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Öğe Is it necessary to place ureteral stenting after uncomplicated ureteroscopic lithotripsy?(2006) Atuğ F.; Akay F.; Akkuş Z.; Örgen S.; Alar S.; Şahin H.Introduction: The routine placement of ureteral stents after ureteroscopic lithotripsy procedure is controversial. The main aim of placing a ureteral stent is to prevent ureteral obstruction and renal colic which may develop as a result of uretral edema. Additionally, stents are thought to assist the passage of residual fragments after lithotripsy through passive ureteral dilatation. However, the placement of a ureteral stent is associated with complications including stent migration, breakage, encrustation, stone formation, urinary tract infections and patient discomfort. Therefore numerous studies have been questioned the routine use of ureteral stents after uncomplicated uretroscopic lithotripsy. In this study we compared the results and stone free rates of patients with and without ureteral stenting after uncomplicated ureteroscopic lithotripsy. Materials and methods: In this study, 367 patients who underwent ureteroscopie lithotripsy between 1996 and 2004 were evaluated retrospectively. Patients were divided into two groups. The first group consisted of 236 stented patients and the second group consisted of 132 non-stented patients. In both groups, patients were evaluated for results and stone free rates. Only uncomplicated ureteroscopy patients were included to the study. Patients with solitary kidney, history of renal failure, transplant kidney and a significant perforation or injury to ureter, high grade hydronephrosis, urinary tract infections and patients with impacted stones were excluded from the study. Additionally, patients with retrogarde stone migration were excluded from the study. The operation was performed under general anesthesia with 8.5 F rigid ureteroscope and stones were fragmented with pneumatic lithotriptor. In stented patients a double-J stent was placed in the treated ureter under fluoroscopic monitoring. In the non-stented group the safety wire was removed from the ureter and then the procedure was terminated. In stented patients, stents were removed cystoscopically under local or general anesthesia. Results: The mean age of patients was 40.1 years (range 22 to 76) in the stented group and 37.8 (range 19 to 65) in the non-stented group. The mean stone size was 9.1 mm (range 4 to 21) and 7.8 mm (range 3 to 17) in the in the stented and nonstented patients, respectively. There was no statistical difference between stone free rates in both groups. The stone free rate was %92.4 in stented group and %90.8 in the non-stented group (p>0.05). However, there was statistically significant difference for operative times between the two groups. The mean operative time was 51.4 min (range 30 to 110) in the stented group and 40.2 min. in the non-stented group (range 25 to 70) (p<0.05). The mean operative times increased 28% in the stented group. The symptoms of urinary frequency, flank pain, urgency and dysuria were more common and severe in the stented group. Additionally, hematuria was more severe and prolonged in stented patients when compared to non-stented patients. Conclusion: Our results demonstrate that it is not necessary to place uretral stent after uncomplicated ureteroscopic pneumatic lithotripsy. There was no difference between nonstented and stented patients with respect to stone free status. Ureteral stent placement following uncomplicated lithotripsy augments the operation time, surgical cost and increases patient morbidity.Öğe Vesicoureteral reflux incidance in children with urinary stone disease(2005) Akay A.F.; Uzun F.; Akay H.Ö.; Aflay U.; Şahin H.Introduction: In spite of the frequent association of urinary infection with vesicoureteric reflux and urinary calculi, the coexistence of vesicoureteric reflux and calculi is rare. Four factors (urinary calculi, urinary tract infection, structural changes at the uretero vesical junction and reflux) may interact in these cases. In this prospective study we studied the prevalence of vesicoureteral reflux (VUR) in children with urinary stone disease. Materials and methods: Between September 2000 and March 2004 we evaluated the prevalence of VUR in children with urinary stone disease. In all patients history, physical examination, biochemical and microbiologic analyses were done before the treatment of stone disease. We did voiding cystouretrography in all patients. Patients were divided based on surgical method, including extracorporeal shock wave lithotripsy (ESWL), endoscopy and open surgery. Some patients required combined treatment. After the treatment of stone disease, all patients with VUR received suppressive antibiotic treatment. During follow up period surgical treatment was applied when necessary. Results: Fifty children between 1.5 and 13 years old (median 6.75 years) were included in this study. 41 of patients (82%) were male, 9 (18%) were female. In 37 of patients stone was located only in kidney, 8 were located in urethra, 2 had kidney and bladder stones, 2 had kidney and urethra stones simultaneously. Only 1 patient had bladder stone. In 6 patients (3 male, 3 female) VUR was diagnosed with voiding cystouretrography. Of the patients 2 had bilateral reflux (1 patient with bilateral calculi and the other with left kidney and bladder calculi), 2 had right side reflux (1 had urethra calculi and 1 has contralateral kidney calculi), 2 had left side reflux (1 on ipsilateral kidney calculi and 1 on ipsilateral ureteral calculi). The prevalence of VUR was 12%. Conclusion: In children with urinary stone disease one must always remember that VUR can be seen simultaneously. So if necessary VSUG should always be applied. All patients with urinary stones, particularly staghorn calculi, and urinary tract infection have to be examined for vesicouretral reflux, after the stone or stones have been removed and appropriate antimicrobial therapy has been given.
