| Abstract | Cilj istraživanja:
Odrediti učestalost i vrstu komplikacija perkutane nefrolitotripsije na Zavodu za urologiju KBC Split od 2014.-2018. godine. Utvrditi povezanost komplikacija sa s spolom, dobi, smještajem, pozicijom, veličinom i brojem kamenaca.
Ustroj istraživanja:
Retrospektivno istraživanje.
Mjesto istraživanja:
Zavod za urologiju KBC Split:
Sudionici istraživanja:
Istraživanje uključuje 114 bolesnika s bubrežnim kamencima liječenih perkutanom nefrolitotripsijom na Zavodu za urologiju KBC Split u razdoblju od 1. siječnja 2014. godine do 15. ožujka 2018. godine. U studiju su uključeni bolesnici kojima je urađena perkutana nefrolitotripsija zbog liječenja bubrežnih kamenaca, uz opis operacije i postoperativnog tijeka.
Istraživane varijable:
Prikupljani su slijedeći podatci: spol, dob, smještaj kamenca, pozicija kamenca unutar kanalnog sustava, veličina kamenca, broj kamenaca, prisutnost krvarenja, nadoknada krvi, broj nadoknađenih doza krvi, prisutnost postoperativnog febriliteta, uzrok febriliteta kao i prisutnost ostalih komplikacija. Također su prikupljeni podatci za duljinu hospitalizacije, vrijeme do uklanjanja nefrostome i ureteralnog katetera, uspješnost operacije i operater.
Rezultati:
Učestalost komplikacija perkutane nefrolitotripsije na Zavodu za urologiju KBC Split iznosi 21%. Najčešća komplikacija je krvarenje (10,5%). Postoperativni febrilitet se pojavljuje je u 4,4% bolesnika. Ostale komplikacije, uključujući postoperativnu opstrukciju uretera, perforaciju pijelona, razlijevanje kontrasta te izlazak fragmenta kamenca van kanalnog sustava, imaju učestalost od 6,1%. Bolesnici s komplikacijama nisu se statistički značajno razlikovali prema spolu, dobi i broju kamenaca u odnosu na bolesnike bez komplikacija. Izgled za nastanak komplikacije je za 2,9 puta veći u skupini bolesnika s kamencem u lijevom bubregu nego u skupini bolesnika s kamencem u desnom bubregu. Postoji statistički značajna povezanost veličine kamenca s komplikacijama. Udio velikih (3-4cm) i odljevnih zajedno za 2,5 puta je veći u skupini bolesnika s komplikacijama u odnosu na skupinu bolesnika bez komplikacija. Ne postoji statistički značajna razlika u pojavnosti komplikacija kod bolesnika s kamencem u pijelonu u odnosu na bolesnike s kamencem u čašicama. Izgled za nastanak komplikacija za 3,9 puta je veći u skupini bolesnika s odljevnim ili multiplim kamencima u odnosu na skupinu bolesnika sa kamencem u čašicama ili pijelonu. Duljina hospitalizacije svih bolesnika iznosila je 4+-2 dana. Medijan je iznosio 3 dana (min-max : 2-14 dana). Vrijeme od operacije do uklanjanja nefrostome je iznosilo 1,4 +- 1 dana. Medijan je iznosio 1 dan (min-max: 1-8 dana). Vrijeme do uklanjanja ureteralnog katetera je iznosilo 2,3 +- 1 dan. Medijan je iznosio 2 dana (min-max: 1-7 dana). Medijan trajanja hospitalizacije kod bolesnika s krvarenjem i kod bolesnika s ostalim komplikacijama je za 3 dana veći u odnosu na bolesnike bez komplikacija. Postoperativni febrilitet produljuje vrijeme do uklanjanja nefrostome za 1,5 dana. Uspješnost operacije je iznosila 96,5%.
Zaključci:
Perkutana nefrolitotripsija je sigurna metoda s niskom učestalošću ozbiljnih komplikacija. Učestalost komplikacija na Zavodu za urologiju KBC Split je niska i usporediva s najvećim svjetskim centrima. Najčešća komplikacija je krvarenje, potom slijedi postoperativni febrilitet i manje češće komplikacije smještene u skupini ostalih komplikacija. Istraživanje je pokazalo da smještaj, veličina i pozicija kamenca imaju utjecaj na pojavnost komplikacija. S druge strane, bolesnici s komplikacijama nisu statistički značajno razlikovali prema dobi, spolu i broju kamenaca u odnosu na bolesnike bez komplikacija. Krvarenje i komplikacije iz skupine ostalih komplikacija produljuju medijan trajanja hospitalizacije za 3 dana. Postoperativni febrilitet produljuje vrijeme do uklanja nefrostome za 1,5 dana. Perkutana nefrolitotripsija omogućuje izlječenje ili poboljšanje u 96,5% pacijenata. |
| Abstract (english) | Objective:
To determine the frequency and type of complications of percutaneous nephrolitotripsy at the Department of Urology, University Hospital of Split from 2014 to 2018. Furthermore, the goal is to determine the correlation of complications with gender, age, placement, position, size and number of stones.
Study Design:
Retrospective study.
Settings:
Department of Urology, University Hospital of Split.
Participants:
The study included 114 patients with kidney stones treated with percutaneous nephrolitotripsy at the Deparment of Urology, University Hospital of Split in the period from January 1, 2014 to March 15, 2018. The inclusion criterion is accession to percutaneous nephrolitotripsy for the treatment of renal stones with a description of the operation and postoperative course.
Researched variables:
The following data were collected: sex, age, placement of stone, position of stone, stone size, number of stones, presence of bleeding, blood transfusion, number of blood doses, presence of postoperative fever, cause of fever, presence of other complications, duration of hospital stay, duration of keeping the nephrostomy tube and ureteral catheter, operation success and operator.
Results:
The complication rate of percutaneous nephrolitotomy at the Department of Urology of University Hospital Split is 21%. The most common complication is bleeding (10.5%). Postoperative fever occurs in 4.4% of the patients. Other complications, including postoperative ureteral obstruction, perforation of the renal pelvis, pouring out of the contrast and the stone fragment exit from the renal colleting system, occured in 6,1 % of the patients. There was no satisitically significant difference between patients with complications and those without any complication according to gender, age and number of stones. The appearance of complications was 2.9 times higher in the group of patients with stones in left kidney compared to the group of patients with stones in the right kidney. There is a statistically significant association of stones size with complication rate. The proportion of large (3-4 cm) stones and staghorn stones together is 2.5 times higher in the group of patients with complications compared to the group of patients without complications. There was no statistically significant difference in the appearance of complications in patients with stones in the renal pelvis compared to the patients with stones in renal calyces. The appearance of complications was 3.9 times higher in the group of patients with satghorn or multiple stones compared to the group of patients with stone in renal pelvis or renal calyx. The lenght of stay of all patients was 4 + -2 days. The median was 3 days (min-max: 2-14 days). The time from surgery to removal of nephrostomy tube was 1.4 + - 1 days. The median was 1 day (min-max: 1-8 days). The time from surgery to removal of the ureteral catheter was 2.3 + - 1 day. The median was 2 days (min-max: 1-7 days). Median of the duration of hospitalization in patients with bleeding and in patients with other complications is 3 days higher in comparison to patients without complications. Postoperative fever prolongs the time to remove nephrostomy tube for 1.5 days. The success rate of the operation was 96.5%.
Conlcusion:
Percutaneous nephrolitotripsy is a safe method with a low frequency of serious complications. The complication rate at the Department of Urology, University Hospital Split is low and comparable to the world's largest centres. The most common complication is bleeding, followed by postoperative fever and less frequent complications in the group of other complications. The study has shown that the size, placement and position of the stones have an effect on the occurrence of complications. On the other hand, there was no satisitically significant difference between patients with complications and those without any complication according to gender, age and number of stones. Bleeding and complications from the group of other complications prolong the median of the duration of hospitalization for 3 days. Postoperative fever prolongs the time to remove the nephrostomy tube for 1.5 days. Percutaneous nephrolitotripsy provides healing or significant improvement in 96.5% of patients. |
