Üriner Sistem Taş Hastalığı Cerrahi Tedavisinde Minimal İnvaziv Yaklaşımlar I: Üreterorenoskopi ve Retrograd İntrarenal Cerrahi
Özet
Bu metin, üriner sistem taş hastalığının cerrahi tedavisinde kullanılan üreterorenoskopi (URS) ve retrograd intrarenal cerrahi (RIRS) gibi minimal invaziv yaklaşımları, teknik gelişmeleri ve Avrupa Üroloji Birliği (EAU) kılavuz önerilerini incelemektedir. Endoskop boyutlarının küçülmesi, optik kalitenin artması ve lazer sistemlerinin (özellikle Ho:YAG) gelişimi, 2 cm’den büyük taşlarda bile %91’e varan yüksek taşsızlık oranları sağlamıştır. Operasyonlarda üreteral erişim kılıflarının kullanımı görüş kalitesini artırıp intrarenal basıncı düşürürken, enfeksiyon riskini de azaltmaktadır. Komplike olmayan vakalarda işlem sonrası rutin stent uygulaması post-operatif morbidite ve maliyeti artırdığı için önerilmezken; tıkanıklık, kanama veya perforasyon gibi riskli durumlarda stent tercih edilmektedir. Ameliyat süresinin 90 dakikayı aşması ve yüksek intrarenal basınç, ürosepsis ve üreter hasarı gibi komplikasyon risklerini tetikleyen en önemli faktörler arasında yer almaktadır. EAU kılavuzları da Ho:YAG litotripsiyi güçlü şekilde önermekte ve taş ekstraksiyonunun direkt endoskopik görüş altında yapılmasını tavsiye etmektedir.
This text examines minimal invasive approaches such as ureterorenoscopy (URS) and retrograde intrarenal surgery (RIRS), technical advancements, and the European Association of Urology (EAU) guideline recommendations in the surgical treatment of urinary system stone disease. Advancements including reduced endoscope sizes, improved optical quality, and the development of laser systems (especially Ho:YAG) have provided high stone-free rates up to 91% even for stones larger than 2 cm. The use of ureteral access sheaths during operations improves visualization and decreases intrarenal pressure while reducing the risk of infection. Routine post-operative stenting is not recommended in uncomplicated cases as it increases post-operative morbidity and costs, whereas stenting is preferred in risky conditions such as impaction, bleeding, or perforation. An operative time exceeding 90 minutes and high intrarenal pressure are among the most significant factors triggering complication risks like urosepsis and ureteral injury. EAU guidelines strongly recommend Ho:YAG lithotripsy and advise performing stone extraction only under direct endoscopic visualization.
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