EBM

TUGAS EVIDENCE BASED MEDICINESKENARIOTn. S berumur 55 tahun mengeluh pada istrinya bahwa pinggang kanannya terasa nyeri yang sangat hebat, disertai muntah hilang timbul dan menjalar ke perut bawah sejak 1 bulan yang lalu. Nyeri dirasakan hilang timbul terutama saat beraktivitas. Pasien juga mengeluh nyeri saat berkemih sejak 1 bulan terakhir. BAK sedikit-sedikit berwarna keruh dan berpasir. Pasien juga mengeluh sering tidak tuntas saat BAK, pancaran miksi melemah. Dokter mendiagnosis pasien menderita ureterolithiasis. Dokter akan melakukan tindakan ureterolithotomy laparoskopi namun di RS hanya tersedia ureterorenoscopy.FOREGROUND QUESTION :

Apakah ureterolithotomy laparoskopi (LU) memberikan hasil yang lebih baik dibandingkan ureterorenoscopy (URS) pada terapi ureterolithiasis ?PICO

P: laki-laki dewasa, penderita uroterolithiasis I: ureterolithotomy laparoskopi (LU)C: ureterorenoscopy (URS)

O: terapi yang lebih tepat ?

PANCARIAN BUKTI IMIAH Keyword : ureterolithiasis AND laparoscopic ureterolithotomy AND other therapyPemilihan status : http://web.ebscohost.com Limitasi : January 2011-November 2013Hasil pencarian : 6 artikelJurnal yang dipilih : Laparoscopic Ureterolithotomy as a Primary Modality for Large Proximal Ureteral Calculi: Comparison to Rigid Ureteroscopic Pneumatic Lithotripsy

Pengarang : Young Hwii Ko, MD, PhD, Sung Gu Kang, MD, Jae Young Park, MD, PhD, Jae Hyun Bae, MD, PhD, Seok HO Kang, MD, Phd, Dae Yeon Cho, MD, PhD, Hong Seok, Park, MD, PhD, Jun Cheon, MD, PhD, Jeong Gu Lee, MD, PhD, and Je Jong KimMD, PhDREVIEW JURNALPendahuluan

To define the role of laparoscopic ureterolithotomy (LU) as a primary modality for large proximal ureteral stones, we compared the outcomes of primary LU with those of ureterorenoscopy (URS), the currently established modality in this circumstance.

Metode

Among 71 patients who underwent LU in our institution between February 2005 and

January 2010, 32 patients with stone size over 1.5 cm who underwent LU as a primary modality without prior shockwave lithotripsy or URS and for whom LU was conducted as a separate procedure were exclusively enrolled. Based on preoperative characteristics of patients and stones, this patient group was matched with the URS group (n32, rigid pneumatic lithotripter) during the same period.

Hasil

The LU group and the URS group were similar in age, gender distribution, body mass index, stone size (18.1_4.2 versus 17.9_3.6 mm; P.88), and stone location. Members of the LU group required a longer operative time (118_53 versus 59_41 minutes; P