Aim:The aim of the study was to evaluate possible factors predicting stone-free status at retrograde intrarenal surgery for renal stones. Materials and Methods:A retrospective multicenter study was performed using data from 513 patients treated between February 2016 and January 2020 at four referral centers in Turkey.The patients were divided into two groups whether they had no residual stone over 3 mm (Group 1) or had residual stones (Group 2).Pre and peroperative parameters were compared in both groups (Table 1).Univariate and multivariate analyzes were performed to identify any factors affecting the stone-free rate (Table 2).Results: Overall stone-free rate was 88.5% (454/513).Lower calyx stones and multipl stones were significantly higher in Group 2 (p=0.006,p=0.02, respectively).Also access sheathless procedure rate was significantly higher and the basket catheter useage rate was significantly lower in Group 2 (p=0.04,p<0.001, respectively) (Table 1).Multiple stone presence and basket catheter usage during the procedure were found as independent factors to predict the stone-free status of Retrograde Intrarenal Surgery according to the results of logistic regression analysis (95%CI 3.3577-0.9999;H-L p= 0.05 and 95%CI 0.4442-0.1290;H-L p< 0.001, respectively) (Table 2). Conclusion:The presence of multiple stones in preoperative imaging and the use of basket catheters peroperatively are independent factors predicting stone-free status in Retrograde Intrarenal Surgery.The presence of multiple stones increases the probability of residual stones after the procedure, while the use of basket catheters is to reduce this possibility.
To compare the surgical and functional outcomes of minimally invasive pyeloplasty versus open pyeloplasty.Between 2008 and 2010, 20 patients underwent transperitoneal minimally invasive (13 robot-assisted and 7 laparoscopic) pyeloplasty, and 22 patients underwent conventional open pyeloplasty. Operative and functional outcomes were compared between the minimally invasive and open pyeloplasty groups. The statistical analysis was performed using Fisher's exact test, unpaired t test, and Mann-Whitney U test.The mean age was 31 years in the minimally invasive group and 27 years in the open group. The mean operative time was 131 minutes in the minimally invasive group and 128 minutes in the open group (P=.71). The estimated blood loss was 30 mL in the minimally invasive group and 108 mL in the open group (P=.001). The drain was removed after 1.75 days and 4.48 days in the minimally invasive and open groups, respectively (P=.001). The mean hospital stay was 1.94 days and 4.19 days in the minimally invasive and open groups, respectively (P=.001). Crossing vessels were observed in 21% of all patients, and the transposition of the ureter was performed in all patients with an anterior crossing vessel. One patient in each group had symptomatic and radiographic recurrence and persistently obstructed drainage pattern on diuretic renography. The radiographic and symptomatic success rate was 95% in the minimally invasive group and 95.5% in the open group.Minimally invasive pyeloplasty has low morbidity, short length of stay, and less blood loss compared with open surgical repair. It is an effective and feasible minimally invasive treatment modality for ureteropelvic junction obstruction.
Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery.
The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden.Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS.The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates (p<.001, p<.001, p=.008 and p<.001, respectively). S-ReSC score (p=.02) and stone burden (p<.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618).The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.
GIRIS ve AMAC: Biz bu calismada hipospadiasi olan eriskin hastalarda Tubularized-incised plate urethroplasty onariminin etkinligini ve yapilabilirligini degerlendirmeyi amacladik. YONTEM ve GERECLER: Mart 2013 ve Subat 2016 tarihleri arasinda primer hipospadias tanisi ile tubularized-incised plate urethroplasty onarimi yapilan 12 eriskin hasta calismaya dâhil edildi. Ortalama hasta yasi, eksternal mea yerlesimi, penil egrilik varligi ile ortalama operasyon suresi, cerrahi komplikasyonlar, uretral kateter cikarilma zamani ve hastanede kalis sureleri geriye donuk olarak analiz edildi. Hastalarin tamamina ameliyat sonrasi 6. ayda uroflowmetri yapildi. Cerrahi basari penis ucunda stenotik olmayan yeni uretranin varligi ve uroflowmetride azami idrar akisinin >20 mL/sn olmasi olarak belirlendi. BULGULAR: Ortalama hasta yasi 22.1 yil idi. Ortalama operasyon suresi, hastanede kalis suresi ve uretral katater cikarilma zamani sirasiyla 105 dakika, 3 ve 8,16 gun olarak belirlendi. 2 hastada hafif penis egriligi izlendi. Erken donemde her hangi bir komplikasyon izlenmedi. Ortalama 19 aylik takip doneminde bir hastada uretrokutanoz fistul gelisti. Cerrahi basari %91,6 olarak belirlendi. Ameliyat sonrasi yapilan uroflowmetride fistul gelisen hasta disindaki butun hastalarda azami idrar akis hizi >20 mL/sn idi. TARTISMA ve SONUC: Hipospadiasi olan eriskin hastalarda tubularized-incised plate urethroplasty onarimi, kabul edilebilir kozmetik ve fonksiyonel sonuclar ile etkin ve uygulanabilir bir yontemdir. Turkce Kisa Baslik: Eriskin hipospadiasta TIPU onarimi.
To compare the predictive effects of stone size and volume on the efficacy and safety of retrograde intrarenal surgery (RIRS) and to determine the cutoff values of stone volume for prediction of RIRS efficacy and safety.
