ABSTRACT
BACKGROUND:
Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of ...multiple instruments, and facilitate drainage and removal of the fragmented stones.
OBJECTIVE:
Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery.
DESIGN:
A retrospective patient data review.
SETTING:
Training and research hospital in Turkey.
PATIENTS AND METHODS:
We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis.
MAIN OUTCOME MEASURES:
Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery.
SAMPLE SIZE:
1808 patients met inclusion criteria.
RESULTS:
The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (
P
<.001). The rate of complications was similar in both groups (
P
=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage
CONCLUSION:
The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent.
LIMITATIONS:
Retrospective design.
CONFLICT OF INTEREST:
None.
Objective: To show our retrograde intrarenal surgery (RIRS) experience in anomalous kidney stones and compare its safety and efficiency with
normal kidney stones.
Materials and Methods: Between 2012 ...and 2018, patient data was reviewed retrospectively and 1700 procedures were taken into consideration.
Forty-seven anomalous kidney stones were included in the study (group A). In these patients, 18 had calyx diverticulum, 12 had horseshoe kidney,
8 had ureteral duplication, 2 had ectopic kidneys, 1 had malrotation, and 1 had bifid pelvis. After making a matched pair analysis, 47 normal
kidney stones with similar demographic and stone characteristics were included in our study (group N). Demographic, stone, intraoperative and
postoperative data were recorded. We compared these groups regarding efficiency and safety.
Results: Average scope time, hospitalization time, and postoperative double J-stent rate were higher in group A. The difference was statistically
insignificant (p>0.05). Ureteral access sheath usage was higher in group N, though the difference was statistically insignificant (p=0.63). Stonefree
rates and success rates were higher in group N though the difference was not statistically significant (p>0.05). The rate of complications was
statistically significantly higher in group A (p=0.02).
Conclusion: RIRS can be used in the management of anomalous kidney stones. It is an efficient and safe method. Prospective and larger patient
numbered studies are needed.
Holmium:Yttrium Aluminum Garnet laser lithotripsy is used in Retrograde Intrarenal Surgery. Fragmentation is made with a certain value of pulse energy (Joule) and frequency (Hertz) in Holmium laser ...lithotripsy and the multiplication of these values gives us total power (Watt). Devices with maximum power of 20 Watt and 30 Watt are used in clinical practice. We want to compare the efficiency, safety and pain scores of the lithotripsy made below 20 Watt and over 30 Watt with 30 Watt laser device.
60 patients who had 2-3 cm sized kidney stones and operation planned were prospectively divided into three groups. Groups were random identified. In the first group, fragmentation was performed below 20 Watt power with 20 Watt laser device. In the second group, fragmentation was performed below 20 Watt power with 30 Watt laser device. In the third group, fragmentation was performed over 20 Watt power with 30 Watt laser device. Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency, safety and pain score.
For demographic and stone data, there was a statistically significant difference only for stone number. For intraoperative and postoperative data, there was a statistically significant difference only for ureteral access sheath usage between the groups. Success was lower than the other groups in Group 1.
Success was higher in groups using 30 Watt laser device. There was not statistically significantly difference between complications and pain. 30 Watt laser device is safe and efficient in Retrograde Intrarenal Surgery.
Summary Objectives To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic ...hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. Methods We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. Results Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57–85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45–84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 ( p < 0.05). The remaining analyzed data were similar ( p > 0.05). Conclusion PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.
This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction ...obstruction (UPJO) andstone disease.
Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated.
The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate.
RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.
Purpose Psoriasis, affecting approximately 2% of the world's population, often necessitates systemic treatments, with methotrexate (MTX) as a cornerstone therapy. Despite documented systemic side ...effects of MTX, concerns about its impact on male reproductive health persist. We aim to investigate low-dose MTX effect on hormonal, cellular and functional ability of male reproductive system.
Our prospective study on 40 male psoriasis patients receiving low-dose MTX (<15mg/week) comprehensively investigates its effects on erectile function, sex hormones, and spermiogram parameters.
After six months of MTX treatment, a significant decline in erectile function (p < 0.001) decreased total testosterone levels (p = 0.03) were observed. No significant reduction in sperm count was noted after six months of MTX treatment.
Our study highlights a significant decline in erectile function following low-dose MTX therapy, warranting further investigation into this potential side effect. While reassuring for sperm quantity and quality, the findings emphasize the necessity for larger cohorts and longer follow-up times to validate results and comprehend the complex interactions between MTX and male sexual health.
In cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our ...study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD.PURPOSEIn cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD.A retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure.METHODSA retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure.A total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18 years of age, the duration of symptoms being longer than 9 h, and MER > 28.RESULTSA total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18 years of age, the duration of symptoms being longer than 9 h, and MER > 28.Current urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.CONCLUSIONCurrent urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.
To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters ...associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones.
We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates.
The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9%
3.4%,
= 0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (
< 0.001,
< 0.001,
< 0.001,
< 0.001,
= 0.002, and
< 0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade ≥3 complications according to MCCS (
= 0.032). However, significant predictors were stone burden (
< 0.001), stone density (
= 0.002), and fluoroscopy time (
< 0.001) for those with Grade ≥2b complications according to SCS.
This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.
Objectives
To externally validate and compare Resorlu‐Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S‐ReSC), Ito’s nomogram, and Retrograde Intra‐Renal ...Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone‐free status and complications in a multi‐institutional study.
Materials and Methods
We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f‐URS) and laser lithotripsy for renal stones in two institutions between March‐2015 and June‐2020. The RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone‐free status and complications.
Results
Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2‐84 years). Mean stone burden was 102.6 ± 42.2 (48‐270 mm2). All nomograms predicted stone‐free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito’s nomogram was able to predict Clavien ≥2 complications.
Conclusion
All four scoring systems (RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S.) could predict stone‐free status after f‐URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post‐operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.
To comparatively investigate the efficacy, safety and complications of flexible ureterorenoscopy (f-URS) in the treatment of patients of different age groups (<60, 60-74 and ≥75 years) with proximal ...ureteral and kidney stones.
Descriptive study.
Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, HSU Ankara Diskapi Training, Research Hospital, and Mustafa Kemal University Faculty of Medicine, between March 2014 and June 2020.
Nine hundred and fifty-six patients, who underwent f-URS due to proximal ureteral and kidney stones, were divided into three age groups as <60 years (Group 1), 60-74 years (Group 2) and ≥75 year (Group 3). The patients' American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), anticoagulant use, stone-free rates and surgical and medical complication rates were examined for each group.
There were 688 patients in Group 1, 230 in Group 2, and 38 in Group 3. A significant difference was observed between the age groups in terms of CCI and anticoagulant use (p<0.001 for both). The highest rate of medical complications was observed in Group 3 at 42.1%, followed by Group 2 at 17.8%, while the lowest rate was observed in Group 1 at 2.3% (p<0.001). As a result of the multivariate analysis, receiving anticoagulant treatment (p=0.002) and having a high CCI (p=0.005) were independent predictors of medical complication development.
It was clearly demonstrated that f-URS could be used as a safe and effective alternative for the treatment of moderate-size kidney stones in all age groups. Key Words: Elderly, Geriatric patients, RIRS, Holmium laser lithotripsy, Urolithiasis, Safety, Efficacy.
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