Faktor Prediktif Kejadian Komplikasi Pasca Extracorporeal Shock Wave Lithotripsi

FAJAR NUGROHO YUNIARSO, dr. Untung Tranggono MS. PA(K), Sp.B, Sp.U

2016 | Tesis-Spesialis | SP UROLOGI

Latar Belakang: Extracorporeal shockwave lithotripsy (ESWL) ialah salah satu cara untuk memecah batu selain Percutaneous Nefrolithotomy (PCNL), Ureterorenoscopy (URS) dan operasi terbuka. Teknik dasar mekanisme kerja ESWL ialah mengdisintegrasikan batu menjadi fragmen-fragmen kecil menggunakan gelombang kejut yang difokuskan. Mekanisme kerja ESWL menimbulkan efek pada jaringan ginjal dan jaringan sekitar tidak bisa dihindari, sehingga tindakan ESWL bisa menimbulkan komplikasi Tujuan: mengetahui apakah faktor pre-morbid yaitu kekuatan maksimal, frekuensi maksimal, tindakan ESWL berulang, usia, hipertensi, diabetes, gizi, ganguan pembekuan darah, ganguan fungsi ginjal, persepsi nyeri, stone burden, dan lokasi batu pasien bisa digunakan memprediksi komplikasi ESWL. Metode: Penelitian ini merupakan penelitian retrospektif. Dilakukan analisis pada 50 pasien yang menjalani tindakan ESWL antara bulan juli tahun 2014 sampai dengan bulan desember tahun 2015. Variabel bebas yang di evaluasi ialah kekuatan maksimal, frekuensi maksimal, tindakan ESWL berulang, usia, hipertensi, diabetes, gizi, ganguan fungsi ginjal, persepsi nyeri, stone burden, dan lokasi batu. Variabel tergantung yang dievaluasi ialah kejadian straintase. demam pasca ESWL, kolik pasca ESWL, dan hematuria pasca ESWL. Variabel usia dengan distribusi data normal dan dilakukan analisis univariat dengan student T-test. Selain itu, distribusi data tidak normal dan dilakukan analisis univariat dangan Mann U Whitney. Hasil: Selama periode penelitian diperoleh subyek sebanyak 50 pasien. Sebanyak 60% pasien adalah laki-laki, 40% pasien wanita. usia rerata pasien yang dilakukan ESWL ialah 50.9 + 12.7 tahun. Ukuran batu rerata yang dilakukan ESWL ialah 172.7 + 277.8 mm2. Pasien yang menderita hipertensi sebelum tindakan ESWL ialah 9 pasien. Lokasi batu terbanyak di pyelum ginjal (29 pasien), 11 pasien di kaliks inferior. 5 pasien di kaliks superior, 4 pasien di kaliks media, dan 1 pasien memiliki batu staghorn. . Pasca tindakan ESWL tidak ada pasien yang mengeluhkan nyeri berat, 35 pasien mengeluh nyeri ringan dan 15 lainnya mengeluh nyeri sedang. ESWL ulang dilakukan pada 16 pasien atau 32%. Komplikasi pasca tindakan ESWL berupa hematuria sebanyak 12 pasien, steinstrasse 1 pasien dan kolik 6 pasien. Tidak ada pasien yang mengeluhkan demam. ESWL ulang terjadi pada 32% pasien dan memiliki resiko komplikasi berupa hematuria. (p=0,043). hipertensi berpengaruh secara signfikan terhadap kejadian hematuria paska tindakan ESWL.(p=0,015). Kesimpulan: Faktor pre-morbid hipertensi dan tindakan ESWL ulang berhubungan dengan resiko hematuria.

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is one of ways to break a kidney stone other than Percutaneous Nefrolithotomy (PCNL), Ureterorenoscopy (URS), and open surgery. Basic technique of ESWL mechanism is disintegrating stones into small fragments by using focused shock wave. ESWL mechanism cause complication on the kidney tissues and surrounding that can not be prevented, which leads to complications. Aim of Study: To know if pre-morbid factors such as maximum power, maximum frequency, repeated ESWL, age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location, can be use to predict ESWL complication Methods: This study is done retrospectively. Analysis was done on 50 patients undergoing ESWL between July 2014 to December 2015. Free variables which evaluated were maximum power, maximum frequency, repeated ESWL, age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location. Dependent variable which evaluated was steinstrasse event, post ESWL fever, post ESWL renal colic, post ESWL hematuria. Age variable were distributed normally and done bivariate analysis by student T-test. Others were abnormally distributed and analyzed univariately by Mann U Whitney. Result: During study period, 50 patients were collected. Among them, 60% were men, and 40% were women. Mean age of patients undergo ESWL were 50.9 +12.7 years. Mean stone size that undergo ESWL were 172.7 +277.8 mm2. Patients with hypertension before ESWL were 9 patients. Stones were mostly located on kidney pyelum (29 patients), inferior calix (11 patients), superior calix (5 patients), middle calix (4 patients), and 1 patients has staghorn stone. After ESWL, none of the patients complaining severe pain, 35 patient complaining mild pain, and 15 patient complaining moderate pain. Repeated ESWL done in 16 patients (32%). Post ESWL complication such as hematuria happened on 12 patients, steinstrasse on 1 patients, and colic on 6 patients. None of patients complaining fever. Repeated ESWL happened on 32% patients and have complication risk of hematuria (p=0,043). Hypertension is significantly effecting on hematuria event after ESWL (p=0,015). Conclussion: Hypertension and repeated ESWL can be used as predicting factor of hematuria complication.

Kata Kunci : Extracorporeal Shockwave Lithotripsy (ESWL), Komplikasi pasca ESWL