Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Urology Department, Belgrade, Serbia
  • Mirjana Janković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Urology Department, Belgrade, Serbia
  • Vladimir Kojović Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Urology Department, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP161010012I
Ključne reči: deca;, nefrolitijaza;, litotripsija, laser;, lečenje, ishod.

Sažetak


Uvod/Cilj. Kalkulusi lokalizovani u donjem polu bubrega predstavljaju veliki izazov u hirurškom lečenju kod dece. Mogućnosti su: otvorena hirurgija, ekstrakorporalna litotripsija, perkutana nefrolitotripsija i retrogradna intrarenalna hirurgija. Broj publikacija o endoskopskom lečenju urolitijaze kod dece je ograničen. Cilj istraživanja bio je da se utvrdi efikasnost retrogradne intrarenalne hirurgije kod pedijatrijskih bolesni­ka sa kalkulusima lokalizovanim u donjem polu bubrega. Metode. Retrospektivno su analizirani rezultati retrogradne intrarenalne hirurgije kod 24 bolesnika sa kalkulusima u donjem polu, u periodu od aprila 2012. do aprila 2016. godine. Primenjena je fleksibilna ureterorenoskopija u kombinaciji sa laserskom litotripsijom. Kao mera uspešne dezintegracije kalkulusa smatrana je veličina partikule od 3 mm ili manja. Rezultati. Dužina opšte anestezije prosečno je iznosila 68 (opseg 40–90) minuta. Dužina hospitalizacije iznosila je 1–3 (prosečno 1,6) dana. Komplikacije su zabeležene posle dve (8,4%) hirurške intervencije: perirenalni hematom kod jednog (3,1%) i urinom kod jednog (3,1%) bolesnika. Kalkulus je bio u potpunosti dezintegrisan kod 18 (75%) bolesnika. Kod 3 (12,5%) bolesnika kalkulus je bio delimično dezintegrisan i kod 3 (12,5%) bolesnika kalkulus nije bio dezintegrisan. “Double J” stent plasiran je kod 5 (21%) bolesnika. Prosečni period praćenja iznosio je 9 (opseg 6–18) meseci. Zaključak. Retrogradna intrarenalna hirurgija kod dece je najmanje invazivan, efikasan i bezbedan metod hirurškog lečenja kalkulusa lokalizovanih u donjem polu bubrega, sa niskom stopom pojave komplikacija. Razlog neuspešnog ishoda kod pojedinih bolesnika jeste gubitak savitljivosti ureterorenoskopa sa laserskom sondom u radnom kanalu.

Reference

References.

Copelovitch L. Urolithiasis in children: Medical approach. Pedi-atr Clin North Am 2012; 59(4): 881–96.

Hwang K, Mason MD, Peters CA. Clinical practice: Surgical ap-proaches to urolithiasis in children. Eur J Pediatr 2011; 170(6): 681–8.

Thomas JC, DeMarco RT, Donohoe JM, Adams MC, Brock JW 3rd, Pope JC 4th. Pediatric ureteroscopic stone man¬agement. J Urol 2005; 174(3): 1072–4.

Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A. Retro¬grade intrarenal surgery versus percutaneous nephro¬lithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol 2011; 25(7): 1131–5.

Salerno A, Nappo SG, Matarazzo E, de Dominicis M, Caione P. Treatment of pediatric renal stones in a Western coun¬try: A changing pattern. J Pediatr Surg 2013; 48(4): 835–9.

Wu H, Docimo SG. Surgical management of children with uro-lithiasis. Urol Clin North Am 2004; 31(3): 589–94, XI.

Unsal A, Resorlu B. Retrograde intrarenal surgery in in¬fants and preschool-age children. J Pediatr Surg 2011; 46(11): 2195–9.

Kim SS, Kolon TF, Canter D, White M, Casale P. Pediatric flexi-ble ureteroscopic lithotripsy: the children's hospital of Phila-delphia experience. J Urol 2008; 180(6): 2616–9; discussion 2619.

Kaji DM, Xie HW, Hardy BE, Sherrod A, Huffman JL. The ef-fects of extracorporeal shock wave lithotripsy on renal growth, function and arterial blood pressure in an animal model. J Urol 1991; 146(2 Pt 2): 544–7.

Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, et al. Outcomes of shockwave lithotripsy for upper urinary-tract stones: A large-scale study at a single institu¬tion. J Endourol 2005; 19(7): 768–73.

Ercil H, Alma E, Bas O, Sener NC, Vuruskan E, Kuyucu F, et al. Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Sur¬gery. Urol J 2016; 13(1): 2490–5.

Donaldson JF, Lardas M, Scrimgeour D, Stewart F, MacLen¬nan S, Lam TB, et al. Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, ret¬rograde in-trarenal surgery, and percutaneous nephro¬lithotomy for lower-pole renal stones. Eur Urol 2015; 67(4): 612–6.

Resorlu B, Issi Y, Onem K, Germiyanoglu C. Management of lower pole renal stones: The devil is in the details. Ann Transl Med 2016; 4(5): 98.

Shah HN. Retrograde intrarenal surgery for lower pole re¬nal calculi smaller than one centimeter. Indian J Urol 2008; 24(4): 544–50.

Burr J, Ishii H, Simmonds N, Somani BK. Is flexible uret-erorenoscopy and laser lithotripsy the new gold standard for lower pole renal stones when compared to shock wave litho-tripsy: Comparative outcomes from a University hospital over similar time period. Cent European J Urol 2015; 68(2): 183–6.

Yahsi S, Tonyali S, Ceylan C, Yildiz KY, Ozdal L. Intraparen-chymal hematoma as a late complication of ret¬rograde intrare-nal surgery. Int Braz J Urol 2017; 43(2): 367–70.

Berardinelli F, Cindolo L, de Francesco P, Proietti S, Hennes¬sey D, Dalpiaz O, et al. The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones

Objavljeno
2020/12/21
Broj časopisa
Vol. 75 Br. 10 (2018): Vojnosanit Pregl 2018; October Vol. 75 (No. 10)
Rubrika
Kratko saopštenje