Özellikli Hasta Gruplarında Üriner Sistem Taş Hastalığı Tanı ve Tedavisi
Özet
Gebelik, atnalı böbrek, ektopik böbrek ve üriner diversiyon gibi özel hasta gruplarında üriner sistem taş hastalığının (ÜSTH) tanı ve tedavisi, yapısal ve fizyolojik değişiklikler nedeniyle standart yaklaşımların dışına çıkılmasını gerektirmektedir. Gebelikte radyasyon riski sebebiyle tanı için ultrasonografi ilk sırada, MRG ise ikinci seçenek olarak tercih edilirken; konservatif tedaviye dirençli olgularda üreteroskopik lazer litotripsi veya stent uygulamalarına başvurulmaktadır. En sık görülen renal füzyon anomalisi olan atnalı böbreklerde, üreterin yüksek girişi gibi anatomik varyasyonlar üriner staza ve taş oluşumuna yol açmakta, tedavisinde ise ESWL, PNL ve RIRC yöntemleri kullanılmaktadır. Genellikle pelviste yerleşen ektopik böbreklerde taş tedavisi vasküler ve yapısal farklılıklar nedeniyle oldukça zorlayıcı olup; ESWL ve RIRC’nin yanı sıra laparoskopi yardımlı PNL ile %100’e yakın başarı sağlayan laparoskopik piyelolitotomi tercih edilmektedir. Radikal sistektomi gibi operasyonlar sonrası uygulanan üriner diversiyonlu hastalarda ise değişen anatomi, staz ve metabolik süreçler taş riskini artırmakta, tedavisinde üst üriner sistem taşlarında ESWL ön plana çıkarken, büyük taşlarda ultrasonografi eşliğinde perkütan nefrolitotomi (PNL) ve endoskopik yöntemler başarıyla uygulanmaktadır. Nüks riski yüksek olan bu hastaların takibinde düzenli irrigasyon ve metabolik değerlendirme kritik önem taşımaktadır.
Pregnancy, horseshoe kidney, ectopic kidney, and urinary diversion represent special patient groups where the diagnosis and treatment of urinary system stone disease (USSD) require deviating from standard approaches due to structural and physiological alterations. Due to radiation risks during pregnancy, ultrasonography is the primary choice for diagnosis, and MRI is the second option, whereas ureteroscopic laser lithotripsy or stent applications are performed in cases resistant to conservative management. In horseshoe kidneys, which are the most common renal fusion anomaly, anatomical variations such as high insertion of the ureter lead to urinary stasis and stone formation, and ESWL, PCNL, and RIRS methods are utilized for their treatment. Stone treatment in ectopic kidneys, which are generally located in the pelvis, is highly challenging due to vascular and structural variations; hence, along with ESWL and RIRS, laparoscopy-assisted PCNL and laparoscopic pyelolithotomy, providing nearly 100% success, are preferred. In patients with urinary diversion performed after operations like radical cystectomy, altered anatomy, stasis, and metabolic processes increase the risk of stone formation, where ESWL stands out for upper urinary tract stones, and percutaneous nephrolithotomy (PCNL) under ultrasound guidance as well as endoscopic methods are successfully applied for large stones. Regular irrigation and metabolic evaluation are of critical importance during the follow-up of these patients with a high risk of recurrence.
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