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Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as "aging of the flexible ureteroscope." Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS. Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X 2 ) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups. Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively ( p = 0.304). The complication rates were also similar between the groups ( p = 0.591). Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.

Objective: To evaluate the sensitivity and specificity of ultrasonography (USG) and kidney ureter bladder radiography (KUB) for the determination of stone-free status of retrograde intrarenal surgery (RIRS) according to different stone-free status definitions., Materials and Methods: The patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system USG and noncontrast abdominal tomography at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of USG and KUB on evaluating the stone-free rate were analyzed according to different stone-free status definitions., Results: A total of 178 patients were included in the study. The stone-free rates according to stone-free definitions as; residual stone <4 mm, <2 mm and no residual stone were 79.2%, 64.0%, and 56.7%, respectively. According to its definition as a residual stone <4 mm, the sensitivity and specificity of USG were 64.9% and 84.3%, respectively. The sensitivity of USG was 57.1% and 52.5% as the definitions were residual stone <2 mm and no residual stone, respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity., Conclusion: USG had high specificity but low sensitivity for evaluating stone-free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone-free status and noncontrast abdominal tomography must be used during the clinical trials to document the exact stone-free rates of RIRS., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare.

Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case-control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score-matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm 3 (range: 50.4-7565.9) versus 991.1 mm 3 (range: 201.2-4380.6) ( P  = .09), respectively. The perioperative complication rates were 13.8% ( n  = 4) in Group 1 and 11.8% ( n  = 9) in Group 2 ( P  = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [ n  = 2] versus 13.2% [ n  = 10; P  = .34]), respectively. Surgical success was 82.8% ( n  = 24) in Group 1 and 83.6% in Group 2 ( P  = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values ( P  = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS.

Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients ( n  = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P  = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P  < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P  = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P  = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P  = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P  < .001). Fluroscopy times were 5, 15, and 87 sn, respectively ( P  < .001). Short URS-LT was strongly associated with high frequency of lower calix stones ( r  = -0.94, P  = .005), but URS-LT was not correlated with sheathless case rate ( r  = 0.59, P  = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P  = .03), hydronephrotic (OR: 3.4, P  < .001), and female cases (OR: 1.5, P  = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P  = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.

Purpose: To evaluate the risk factors for urinary tract infection (UTI) after retrograde intrarenal surgery (RIRS)., Materials and Methods: A retrospective evaluation of the records of patients who underwent RIRS from January 2013 to September 2016 was performed. All interventions were done by the same surgeon and by applying the same technique., Result: 111 patients were included in the study with a mean age of 47.5 years (range: 14-84 years). Postoperative infection rate was 12.6% (n= 14). SWL, preoperative double J stent insertion, localization, gender, and the opera-tion side had no impact on origination of infectious complications (P > .05 for all). Preoperative infection history (P = .002, OR=7.96, %95CI: 2.0- 30.5), comorbidity score (P = .008, OR=7.79, CI%95: 1.7- 35.5), and residual fragments (P = .045, OR=5.12, CI%95: 1.03 - 25.36) were found to be the significant risk parameters of postop-erative infectious complications., Conclusion: To reduce UTI complications, it is necessary to pay attention to patients with comorbidities, prescribe appropriate prophylactic antibiotic therapy for those who have urinary tract infection history and help patients to achieve stone free status.

Objective: To evaluate patients' characteristics, surgical procedure data, and outcomes of ureterorenoscopy (URS) stone treatment in patients with a horseshoe kidney (HSK), ectopic kidney (EK), and malrotated kidney (MK)., Materials and Methods: This study is a subanalysis of the Clinical Research Office of the Endourological Society URS Global Study, which was a prospective multicenter observational study, collecting data on URS stone treatment from consecutive patients over a 1-year period. A total of 114 centers in 32 countries participated. This analysis acuminated on URS stone treatment in the specified renal anomalies: HSK, EK, and MK. For each group, patient characteristics, operation data, and treatment outcomes were evaluated., Results: Of the 11,885 patients included in the Clinical Research Office of the Endourological Society URS study, 43 patients had HSK, 27 EK, and 16 MK. The stone-free rate (SFR) in the HSK group was 77% for renal stones and 85% for ureteral stones. In the HSK group, the intraoperative complication rate was 11.6% and the postoperative complication rate was 7%, including 1 Clavien grade IIIa and 1 IIIb complication. In the EK group, the SFR was 20% for renal stones and 94% for ureteral stones, with an intraoperative complication rate of 14.8% and a postoperative complication rate of 7.4%. One Clavien IVa complication was reported. In the MK group, the SFR was 71% for renal stones and 88% for ureteral stones, with an intraoperative complication rate of 6.3%. No postoperative complications occurred in this group., Conclusion: URS is an effective and safe treatment modality to remove ureteral and renal stones in patients with HSK and MK. The effectiveness of URS for renal stones in EK was low., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Currently no definitive cure exists for interstitial cystitis (IC). We investigated the therapeutic effects of hyperbaric oxygen (HBO₂) therapy in this syndrome in an experimental IC model through biochemical analyses and histopathological assessments., Methods: 24 Sprague Dawley rats were divided into three treatment groups sham (transurethral intravesical injection with sterile distilled water), rats with IC (induced by transurethral intravesical injection with hydrochloric acid), and rats with IC + HBO₂. After completion of experiments the animals were sacrificed and their urinary bladders were removed surgically. Tissues were evaluated by light and electron microscopy. Lesion index scoring system for IC was used to evaluate vesical injury. TNF-α levels were measured by ELISA test kit., Results: Lesion index scores and TNF-α levels of the sham and IC + HBO₂ treatment groups were quite similar (p < 0.01). Although HBO₂ treatment did not show any effect in reducing the number of mast cells (p > 0.05), it reduced the mast cell activity (p < 0.05). All parameters except mitochondrial damage (p > 0.05) were improved in the IC + HBO₂ treatment group compared to the IC without HBO₂ treatment group., Conclusion: HBO₂ treatment may alleviate the inflammation, may lead to a certain degree of reversal of adverse histopathological changes, and is effective in enhancing the healing process in interstitial cystitis. We believe that HBO₂ treatment may be included as a weapon in our armamentarium against IC.

Introduction: Our aim was to predict the chemical composition of kidney stones according to their twinkle artefact (TA) features obtained by in vivo color Doppler ultrasonography and to determine the potential factors affecting the formation and intensity of TAs., Materials and Methods: A total of 101 patients who met the inclusion criteria were included in the study. All patients were evaluated for TAs using color Doppler ultrasonography. All stones were subjected to chemical analysis. The relationships between the TA and the size and chemical composition of the stone, presence of hydronephrosis and body mass index (BMI) were evaluated statistically., Results: According to the results of the chemical analysis, 66 (65.3%) were calcium oxalate stones. It was found that the in vivo TA intensity did not predict cystine and calcium oxalate monohydrate stones (p > 0.05) and the intensity of TAs increases with increasing BMI (p = 0.002)., Conclusion: The present study is the first to show that TAs may not be reliable in overweight patients. The TAs could not predict the chemical composition of stones; so future comprehensive in vivo studies will clarify the role of TAs in the prediction of the stone type preoperatively., (© 2016 S. Karger AG, Basel.)

Objective: The objective of the present study was to examine the relationship between work-related factors and lower urinary tract symptoms (LUTS) and to emphasize the vicious circle between symptoms and work conditions., Methods: The Turkish version of the Nurse Bladder Survey was used to estimate the prevalence of LUTS and to assess the relationship between individual characteristics, personal habits and work-related factors in nurses and secretaries who were working in Eskisehir Osmangazi University Hospital. The Turkish version of the Short Form 36 Health Survey was used to assess the nurses' and secretaries' health-related quality of life (HRQL)., Results: Of the 281 women who participated in the study, 218 (77.5%) and 63 (22.5%) were nurses and secretaries, respectively. There were no significant differences in personal habits and work-related factors between the nurses and secretaries. Of the study participants, 121 (43.1%) experienced at least one type of LUTS. There were no significant differences in the prevalence of any type of LUTS between the two groups. Only the mean scores of social functioning were significantly different for nurses and secretaries on the other aspects of HRQL in the SF-36. When the nurses with LUTS and the secretaries with LUTS were compared, the secretaries had a greater score on the general health domain than nurses., Conclusion: There is a vicious circle between symptoms and work conditions. To prevent the working women from harmful effects of this circle, the employers should be aware of this health problem; working conditions should be improved; educational programs for LUTS should be organized and the working women should be encouraged to go to the health providers to seek treatment when the symptoms occurred., (© 2014 Wiley Publishing Asia Pty Ltd.)

Whether lymphovascular invasion (LVI) is an independent prognostic factor in prostate cancer is still controversial. We retrospectively investigated its predictive role in disease progression following radical prostatectomy. The histological sections of radical prostatectomies from 71 clinically localized, prostatic adenocarcinoma patients were reviewed for LVI. Pre- and postoperative follow-up data were collected. LVI was identified in 15.5% of cases. Univariate analysis showed a significant association between LVI and advanced pathological stage, higher Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis (each p < 0.05). Multivariate analyses pointed to vascular involvement as a strong and independent predictor for PSA failure (p = 0.023), and reduced biochemical progression-free survival (p = 0.019). LVI in radical prostatectomy is an adverse prognostic finding that must be recorded in the pathology report.