ÜRİNER SİSTEM TAŞLARINDA ÖNCEKİ MÜDAHALELERİN PREOPERATİF FAKTÖRLERE VE POSTOPERATİF SONUÇLARA ETKİSİ: İKİ MERKEZLİ ANALİZ The Effect of Previous Interventions on Preoperative Factors and Postoperative Results in Urinary Stones: Two-Center Analysis

OZET Amac: Bu calismada uriner sistem tasi olup mudahale oykusu bulunanlarla primer hastalarin preoperatif ve peri-operatif sonuclarini karsilastirmayi amacladik. Gerec ve Yontemler: Lokal etik kurul onayi alindiktan sonra Ekim 2018–Ocak 2019 tarihlerinde her iki merkezde uriner sistem tasi nedeniyle ameliyat edilen hastalar icerisinden sok dalga litotripsi veya tas cerrahisi oykusu olmayan 152 primer hasta Grup 1, mudahale oykusu olan 232 hasta ise Grup 2 olarak calismaya alindi. Bulgular: Demografik ozellikler iki grupta benzer bulundu. Dusuk sosyoekonomik duzey ve dusuk egitim duzeyi olanlar buyuk cogunlugu olusturmaktaydi. Son 1 yilda yapilan BT goruntuleme sayisi sekonder hastalarda istatistiksel olarak daha fazlaydi (p<0,001). Grup I’de ureter taslari cogunlugu olusturmaktayken; Grup 2’de bobrek taslari istatistiksel olarak daha fazlaydi. Tas sayisi primer hastalarda daha dusuktu (p<0,001). Uygulanan baskin prosedur Grup 1’de ureterorenoskopi (URS), Grup 2’de retrograd intrarenal cerrahiydi (RIRC) (p<0,001). Primer hastalarin basari orani daha yuksek bulundu (p=0,015). Postoperatif medikal tedavi verilenler sekonder hastalarda daha yuksek bulundu (p<0,001). Her iki grup arasinda beslenme ve fiziksel aktivite aliskanligi aliskanliklari acisindan istatistiksel farklilik gozlenmezken; sigara kullananlar Grup 2’de daha yuksek orandaydi (sirasiyla %44,1,%52,2, p=0,044). Sonuc: Uriner sistem tas hastalarinin yaklasik yarisi hayatlari boyunca tekrar nuks etmektedir. Sekonder olan bu grupta tas sayisi ve reziduel fragman kalma ihtimali daha yuksek bulundu. Taslarin yerlesimi de sekonder grupta siklikla bobrekte oldugu icin basari goreceli olarak daha az bulundu. Tas protokollu bilgisayarli tomografinin ve postoperatif medikal tedavinin sekonder hastalarda kullanimi daha fazla bulundu. Daha once tas oykusu bulunmasinin bu konuda etkili oldugunu dusunmekteyiz. Sonuc olarak, sekonder tas hastalarinin yonetimi daha zorlu gorunmektedir. Anahtar Kelimeler: Mudahale Oykusu; Nuks; Onceki Mudahale; Primer; Sekonder; Urolitiyazis ABSTRACT Objective: We aimed to compare the preoperative and per-operative outcomes of patients with urinary tract stones with a history of intervention. Material and Methods: Patients who underwent surgery in our clinic for urolithiasis between October 2018 and January 2019 were included in the study. Of the 384 patients, 152 primary patients without shock wave lithotripsy or stone surgery were included in Group 1, and 232 patients with intervention history were included in Group 2 Results: The number of computed tomography scans performed in the last 1 year was statistically higher in secondary patients (p <0.001). In Group I, ureteral stones constitute the majority; renal stones were significantly higher in Group 2. Stone number was lower in primary patients (p <0.001). The dominant procedure was ureteroscopy (URS) in Group 1 and retrograde intrarenal surgery (RIRS) in Group 2 (p <0.001). The success rate of primary patients was higher (p = 0.015). The use of postoperative medical treatment was higher in secondary patients (p <0.001). There was no statistical difference between the two groups in terms of nutritional and physical activity habits. Conclusion: The number of stones and residual fragments were found to be higher in secondary group. The success of the surgery was relatively lower in the secondary group. The use of computed tomography and postoperative medical therapy were more common in secondary patients. We think that the presence of a history of stone was effective in this regard. As a result, management of secondary stone patients seems more challenging. Keywords: History Of Intervention; Recurrence; Previous Intervention; Primary; Secondary; Urolithiasis