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Perbedaan proporsi antara lokasi batu,skin-to-stone distance, kekerasan batu, ukuran batu pada computed tomography stonografi serta index massa tubuh dan fungsi ginjal dengan angka bebas batu pasca extracorporeal shock wave lithotripsy pada pasien batu gi

Abstract

Background: Kidney stones are a health problem that is still commonly found in the world. Along with the increasing incidence of kidney stones today, the choice of therapeutic modalities is also increasingly varied. Extracorporeal Shock Wave Lithotripsy (ESWL) is still the first line for the treatment of small kidney stones, with success rates varying. This can be influenced by several risk factors. A predictor of these risk factors is needed to get a high stone-free numbers from the therapy that will be used especially in ESWL. Objective of this study is to determine the differences in the proportion between risk factors related to stone free numbers in patients with kidney stones post ESWL so that more efficiency in time and financing in handling them.

Method: This observational a retrospective cohort study design, carried out through observing the patient’s medical records at the Medical Record Installation at the Sanglah Educational General Hospital in Denpasar. The study was conducted during the period from November 2018 to March 2019 and it was recorded that 41 kidney stone patients underwent ESWL, then divided into two groups: negative stone free numbers (n = 24) and positive stone free numbers (n = 17). From the data collected then traced through the patient medical record regarding the location of the stone, SSD or the distance between the skin to stone, stone hardness, stone size, which can be seen on CT Stonography and BMI and renal function through urine per 24 hours. After that, we do data analysis.

Result: The statistical results showed that the stone size has a value of p = 0.000 or <0.05, which means that it affects the stone-free number after undergoing ESWL and the PR value is 22.8, which means the chance for residuals in stone is ≥10mm, 22.8 times greater than on stones that are <10mm. There were no statistically significant differences in other risk factors, namely location (p = 0.434), SSD (p = 1.000), stone dencity (p = 0.098), BMI (p = 0.175). Multivariate statistical tests with logistic regression analysis showed that stone size is a statistically significant as a potential risk factor for stone free numbers (OR 0.003, p = 0.02).

Conclusion: The risk factors for stone size were found to be very significant in influencing stone free numbers in patients with kidney stones who will undergo ESWL, so that through the size of the stones we can determine the therapeutic modalities that we will give patients to be more precise, more time efficient and financing.


Latar Belakang: Batu ginjal merupakan masalah kesehatan yang masih banyak ditemui di dunia. Seiring dengan meningkatnya insiden batu ginjal dewasa ini, pilihan modalitas terapi juga semakin bervariasi. Extracorporeal Shock Wave Lithotripsy (ESWL) masih menjadi lini pertama untuk terapi batu ginjal berukuran kecil, dengan angka keberhasilan bervariasi. Hal ini dapat dipengaruhi oleh beberapa faktor risiko. Diperlukan suatu prediktor faktor-faktor risiko tersebut, untuk mendapatkan angka bebas batu yang tinggi dari terapi yang akan digunakan khususnya pada ESWL. Penelitian ini dilakukan untuk mengetahui perbedaan proporsi antara faktor-faktor risik oyang berhubungan angka bebas batu pada pasien dengan batu ginjal pasca ESWL sehingga lebih efisiensi pada waktu dan pembiayaan dalam penanganannya.

Metode: Penelitian observasional dengan rancangan penelitian kohort retrospektif, dilakukan melalui pengamatan rekam medis pasien di Instalasi Rekam Medis di RSUP Sanglah Denpasar. Penelitian dilaksanakan selama November 2018 sampai Maret 2019 dan telah tercatat 41 pasien batu ginjal telah menjalani ESWL, selanjutnya dibagi menjadi dua kelompok: angka bebas batu negatif (n = 24) dan angka bebas batu positif (n = 17). Kemudian ditelusuri lewat rekam medis penderita mengenai lokasi batu, SSD atau jarak antara kulit ke batu, kekerasan batu, ukuran batu, yang dapat dilihat pada CT-stonografi serta IMT dan fungsi ginjal melalui urine 24 jam. Dilanjutkan dengan analisis data.

Hasil: Pada hasil statistik didapatkan ukuran batu mempunyai nilai p = 0.000 atau <0,05 yang artinya bermakna dalam mempengaruhi angka bebas batu setalah menjalani ESWL dan didapatkan nilai PR 22.8 yang artinya peluang untuk residual pada batu ukuran ≥10mm, lebih besar 22.8 kali dari pada batu yang ukuran <10mm. Terdapat perbedaan yang tidak bermakna secara statistik pada faktor-faktor risiko yang lain yaitu lokasi (p = 0,434), SSD (p = 1,000), kekerasan batu (p = 0,098), IMT (p = 0,175). Uji statistik multivariat dengan analisa regresi logistik tersebut menunjukan bahwa ukuran batu bermakna signifikan secara statistik sebagai potensial faktor risiko angka bebas batu (OR 0,003, p = 0,02).

Kesimpulan: Faktor risiko ukuran batu didapatkan sangat bermakna dalam mempengaruhi angka bebas batu pada pasien dengan batu ginjal yang akan menjalani ESWL, sehingga melalui ukuran batu dapat, kita dapat menentukan modalitas terapi yang akan kita berikan kepada pasien agar bisa lebih tepat, lebih efisiensi waktu dan pembiayaan.


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How to Cite

Uneputty, Y. F., Duarsa, G. W. K., Yudiana, I. W. Y., Santosa, I. K. B., Tirtayasa, P. M. W., Pramana, I. B. P., Mahadewa, T. G. M., & Oka, A. G. (2020). Perbedaan proporsi antara lokasi batu,skin-to-stone distance, kekerasan batu, ukuran batu pada computed tomography stonografi serta index massa tubuh dan fungsi ginjal dengan angka bebas batu pasca extracorporeal shock wave lithotripsy pada pasien batu gi. Medicina, 51(1). https://doi.org/10.15562/medicina.v51i1.732

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Yulandri Franeldo Uneputty
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Gede Wirya Kusuma Duarsa
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I Wayan Yudiana Yudiana
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I Kadek Budi Santosa
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Pande Made Wisnu Tirtayasa
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Ida Bagus Putra Pramana
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Tjok G.B Mahadewa Mahadewa
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A.A. Gde Oka
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