| Abstract (croatian) | Tijekom deset i pol godina učinjene su na Urološkom odjelu Kirurške klinike KBC-a Rijeka 1554 ureterorenoskopije, od kojih je većina, 1374 (88,4%), učnjena radi liječenja ureteralne litijaze. Budući da Odjel ne posjeduje aparat za ekstrakorporalno mrvljenje kamenaca, metoda izbora postao je endoskopski način liječenja litijaze, bez obzira na položaj, broj i veličinu kamenaca. U zadnjih šest godina 960 (75,5%) bolesnika liječeno je ureteroskopski, 162 (12,7%) perkutanom litotripsijom, 92 (7,2%) upućeno je na ESWL, a samo u 58 (4,6%) bolesnika je uičnjena klasična ureterolitotomija. Uspje{nost liječenja urolitijaze pomo}u ureterorenoskopa iznosi vi{e od 90%. U 8,3% bolesnika kamenci nisu potpuno odstranjeni ili su potisnuti natrag u bubreg, zbog čega su ti bolesnici upućeni na ESWL. Do perforacije uretera kao teške intraoperacijske komplikacije došlo je samo u 8 (0,5%) bolesnika. Laceracije sluznice, blaga krvarenja, febrilitet, postoperacijska bol u slabini ili renalna kolika, nešto su ve{će komplikacije koje se smatraju lakšim i jednostavno se lijče. Do sepse je do{lo samo u jednog bolesnika koji je uspješno izliječen primjenom antibiotika. Dvije manje izražene stenoze lumbalnog segmenta dilatirali smo balonom te postavili endoproteze. Zbog perforacije uretera, kamenaca pretvrdih za mrvljenje ure|ajima kojima smo u aktualnom trenutku raspolagali i kamenaca do kojih nismo uspjeli doprijeti ureteroskopom, u 20 bolesnika učnjene su otvorene operacije (ureterolitotomija, ureterolitotomiju s resekcijom stenoze i T-T anastomozom uretera, ureterolitotomija s apendektomijom zbog akutnog apendicitisa i jednom nefrektomija). U 146 (9,6%) bolesnika u~injena je dijagnosti~ka URS radi istra`ivanja uzroka unilateralnog krvarenja i dijagnosticiranja suženja ili opstrukcije uretera (benigna, odnosno maligna stenoza). U trideset četiri bolesnika (2,2%) pomo}u ureterorenoskopa odstranjena je retrahirana endoproteza iz uretera. Smatramo da URS ima posebnu važnost primarnog liječenja u bolnicama koje ne raspolažu uređajem za ESWL. Indiciran je kod svih kamenaca, bez obzira na njihov položaj, broj i veli~čnu. Za uspješan rad, uz obvezno iskusnog operatera, potreban je adekvatan, kvalitetan ureterorenoskop, s pripadajućim pomoćnim instrumentima, više različitih tipova uređaja za mrvljenje kamenaca. |
| Abstract (english) | During the last 10 years 1.554 ureterorenoscopies were done at our department. Most of them, 1.374 (88.4 %) were applied in ureteral stone treatment. Since we do not have an instrument for extracorporeal shock wave lithotripsy (ESWL), ureteroscopic approach to the stones, regardless of the size, number and localization, becomes a method of choice in the treatment. During the last six years 960 (75.5%) patients were treated ureteroscopically (URS), 162 (12.7%) by percutaneous lithotripsy, 92 (7.2%) were directed to ESWL and only in 58 (4.6%) of them classical ureterolithotomy was done. Complete stone clearance after URS was achieved in more than 90% of patients. In 8.3% of patients the stones could not be completely removed or were pressed to the kidneys, and therefore the patients were directed to ESWL. Serious intraoperative complication, the perforation of ureters occurred only in 8 (0.5%) patients. Mucosal lacerations, mild bleeding, fever, postoperative lumbal pain or kidney colic are possible complications, but they are usually mild and simple to treat. Sepsis occurred in one patient only and was successfully treated by antibiotics. Two mild lumbar stenoses were balloon dilated and stented. In 20 patients where stones could not be reached or fragmented by available methods (US, EH) or due to a complication (perforation), open surgery was performed: ureterolithotomy, ureterolithotomy with the resection of ureteral segment stenosis and T-T ureteral anastomosis, ureterolithotomy with appendectomy due to acute appendicitis and in one case nephrectomy was indicated. In 9.6% of patients explorative URS was done with the purpose to determine the cause of unilateral bleeding, stenosis or obstruction of ureter (benign, malignant stenosis). In 34 patients retracted endoprothesis was removed by URS. In conclusion, we consider URS a primary method for hospitals without ESWL. The use of URS is indicated in all cases of ureteral stones regardless of the size, number and localisation. For a successful stone clearance, a good and adequate ureteroscope is needed, corresponding instruments, several possibilities for stone fragmentation and above all an experienced urologist. |
