Büyük Koraliform Böbrek Taşlarının Tedavisinde Multitrakt Perkütan Nefrolitotripsi ve Sandviç Tedavi Yöntemlerinin Başarı ve Komplikasyon Oranları Açısından Karşılaştırılması

Objective: Percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) are performed in treatment of kidney stone disease for a long period beside the other treatment methods. Since 1987 PNL procedure has been used successfully and safely in our clinic for treatment of kidney stones. We aimed to compare the success rates of multitract access and sandwich therapies (PNL+SWL+PNL) in staghorn kidney stones performed in four years period. Materials and Method: During last four years 462 patients underwent PNL procedures in our clinic. 126 of the patients had staghorn kidney stones 23 of the patients (16male/7female) had multitract PNL while 16 (12male/4female) underwent sandwich therapy. We compare these two groups for postopertive early period and in 6th month success, major (bleeding and adjecent organ injury etc.) and minor (fever, urinary tract infections) complications, total hospitalization period, additional treatment requirements and total operation duration. Results: Statistically significant differences were appearent between two groups while total hospitalization period (9,74±3,19 days in multitract PNL group and 22,12±10,19 days in sandwich therapy group), total operation duration (110,78±35,57 minutes in multitract PNL group and 176,87±31,51 minutes in sandwich therapy group)(p<0,001) and blood replacement volumes (1,86±1,63 IU in multitract PNL group and 3,37±1,89 IU in sandwich therapy group) (p<0,05). The early postoperative period results (69,5% stone free rates, 17,4% ‘clinically insignificant residual fragments’ (CIRF) rates and 13,04% residual stone rates in in multitract PNL group and 62,5% stone free rates, 17,4% CIRF rates and 13,04% residual stone rates in days in sandwich therapy group) and in 6th month success findings were similar between two groups (p>0,05). Also additional treatment requirements, complication (major and minor) rates, stone analysis are compared and we did not find statistically significant differences between two groups (p>0,05). Conclusion: PNL is successfull and safe treatment method of staghorn stones. It can be performed with multitract technique in one session or with sandwich therapy technique which can be combined with SWL due to conditions. Besides the blood replacement volumes, hospitalization period and the ooperation, the comparison of these treatment modalities did not exhibit any significant differences for success and complication rates. Our outcomes are compatible with the literature.