Üriner Sistem Taş Hastalığı Tedavisinde Açık Cerrahi Yaklaşımlar
Özet
Üriner sistem taş hastalığı, son 30 yılda endoürolojik ve minimal invaziv yöntemlerin gelişmesiyle açık cerrahi yerine ESWL, PCNL ve URS gibi tedavilere bırakmıştır. Günümüzde açık cerrahi gereksinimi %1-5,4 oranına gerilese de, başarısız endoürolojik girişimlerde ve anatomik anomalilerde halen birincil seçenek olabilmektedir. Böbrek taşlarında anatrofik nefrolitotomi yüksek morbidite riski taşısa da kompleks taşlarda uygulanırken; piyelolitotomi ise büyük renal pelvis taşlarında tercih edilmektedir. Üreter taşlarında, lazer ekipmanı eksikliği veya laparoskopik deneyim yetersizliğinde açık üreterolitotomi; mesane taşlarında ise 6 cm'den büyük veya sert taşların varlığında açık sistolitotomi yöntemi kullanılmaktadır.
Urinary system stone disease has shifted from open surgery to treatments like ESWL, PCNL, and URS over the past 30 years due to the development of endourological and minimally invasive methods. Although the requirement for open surgery has currently decreased to 1-5.4%, it remains a primary option in cases of failed endourological interventions and anatomical anomalies. While anatrophic nephrolitotomy for kidney stones carries a high risk of morbidity, it is applied in complex stones; pyelolithotomy is preferred for large renal pelvis stones. For ureteral stones, open ureterolithotomy is utilized in the absence of laser equipment or laparoscopic experience, whereas open cystolithotomy is used for bladder stones larger than 6 cm or in the presence of hard stones.
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