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Aim:The Hounsfield unit (HU) value can predict the stone-free status of retrograde intrarenal surgery (RIRS) for kidney stones. The purpose of this study was to investigate the effect of HU and HU-related variables on RIRS outcomes in isolated lower pole kidney stones.Methods:This single-center cross-sectional study was conducted between January 2017 and March 2023. One hundred thirty-three patients who underwent RIRS for lower pole kidney stones were evaluated. These were divided into stone-free (Group 1) and remnant (Group 2) groups, and the effects of the HU-related variables on RIRS outcomes were investigated.Results:One hundred-five (78.9%) patients in Group 1 and 28 (21.1%) in Group 2 were enrolled in the study. Significant differences were observed between the groups in terms of mean stone area (p=0.003), stone size (p

Objective: Water for human consumption is water that is used for all kinds of human needs in its original form or after processing. In this study, it was planned to examine the effect of sociodemographic characteristics and drinking water preferences of individuals on kidney stone formation. Methods: In this cross-sectional study, 237 patients aged 18-55 years who applied to Karabük Training and Research Hospital Family Medicine Outpatient Clinic in 2020 were included. Individuals who had undergone renal ultrasonography (USG) for any reason in the last six months were included in the study. Patients with diabetes mellitus (DM), hypertension (HT), acute and chronic renal failure (AKI and CRF) were excluded. Sociodemographic characteristics of the participants such as age, gender, occupation, the type of drinking water they used, the average amount of water consumed per day, the criteria affecting the water preference of those using ready-to-drink water and ultrasonography results were recorded. Mann-Whitney U test was used for two-group comparisons and Kruskall-Wallis H test was used for comparisons with three or more groups. The relationship between categorical variables was analyzed by Chi-Square analysis. Results: 51.1% of the participants were male, 38.8% were primary school graduates, 38.8% were unemployed, 67.5% were married, 79.2% lived in an apartment building, 55.5% had a family structure consisting of 3-4 people. 40.1% of the participants preferred ready-to-drink water. Ultrasonography of the participants revealed that 14.8% had urinary calculi. Of the individuals with stones, 17.2% were female, 19.6% were primary school graduates, 18.8% were self-employed, and 33.3% were widowed/divorced. Among the individuals with stones, 26% used tap water as drinking water. The likelihood of stones in renal ultrasonography increased significantly with increasing age. Conclusion: It was found that the individuals with stones in the renal system were more likely to be female, primary school graduates, widowed/divorced and consumed tap water as drinking water. In terms of drinking water consumption, it should be paid attention that tap water has been analyzed. Water should not be consumed from sources that do not meet the reliability conditions and the water source with the highest suitability should be preferred. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Reconstructive Urology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: this study, we aimed to investigate the efficacy and safety of (Retrograde Intrarenal Surgery) RIRS in patients over 65 years of age. Materials and Methods: 107 patients over 65 who underwent RIRC in our clinic were evaluated retrospectively. The patients were divided into two groups, according to whether there were complications (Group 1: without complications, Group 2: with complications) and according to age (Group 1: 65-74 years, Group 2: 75 years and above). The groups were compared with each other regarding stone-free rate, complication rate, stone characteristics, and hospital stay. Results: When divided into groups according to age, no difference was observed between group 1 (65-74 years old) and group 2 (75 years and older) in terms of American Society of Anesthesiogists score, stone size, number of stones, and Hounsfield unit of the stone. On the other hand, it was observed that the hospital stay and complication rate of group 2 were higher than group 1. (p value 0.01 and 0.02, respectively). The patients were divided into two groups according to whether there were complications. There was no significant difference in ASA score, Hounsfield unit of stone, and stone-free rate between group 1 (without complications) and group 2 (with complications). (p value respectively: 0.127, 0.915, 0.379 ) Conclusions: The number of elderly patients with kidney stones is increasing day by day. The most appropriate and reliable treatment modalities gain importance in treating kidney stones in these patients. The result of our study revealed that RIRC is an effective and safe procedure in geriatric patients with kidney stones. [ABSTRACT FROM AUTHOR]

Objective: In urology guidelines, endourological treatments such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are recommended for lower pole stones with a diameter of 10-20 mm, especially in cases where extracorporeal shock wave lithotripsy (SWL) fails or SWL is not appropriate. In this study, we compared the results of patients who underwent RIRS and mini percutaneous nephrolithotomy (m-PCNL) for lower pole stones with a diameter of 10-20 mm. Material and Method: The data of 187 patients (116 RIRS, 71 m-PCNL) who underwent endourological treatment (RIRS or m-PCNL) for 10-20 mm lower pole kidney stones between 2020 and 2022 were retrospectively analyzed. To avoid preoperative biases, propensity score-matching was applied based on a 1:1 ratio. According to the results of the analysis, 65 patients who underwent RIRS and 65 patients who underwent m-PCNL were included in the study. Intraoperative (operation time, fluoroscopy time) and postoperative findings (hospitalization time, drop in hematocrit, stone-free rates, and complications) were compared between the two groups. Postoperative stone detection of 4 mm or larger was defined as clinically significant residue. Complications were classified according to the Clavien scoring system and as intraoperative-postoperative. Results: When the two groups were compared in terms of demographic characteristics (age, gender, body mass index) and radiographic stone characteristics (stone size, stone laterality, stone opacity, and stone density), no statistically significant difference was observed. When the groups were compared in terms of operation time, fluoroscopy time and hospitalization time, these periods were statistically significantly shorter in the RIRS group (p<0.001). In addition, the decrease in the amount of hematocrit in the RIRS group was significantly less than in the m-PCNL group (p<0.001). When the postoperative stone-free rates and intraoperative and postoperative complication rates were examined, it was seen that the results in both groups were similar. Conclusion: RIRS operation is an effective and successful endourological treatment alternative with stonefree rates and complication rates similar to m-PCNL operation in lower pole kidney stones between 10-20 mm. However, the fact that the RIRS operation has shorter operation, fluoroscopy and hospitalization times compared to the m-PCNL operation and causes less blood loss shows that it can be applied more reliably. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the operative and postoperative outcomes in patients >70 years of age who underwent PNL and to compare them with a younger group. Materila and Methods: We retrospectively evaluated 508 patient data who underwent conventional PNL for >2 cm kidney stones in our institution between 2016 and 2019. The patients were divided in to two group according to their age. Group 1 consisted with patient whose age is younger than 70 years and Group 2 consisted with patient whose age is equal or higher than 70 years. Patients’ comorbidities, ASA scores, body mass indices (BMI), stone size and perioperative values such as surgery time, fluoroscopy time, complication rates, length of hospital stay and stone-free rates were compared between the groups. Results: 476 patients were identified in Group 1 (younger), and 32 patients were in Group 2 (elderly). The mean age in elderly patients was 73 years (range 70-86) and 48 years (range 18-69) in younger group. There is no difference in multiple stone rate, operation time, fluoroscopy time, length of hospital stay, the levels of stone free rate and complication rates between groups. Preoperative stone size, staghorn stone rate, and transfusion rate was significantly higher in elderly patients than younger group (respectively; p = 0.027, 0.009, 0.003). Conclusion: PNL had acceptable results for large kidney stones and was safe in elderly patients.

Objective: In this study we aimed to evaluate the effectiveness of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRC) in treatment of lower pole kidney stones. Material and Methods: The data of 134 patients who underwent SWL or RIRC treatment for lower pole kidney stone between January 2018 and August 2019 were retrospectively reviewed. The groups were compared statistically in terms of demographic characteristics, stone characteristics and stone-free rates. Results: Ninety-two (68.7%) male and 42 (31.3%) female patients were included in the study. Fifty-nine (44.0%) patients had stone in the right kidney and 75 (56.0%) had stone in the left kidney. The mean age of all patients was 47 ± 16 years, stone burden was 94.7 ± 62.0 mm2 and Hounsfield Unit was calculated as 819.5 ± 256.2. There were 73 (54.5%) patients in the SWL group and 61 (45.5%) patients in the RIRC group. Stone-free rates were calculated as 52.1% and 72.1% for SWL and RIRC groups, respectively. Although stone burden was higher in RIRC group than SWL group, stone-free rate was higher (p=0.004 and p=0.018, respectively). Conclusion: When compared with SWL, higher stone-free rates can be achieved with RIRC with lower number of sessions even in cases with higher stone burden.

Aim:To compare the results of micro-percutaneous nephrolithotomy (micro-PNL) and retrograde intrarenal surgery (RIRS) for symptomatic renal stones 5-10 mm in diameter.Methods:A total of 86 patients, who underwent RIRS (n=53) and micro-PNL (n=23), were evaluated retrospectively. Urine analysis, serum creatinine level, urine culture and non-contrast computed tomography scan were performed in all patients preoperatively. Kidney stones were opaque in all cases. Unresolved coagulopathy, active urinary infection, morbid obesity, missing data and pregnancy were considered the criteria for exclusion. The groups were compared in terms of operative time, Visual analogue scale score, analgesic requirement, retreatment, transition to other treatment, complication and stone-free rates and length of hospital stay.Results:Both surgical techniques were similar for all parameters except need for analgesics, which was higher in the micro-PNL group (p=0.026). The stone-free rate was 85.7% in the RIRS group and 78.2% in the micro-PNL group (p=0.43).Conclusion:Both methods can be administered as alternative modalities with high success and low complication rates. However, analgesics requirement was higher in micro-PNL group.

Objective: In this study, it was aimed to present the efficacy and safety results of geriatric male patients who underwent retrograde intrarenal surgery (RIRC) in our clinic for the treatment of kidney stones, by comparing them with the younger age group. Material and Methods: The data of male patients over 40 years of age who underwent RIRC for kidney stones in our clinic were evaluated retrospectively. The patients were divided into two groups according to their age: 40-64 years (Group 1) and 65 years and older (Group 2). The data on the comorbidity status of the patients were compiled from their files. American Society of Anesthesiologists score(ASA) and modified Charlson comorbidity index(MCCI) were used for comorbidity assessment. General information, complication information, presence of renal abnormality, kidney and location of the stone, density of the stone, size of the stone, number of stones and postoperative stone clearance data were obtained from the hospital’s registry system and the files of the patients. Results: A total of 294 patients were included in the study, of which 233 were in Group 1 (40-64 years old) and 61 in Group 2 (65 years and older). In terms of ASA and MCKI scores, the scores of the patients in Group 2 were found to be statistically significantly higher than Group 1 (p<0.001, p<0.001, respectively). There was no difference between the groups in terms of preoperative DJ catheter set, presence of renal abnormalities and non-functioning kidneys. There was no difference between the groups in terms of stone density, stone size, stone volume, operation time, hospital stay, and postoperative stone-free rates. Complications were detected in 25 (10.7%) patients in Group 1 and in 10 (16.4%) patients in Group 2, and there was no statistical difference between the groups in terms of overall complication rates (p=.265). Conclusion: With the aging of the world population, the importance of treating the diseases of this patient group with the most appropriate treatment methods has increased. In our study, kidney stone treatment with the RIRC method was found to be safe and effective in the elderly patient group. [ABSTRACT FROM AUTHOR]

ÖzetGiriş: Çocukluk çağı taş hastalığında en sık görülen taş tipi kalsiyum taşlarıdır ve genellikle altta yatan metabolik bir anormalliğe bağlı görülür. Kalsiyum taşlarının tedavisinde potasyum sitrat sık kullanılan bir tedavi seçeneğidir. Bu çalışmada kalsiyum taşı tanısı ile takip edilen ve hiperkalsiüri/hiperokzalüri/hipositratüriye ek olarak hipomagnezürisi çocuklarda potasyum sitrat tedavisi ile potasyum sitrat ve magnezyum kombinasyonunun etkinliği araştırılmıştır.Metod: Kliniğimizde üriner sistem taş hastalığı tanısı ile takip edilen hasta dosyaları geriye dönük incelendi. Metabolik taramada hiperkalsiüri/hiperokzalüri/hipositratüri (biri veya birden fazlası) anormalliklerine ek olarak hipomagnezüri saptanan hastalar çalışmaya dahil edildi. Hiperürikozüri, primer hiperokzalüri, sistinüri ile başlangıç taş boyutu ≤3 mm ve 2 yaşın altında olan hastalar çalışma dışı bırakıldı. Tedavide sadece potasyum sitrat kullanan grup ile potasyum sitrata ek olarak magnezyum tedavisi ilave edilen grup arasında tedavi öncesi ve sonrası taş boyutları, taş düşürme oranları ve tedavi süreleri karşılaştırıldı.Bulgular: Çalışmaya potasyum sitrat kullanan 14 hasta (grup I) ile potasyum sitrat ve magnezyum kullanan 15 hasta (grup II) olmak üzere toplam 29 hasta alındı. Grup I’de 9 kız ve 5 erkek, (yaş ortalaması 9.3±4.3 yıl), grup II’de ise 7 kız ve 8 erkek (yaş ortalaması 7.0±3.9 yıl) mevcuttu. Her iki grupta yaş ve cinsiyet açısından fark yoktu (p˃0.05). Tedavi süreleri açısından iki grup arasında fark bulunmadı (grup I, 3.2±1.2 ay vs. grup 2, 3.1±1.4 ay, p=0.872). Tedavi öncesi taş boyutları grup I’de ortalama 5.2±1.6 mm, grup II’de 5.1±0.9 mm iken, tedavi sonrası grup I’de 3.4±1.3 mm, grup II’de 4.6±1.6 mm idi. Tedavi sonrası taş düşürme grup I’de 2 hastada (%14.3), grup II’de ise 5 hastada (%33.3) gözlendi. Tedavi öncesi ve sonrası taş boyutları ile taş düşürme oranları açısından her iki grupta anlamlı fark saptanmadı.Sonuç: Kalsiyum taşlarında risk faktörlerine eşlik eden hipomagnezürinin tedavi edilmesi kısa dönemde çocukluk çağı taş hastalığında etkili bulunmamıştır.

ÖzetGiriş: Çocukluk çağı taş hastalığında en sık görülen taş tipi kalsiyum taşlarıdır ve genellikle altta yatan metabolik bir anormalliğe bağlı görülür. Kalsiyum taşlarının tedavisinde potasyum sitrat sık kullanılan bir tedavi seçeneğidir. Bu çalışmada kalsiyum taşı tanısı ile takip edilen ve hiperkalsiüri/hiperokzalüri/hipositratüriye ek olarak hipomagnezürisi çocuklarda potasyum sitrat tedavisi ile potasyum sitrat ve magnezyum kombinasyonunun etkinliği araştırılmıştır.Metod: Kliniğimizde üriner sistem taş hastalığı tanısı ile takip edilen hasta dosyaları geriye dönük incelendi. Metabolik taramada hiperkalsiüri/hiperokzalüri/hipositratüri (biri veya birden fazlası) anormalliklerine ek olarak hipomagnezüri saptanan hastalar çalışmaya dahil edildi. Hiperürikozüri, primer hiperokzalüri, sistinüri ile başlangıç taş boyutu ≤3 mm ve 2 yaşın altında olan hastalar çalışma dışı bırakıldı. Tedavide sadece potasyum sitrat kullanan grup ile potasyum sitrata ek olarak magnezyum tedavisi ilave edilen grup arasında tedavi öncesi ve sonrası taş boyutları, taş düşürme oranları ve tedavi süreleri karşılaştırıldı.Bulgular: Çalışmaya potasyum sitrat kullanan 14 hasta (grup I) ile potasyum sitrat ve magnezyum kullanan 15 hasta (grup II) olmak üzere toplam 29 hasta alındı. Grup I’de 9 kız ve 5 erkek, (yaş ortalaması 9.3±4.3 yıl), grup II’de ise 7 kız ve 8 erkek (yaş ortalaması 7.0±3.9 yıl) mevcuttu. Her iki grupta yaş ve cinsiyet açısından fark yoktu (p˃0.05). Tedavi süreleri açısından iki grup arasında fark bulunmadı (grup I, 3.2±1.2 ay vs. grup 2, 3.1±1.4 ay, p=0.872). Tedavi öncesi taş boyutları grup I’de ortalama 5.2±1.6 mm, grup II’de 5.1±0.9 mm iken, tedavi sonrası grup I’de 3.4±1.3 mm, grup II’de 4.6±1.6 mm idi. Tedavi sonrası taş düşürme grup I’de 2 hastada (%14.3), grup II’de ise 5 hastada (%33.3) gözlendi. Tedavi öncesi ve sonrası taş boyutları ile taş düşürme oranları açısından her iki grupta anlamlı fark saptanmadı.Sonuç: Kalsiyum taşlarında risk faktörlerine eşlik eden hipomagnezürinin tedavi edilmesi kısa dönemde çocukluk çağı taş hastalığında etkili bulunmamıştır.

Objective: Percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) are performed in treatment of kidney stone disease for a long period beside the other treatment methods. Since 1987 PNL procedure has been used successfully and safely in our clinic for treatment of kidney stones. We aimed to compare the success rates of multitract access and sandwich therapies (PNL+SWL+PNL) in staghorn kidney stones performed in four years period. Materials and Method: During last four years 462 patients underwent PNL procedures in our clinic. 126 of the patients had staghorn kidney stones 23 of the patients (16male/7female) had multitract PNL while 16 (12male/4female) underwent sandwich therapy. We compare these two groups for postopertive early period and in 6th month success, major (bleeding and adjecent organ injury etc.) and minor (fever, urinary tract infections) complications, total hospitalization period, additional treatment requirements and total operation duration. Results: Statistically significant differences were appearent between two groups while total hospitalization period (9,74±3,19 days in multitract PNL group and 22,12±10,19 days in sandwich therapy group), total operation duration (110,78±35,57 minutes in multitract PNL group and 176,87±31,51 minutes in sandwich therapy group)(p0,05). Also additional treatment requirements, complication (major and minor) rates, stone analysis are compared and we did not find statistically significant differences between two groups (p>0,05). Conclusion: PNL is successfull and safe treatment method of staghorn stones. It can be performed with multitract technique in one session or with sandwich therapy technique which can be combined with SWL due to conditions. Besides the blood replacement volumes, hospitalization period and the ooperation, the comparison of these treatment modalities did not exhibit any significant differences for success and complication rates. Our outcomes are compatible with the literature.

Copyright of Yeni Üroloji Dergisi is the property of Ali Ihsan Tasci and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Several methods including extracorporeal shock wave lithotripsy(ESWL), standard percutaneous nephrolithotomy(PCNL), mini-PCNL and retrograde intrarenal surgery(RIRS) have been recommended to treat kidney stones. A major advantage of mini-PCNL is that it provides similar stone-free and success rates and is less invasive when compared with standard PCNL. In this report, we evaluated our experiences and outcomes with mini-PCNL in a pediatric population. Material and Methods: From January 2011 to November 2016, the medical records and radiographic images of children who underwent mini-PCNL with a 15 Fr peel-away sheath and 12 Fr miniature nephroscope were evaluated. We reviewed the patients' demographic details, hemogram, stone characteristics, stone free rate and success rates, additional procedures, complications, hospital stay and nephrostomy retrieval. Stones were classified according to kidney localization as simple (single calyx or pelvic stones) or complex (choraliform, pelvic+calyx stones or multiple calyx stones). Results: The study included 12 girls and 28 boys, with a mean age of 7.84±5.62 years (1-17 years). The mean diameter of the stones was 24.4±15.3 mm (10-65 mm). The mean stone size was 14.76±6.52 mm for the simple stone group and 35.05±15.22 mm for the complex stone group (p=0.000). The mean operative and fluoroscopy times were 89.17±31.48 minutes and 146.35±63.16 seconds. The first success rate was 55% (n=22). 8 patients underwent additional procedures and the success rate increased to 77.5% (n=31). The success rate was significantly higher in simple stones (95.2% vs. 57.9%; p=0.005). The complication rate of the mini-PCNL procedure was 22.5% (n=9). The mean hemoglobin decrease was 0.73±1.06 mg/dl and only 1 patient required a blood transfusion. The mean hospital stay and nephrostomy retrieval time was 3.77±2.32 and 2.00±1.70 days, respectively. Conclusion: Our experiences indicate that mini-PCNL is a safe and effective procedure for the management of renal stones in children and stone-free and success rates similar to standard PCNL are obtained. [ABSTRACT FROM AUTHOR]

Although Double-J stents have become very common in the urological practice and are effectively used for various reasons, several complications related to it, such as hematuria, infection, irritative symptoms, pain, perforation, encrustation, and migration, have been observed. The present study reports five case reports of stent encrustation due to forgotten stents. [ABSTRACT FROM AUTHOR]

Amaç: Perkütan nefrolitotripsi (PNL), ürolojinin son yıllarına damga vurmuş, pek çok merkezde uygulanabilen, morbiditesi ve mortalitesi son derece düşük bir tedavi yöntemi olarak karşımıza çıkmaktadır. Biz bu çalışmamızda, PNL öncesi serum kreatinin değerindeki yüksekliğin post operatif kanama durumuna etkisini araştırmayı amaçladık. Materyal ve Metod: Kliniğimizde PNL uygulanmış olan hastalar arasında üre ve kreatinin değerleri yüksek olan hastalar ayrıldı. Bu hastaların yaşları, taş boyutları, cinsiyetleri, tedavi öncesi hematokrit değerleri ve ek ko-morbiditeleri kaydedilerek hastaların bu değerlerine benzer değerleri olan hastalar ile diğer grup oluşturuldu. Serum kreatinin Araştırma Makalesi / Research Article 221 Şener ve ark. Cukurova Medical Journal değerleri yüksek olanlar Grup 1, normal olanlar ise Grup 2 olarak adlandırıldı. Hastaların beden kitle endeksi, taş boyutları, operasyon öncesi ve sonrası kreatin değeri, operasyon öncesi ve sonrası hematokrit değeri, preoperatif trombosit sayısı, koagülasyon parametreleri (aPTT, INR değerleri), trakt sayısı, operasyon süresi, preoperatif trombosit sayısı, taşsızlık oranları ve eritrosit transfüzyonu olup olmadığı kaydedilerek kıyaslandı. Bulgular: Gruplarda preoperatif kreatinin değerleri sırası ile Grup 1 ve 2 için 2,11 ± 0,44 ve 0,98 ± 0,27 idi. Taş boyutları 1. Grup için 29,41 ± 3,83 mm, 2. Grup için ise 29,49 ± 2,99 idi (p=0,317). Hastaların operasyon öncesi hematokrit değerleri 1 ve 2. Gruplar için sırasıyla 44,88 ± 5,61 ve 47,51 ± 4,61 idi (p=0,381). Bu değerler operasyon sonrası her iki grup için sırası ile 30,27 ± 7,01 ve 37,74 ± 7,11 idi (p=0,044). Sonuç: Çalışmamızda kreatinin değerlerinin PNL sonrası kanama için bir risk faktörü olduğu, serum kreatinin değerlerinin yüksekliği olan hastalarda, olmayanlara oranla hematokrit düşüşünün daha fazla olduğu görülmektedir.

Aim: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in pediatric age group. Methods: Data of patients who underwent RIRS for the treatment of kidney stones were retrospectively analyzed. The procedure was performed using 7.5 Fr FlexX™ 2 flexible ureterorenoscope in all patients. Ureteral access sheath was not used in any patients. A double-j stent was inserted and the procedure was delayed for 2 weeks whenever access to the ureter was not possible. The stones were fragmented using laser and fragments smaller than 2 mm were left for spontaneous passage. Postoperative success was evaluated using ultrasonography and kidney, ureter and bladder (KUB) x-ray. Results: 14 patients with a mean age of 7.5±2.47 (range: 3-12) years were included. Male to female ratio was 8/6 and six patients had a stone on the right side. The mean stone size was 12.3±3.49 (range: 8-20) mm. Of the patients, 10 had a history of unsuccessful shock wave lithotripsy (SWL) treatment. Mean operation and fluoroscopy screening times were 33.5±6.9 (range: 25-45) and 45.3±15.4 (range: 30-75) minutes, respectively. The median hospital stay was 1.07±0.2 (range: 1-2) days. No major complications were noticed during the operation. Double-J stents were removed on the 2nd postoperative week and all patients were stone-free during the follow-up. Conclusion: RIRS can be performed safely and efficaciously in pediatric patients. (The Medical Bulletin of Haseki 2015; 53:52-6)

Objective: Percutaneous nephrolithotomy (PNL) has become the primary treatment option for large or multiple renal stones and inferior caliceal stones where ESWL (extracorporeal shock wave lithotripsy) therapy fails. In our study, we investigated the factors that predict the success of PNL operations and the development of complications. Material-Method: A total of 64 cases above 18 years old with renal stones, who would undergone only PNL surgery by a single specialist between December 2008 and June 2009 dates have been included in this study. Data of the patients were collected prospectively. Percutaneous access tract was established by using semi-rigid amplatz dilators, under C-armed fluoroscopy, while the patient was at prone position. During the operation, pneumatic litotriptor device was used to break the stones. The effect of some factors related to stone (size and localization), operation (number of access and localization) and patient (age) on the successfull outcome rate and complications of PNL was investigated. Results: We have gained a 89.1% of success rate after including also clinically unimportant stones. This rate has increased to 93.8% with additional treatment. In 10.9 % of the patients, additional treatment was applied. The size, localization and dilatation degree of the stone are the predictor factors of successfull outcome. It has been found that making numerous percutaneous entrance has no effect on results. Our complication rate was 59.4% (38 patients) in this study. Postoperative high fever was observed in 14 patients (21.9%) and this was the most frequent complication. There was no serious complication excluding hemorrhage which requires blood transfusion. Bleeding was encountered with 12.5% rate. Increased or complex stone burden, multiple entrance number and intercostal intervention were factors affecting the complication rates. Patient related factors such as age did not affect this rate. Conclusions: We have conluded that stone related factors (size, localization and dilatation grade) have effect on the outcomes of PNL operations, whereas percutaneous entrance numbers and localization are independent factors which predict the development of complications. Also, as a result of this study, we can say that PNL is an effective, reliable and applicable method in elderly patients. [ABSTRACT FROM AUTHOR]

Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery. Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine. PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues. Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16- 0.8. 25 left-sided and 29 right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was 370±45 mm2, while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days. Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens. Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure. [ABSTRACT FROM AUTHOR]

Aim: In this study, we evaluated the results of 2300 patients who underwent percutaneous nephrolithotomy (PNL) between March 2002 and April 2013. Methods: In our clinic, a total of 2300 PNL operations were performed between March 2002 - April 2013. Demographic characteristics (age, gender), body mass index, stone features (side, size, location), clinical characteristics of the urinary tract (renal anomaly, previous surgery, previous extracorporeal shock wave lithotripsy), operation parameters (duration of the intervention and fluoroscopy, number of access, location of access, transfusion, complications), post-operative data (length of hospital stay, transfusion, complications, stone-free) were recorded on PNL forms. The data were analyzed retrospectively. Results: Of all the PNL operations, 1225 (53.2%) were left-sided, 1074 (46.6%) were right-sided and 1 was bilateral. The mean age of the subjects was 43.5 (7-83) years and the mean body mass index was 26.6 kg/m2 (12-51). A total of 46 (2%) cases had renal anomalies. There were 16 patients with horseshoe kidney. More than one accesses was performed in 18.6% of the patient and intercostal access was done in 9.8%. Perioperative and post-operative transfusion rates were 1.4% and 2.9%, respectively. The mean stone size was 7.5±4.1 cm2. Stone-free (SF) rate was 65.1% and success rate was 78.5%. Conclusion: With increasing experience and advances in endourology, PNL is being widely performed with low morbidity and high success in our country as in the world. (The Me­di­cal Bul­le­tin of Ha­se­ki 2013; 51: 19-24)

Amaç: Bu çalışmada tam tüpsüz perkutan nefrolitotomi (PNL) uygulamasıyla ilgili deneyimlerimiz aktarılmıştır. Materyal-Metod: Ocak 2010-Aralık 2012 tarihleri arasında böbrek taşı olan 140 olguda uygulanan tam tüpsüz PNL yönteminin sonuçları incelendi. Bulgular: Hastaların yaş ortalaması 47,84(5-73) idi. Ortalama operasyon süresi 88.8(45-110) dk, taş alanı ise 375.2(110-175) mm² idi. Taşsızlığa ulaşma oranımız KÖRF dahil 130(%92.8) olarak hesaplandı. PNL uyguladığımız hastalarımızdan 1 tanesinde serozal kolon yaralanması 2 hastada postoperatif perirenal hematom izlendi. Sonuç: Sonuç olarak uygun vakalarda tam tüpsüz PNL, günümüzde böbrek taşı tedavisinde taşsızlığa ulaşma noktasında standart PNL kadar güvenle uygulanabileceğini düşünmekteyiz.

AIM: Management of kidney stone in pediatric patients is an important problem. Shock Wave Lithotripsy (SWL), mini-percutaneous nephrolithotomy (mini-PNL), micro PNL and recently developing Retrograde Intrarenal Surgery (RIRS) are the methods used in stone management. METHODS: Among from the 1047 patients who had undergone RIRS and mini-PNL in Dıskapı Yıldırım Beyazıt Training and Research Hospital, 27 patients who are younger than 17 years were included our study. The demographic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively. RESULTS: For 1-2 cm diameter stones, the success for RIRS and mini-PNL were %70 and %100, respectively. For 2-3 cm diameter stones, the success for RIRS and mini-PNL were %50 and %100, respectively. There was no major complication in both groups. Scopy time, operation time, stone burden, hospital stay were different between two groups. And the difference was statistically significant. CONCLUSION: As a result RIRS and mini-PNL are effective and safe methods and they are feasible in treatment of pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure that is safely performed for kidney stone surgery all over the world. In our clinic, PNL surgery was first performed in March 1998. In parallel with our increasing experience, PNL has been performed in pediatric cases. In our study, PNL operations performed in pediatric patients under the age of 10 years and in those over the age of 10 years were retrospectively investigated. Methods: Patients were between 0 and 16 years of age. They were divided into 2 groups according to age: 0-10 and 11-16 years. The PNL procedure was performed under general anesthesia with C-arm fluoroscopy in the prone position. Results: Between March 1998 and December 2014, a total of 208 pediatric urinary stone patients were operated on. The PNL procedure was performed in 210 renal units, 1 of which was performed bilaterally. In the =10-year-old patient group, 98 procedures (87.5%) were stone free, while clinically insignificant residual fragments (CIRFU) were found in 13 procedures (12.5%). In the >10-year-old patient group, 88 procedures were stone free (89.79%), while clinically insignificant residual fragments were found in 9 procedures (10.2%). In the =10-year-old patient group, tubeless PNL was performed in 1 patient. In both groups combined, bleeding requiring transfusion occurred in just 1 case. A tract leak requiring a double J stent was detected in 1 patient in the =10-year-old patient group and in 2 patients in the other group. There was no other organ injury. Conclusion: PNL is a minimally invasive method and has become advantageous over open surgery because it offers higher security, particularly in experienced clinics, and procedures on pediatric patients can therefore be successfully performed. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to present the data on totally tubeless nephrolitotomy (PNL) outcomes undergone in our clinic. Materials and Methods: We retrospectively analyzed 140 patients undergone totally tubeless PNL in our clinic between January 2010 and December 2012. Results: Mean patient age was 47,84 (5-73). Mean operative time was 88,8 (45-110) minutes where mean stone area was 375,3 (110-175) mm2 . 92,8% was our stone free rate. Remaining 10 patients had undergone ureterorenoscopy for ureteral stones. Two patients having non-opaque stones had residual kidney stones and treated by SWL. 8 patients (%5,7) needed blood transfusion, 2 patients needed perirenal hematoma and treated conservatively. No patients needed additional treatment or encountered vascular complications. One patient encountered serozal colon injury and treated conservatively. Conclusion: With regard to patient comfort, shorter hospital stay, low analgesic requirement, totally tubeless PNL gained popularity. We believe totally tubeless PNL may be used in suitable cases. Key Words: Kidney Stone, Totally Tubeless, Nephrolithotomy [Cukurova Med J 2013; 38(4.000): 636-641]

The Horseshoe kidney is the most common fusion anomaly and its incidence is around 1/400. It is two times more common in males than females. Because of the urinary stasis due to the higher location of the ureteropelvic junction in horseshoe kidney, the incidence of kidney stones is high. In this study we aimed to present a laparoscopic pyelolithotomy case performed after a failed ESWL treatment in a kidney stones patient with a horseshoe kidney. [ABSTRACT FROM AUTHOR]

Urinary stone disease is a common health problem in the community. In the last two decades, percutaneous nephrolithotomy (PNL), extracorporeal shock wave lithotripsy (ESWL), and retrograde intrarenal surgery (RIRS) have become popular as minimally invasive methods. The European Association of Urology 2014 urinary stones guideline recommends PNL as the first line of treatment for kidney stones above 20 mm. ESWL remains the first choice for stones of <1 cm within the renal pelvis and upper or middle calices. For kidney stones between 10 to 20 mm, the location and movement of the stone, stone type, calyx anatomy, and patients status contribute to the choice of treatment. RIRS in combination with holmium YAG laser is effective and safe. Initially, RIRS was offered for was lower calyceal stones, multiple stones, post-ESWL failure, comorbid illnesses, reduction in the diameter of development of surgical experience ureteroscopy, the development of optics providing better visibility, and the diversification of the equipment. At present, RIRS has become an alternative treatment modality to other minimally invasive therapy. It is thought that advances in technology will lead to more flexible instruments and surgical equipment for RIRS therapy. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous Nephrolithotomy (PNL), has been a breakthrough in urology practice; it can be performed in various centers, with high success rates and low morbidity and mortality rates. In this study, we aimed to investigate the effect of plasma creatinine levels upon the hemorrhage on PNL procedures. Material and Methods: Patients underwent PNL were categorized as having high plasma urea and creatinine levels. Patient age, stone size, gender, hematocrit levels and additional co-morbidities were recorded and a matching group was designed using same variables. Group 1 consisted of patients with high creatinine levels and Group 2 consisted of normal creatinine levels. Body mass index, stone size, hematocrit levels, plasma creatinine levels before and after the operation, coagulation parameter (aPTT, INR), number of access tracts, operative time, preoperative platelet number, stone free rates and transfusion rates were recorded and compared. Results: Mean plasma creatinine levels were 2,11 ± 0,44 and 0,98 ± 0,27 for Groups 1 and 2, respectively. For Groups 1 and 2, stone sizes were 29,41 ± 3,83 mm, and 29,49 ± 2,99 (p=0,317). Mean peroperative hematocrit levels were 44,88 ± 5,61 and 47,51 ± 4,61 (p=0,381) for Groups 1 and 2, respectively. Those levels were 30,27 ± 7,01 and 37,74 ± 7,11 (p=0,044) for Groups 1 and 2 post operatively. Conclusion: In conclusion, having high levels of plasma creatinine preoperatively for PNL was seen to be a risk factor for hemorrhage. If a patient has high creatinine levels preoperatively, he/she may be more prone to bleeding after PNL. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in pediatric age group. Methods: Data of patients who underwent RIRS for the treatment of kidney stones were retrospectively analyzed. The procedure was performed using 7.5 Fr FlexX™ 2 flexible ureterorenoscope in all patients. Ureteral access sheath was not used in any patients. A double-j stent was inserted and the procedure was delayed for 2 weeks whenever access to the ureter was not possible. The stones were fragmented using laser and fragments smaller than 2 mm were left for spontaneous passage. Postoperative success was evaluated using ultrasonography and kidney, ureter and bladder (KUB) x-ray. Results: 14 patients with a mean age of 7.5±2.47 (range: 3-12) years were included. Male to female ratio was 8/6 and six patients had a stone on the right side. The mean stone size was 12.3±3.49 (range: 8-20) mm. Of the patients, 10 had a history of unsuccessful shock wave lithotripsy (SWL) treatment. Mean operation and fluoroscopy screening times were 33.5±6.9 (range: 25-45) and 45.3±15.4 (range: 30-75) minutes, respectively. The median hospital stay was 1.07±0.2 (range: 1-2) days. No major complications were noticed during the operation. Double-J stents were removed on the 2nd postoperative week and all patients were stone-free during the follow-up. Conclusion: RIRS can be performed safely and efficaciously in pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous nephrolithotomy (PNL) is the firstline treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods: Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7%) (Group 1) of them and 38 (43.1%) (Group 2) patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results: The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare demographic data in adult patients undergoing percutaneous nephrolithotomy (PNL) for kidney stone disease in university hospitals from Southeastern Anatolia and the Black Sea regions. Material and methods: The demographic data of 535 (53.3%) patients undergoing PNL from Gaziantep University, Department of Urology (GAUN group), and 468 (46.6%) patients undergoing PNL from Ondokuz Mayıs University, Department of Urology (OMU group) were evaluated retrospectively. Patients' gender, mean age, stone laterality, and size and results of the stone analyses were compared. Results: The mean patient ages were 40.94±13.33 (17-81) and 48.03±13.95 (17-81) years in the GAUN and OMU Groups, respectively, (p=0.0001). The mean stone size was 716.01±449.60 (100-3000) mm² and 612.7±445.87 (65-3220) mm² in the GAUN and OMU Groups, respectively (p=0.0001). There were no statistically significant differences between the groups with respect to stone laterality (p=0.196), and gender of the patients (p=0.65). Stone analysis revealed that the distribution of stone composition was as follows in the GAUN group: Ca oxalate (90.19%), cystine (7.84%), uric acid (5.88%), and struvite (1.96%). In the OMU group, the stone composition was as follows: Ca oxalate (86.84%), cystine (1.34%), uric acid (13.15%), and struvite (9.21%). Conclusion: The incidence of kidney stone disease varies throughout Turkey based on etiological factors, and a higher incidence of kidney stone disease is observed in the Southeastern Anatolia region endemically. Lower mean ages and higher stone sizes in patients undergoing PNL in southeastern Anatolia suggest that geographic factors can affect stone disease. [ABSTRACT FROM AUTHOR]

Aim: In this study, we evaluated the results of 2300 patients who underwent percutaneous nephrolithotomy (PNL) between March 2002 and April 2013. Methods: In our clinic, a total of 2300 PNL operations were performed between March 2002 - April 2013. Demographic characteristics (age, gender), body mass index, stone features (side, size, location), clinical characteristics of the urinary tract (renal anomaly, previous surgery, previous extracorporeal shock wave lithotripsy), operation parameters (duration of the intervention and fuoroscopy, number of access, location of access, transfusion, complications), post-operative data (length of hospital stay, transfusion, complications, stone-free) were recorded on PNL forms. The data were analyzed retrospectively. Results: Of all the PNL operations, 1225 (53.2%) were left-sided, 1074 (46.6%) were right-sided and 1 was bilateral. The mean age of the subjects was 43.5 (7-83) years and the mean body mass index was 26.6 kg/m2 (12-51). A total of 46 (2%) cases had renal anomalies. There were 16 patients with horseshoe kidney. More than one accesses was performed in 18.6% of the patient and intercostal access was done in 9.8%. Perioperative and postoperative transfusion rates were 1.4% and 2.9%, respectively. The mean stone size was 7.5±4.1 cm2. Stone-free (SF) rate was 65.1% and success rate was 78.5%. Conclusion: With increasing experience and advances in endourology, PNL is being widely performed with low morbidity and high success in our country as in the world. (The Medical Bul le tin of Ha se ki 2013; 51: 19-24) [ABSTRACT FROM AUTHOR]

Urolithiasis is one of the most common urinary tract disorders in childhood and the prevalance of the disease increases in last decade. An important feature of childhood urolithiasis is presence of the underlying cause of methabolic and anatomic disorders. Interventions of the underlying causes are reduces morbidity due to this disease. Characteristics of urolitiasis in children, as well as diagnostic and therapeutic approaches were evaluated in this report. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to present the data on totally tubeless nephrolitotomy (PNL) outcomes undergone in our clinic. Materials and Methods: We retrospectively analyzed 140 patients undergone totally tubeless PNL in our clinic between January 2010 and December 2012. Results: Mean patient age was 47,84 (5-73). Mean operative time was 88,8 (45-110) minutes where mean stone area was 375,3 (110-175) mm2. 92,8% was our stone free rate. Remaining 10 patients had undergone ureterorenoscopy for ureteral stones. Two patients having non-opaque stones had residual kidney stones and treated by SWL. 8 patients (%5,7) needed blood transfusion, 2 patients needed perirenal hematoma and treated conservatively. No patients needed additional treatment or encountered vascular complications. One patient encountered serozal colon injury and treated conservatively. Conclusion: With regard to patient comfort, shorter hospital stay, low analgesic requirement, totally tubeless PNL gained popularity. We believe totally tubeless PNL may be used in suitable cases. [ABSTRACT FROM AUTHOR]

Kidney stone formation has a multifactorial pathology involving the interaction of genetic and environmental factors. There is increased risk of stone formation in the relatives of idiopathic stone patients, which can be explained up to 60% by genetic factors. 30-60% of the patients with calcium oxalate (CaOx) stones are proved to have hypercalciuria. The most important factor in the active calcium absorption is 1,25-dihidroxy vitamin D, which is also known as calcitriol. Calcitriol has indirect effects on bone and kidney in addition to its role in intestinal calcium absorption. Therefore vitamin D has a central role in the control of endocrine system, bone and calcium homeostasis. Calcitriol mediates its genomic activities via vitamin D receptor (VDR). There are lots of polymorphisms identified in the VDR locus, the most widely studied ones are ApaI, EcoRV, BsmI, TaqI, FokI and Tru9I. There are ethnic variations in the distribution of VDR polymorphisms. The outcomes of the ethnic variations are not easy to understand due to differences in dietary habits and environmental factors among ethnic groups. In addition to that, there are different genetic backgrounds on which VDR polymorphisms interact with each other and with variants of other genes. Therefore it is important to identify the haplotype stuructures of VDR polymorphisms in different ethnic groups. [ABSTRACT FROM AUTHOR]