Defining the Learning Curve of Flexible Ureterorenoscopy and Laser Lithotripsy.

PURPOSE: To investigate the impact of learning curve (LC) on flexible ureterorenoscopy (f-URS). MATERIALS AND METHODS: Patients who underwent kidney stone surgery in a urology clinic from a tertiary health care institution with f-URS were enrolled in the study. Patient characteristics, the properties of kidney and kidney stones were recorded. Also, f-URS-related parameters, hospitalization time, the success of the procedure, and complications were noted. Patients were categorized equally into 4 groups, the first 20 f-URS cases in Group 1, and the last 20 f-URS cases in Group 4. Groups were compared according to patient preoperative parameters, intraoperative outcomes, success rate and complication rate. RESULTS: Time from the induction of anaesthesia to insertion of flexible ureterorenoscope was 18.6 min in group 1 and 17.2 min in group 2; then it significantly decreased to 15.0 min for cases 40 through 60 and 12.4 min for cases 60 through 80 (p = 0.001). Operation time in group 3 and group 4 was significantly shorter than in group 1 and group 2 (p = 0.001). Also, fluoroscopy time was significantly longer in group 1 (82.9 seconds) and reached a plateau in group 3 (50.3 seconds) and group 4 (41.7 seconds) (p = 0.001). Additionally, after the 20th case, we achieved a significantly higher success rate in comparison to the first 20 cases (65% in group 1, 85% in group 2, 85% in group 3, and 90% in group 4, p = 0.001). CONCLUSION: Flexible ureterorenoscopy is a surgery that requires high technique and experience. The present study found that success of f-URS reached satisfactory levels after 20th cases. In addition, 40 cases may be enough for surgical proficiency regarding decreases in preparation time, operation time, and fluoroscopy time.

Comparison of Shock Wave Lithotripsy and Flexible Ureterorenoscopy in the Treatment of 10-20 mm Lower Pole Stone: Prospective Non-randomized Study.

INTRODUCTION: The objective of the study is to clarify the efficiency, safety, and limitations of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) in the management of lower pole stones (LPS). METHODS: The present study was planned prospectively in a non-randomized manner. Patients who had LPS between 10 and 20 cm in size were enrolled in the study. Patient demographic characteristics, stone-related parameters, complications, and success were noted. Patients who underwent SWL and patients who underwent f-URS were compared according to demographic characteristics, procedure-related parameters, complications, and success rate. RESULTS: A total of 82 patients matched the study inclusion criteria, with 44 patients treated with SWL and 38 patients treated with f-URS. The time between diagnosis and the end of the treatment was 29.2 days in the SWL group and 15.2 days in the f-URS group (p = 0.001). The success rate was 89.5% with f-URS and 72.7% with SWL (p = 0.036). Receiver operating curve analysis revealed that a stone size larger than 14 mm in the lower pole was significantly associated with SWL failure (area under the curve [AUC]: 0.711, p = 0.033), and a stone size larger than 16 mm was a predictive factor for f-URS failure. CONCLUSION: The present study found that f-URS had a significantly higher stone-free rate in the management of 10-20 mm LPS compared to SWL. For the first time, this study showed that the time between diagnosis and the end of treatment was significantly shorter with f-URS. Moreover, LPS larger than 14 mm and 16 mm were predictive factors for SWL and f-URS failure, respectively.

The Assessment of Reconstructive Urology-Associated Google Search Trends During COVID-19.

INTRODUCTION: To demonstrate public interest in reconstructive urology during the COVID-19 pandemic by using Google Trends (GT). METHODS: The study was conducted between August 1 and August 11, 2021. A total of 18 terms related to reconstructive urology were determined. Public interest in all terms were evaluated with the GT application using the filters 'worldwide', 'all categories', and 'web search'. To determine public interest in reconstructive urology during the COVID-19 pandemic, three 12-week periods following the declaration of COVID-19 (March 11 to June 4, 2020, June 5 to August 29, 2020, and August 30 to November 23, 2020) were compared with the same periods in the past four years (2016-2019). RESULTS: Comparisons of March 11 to June 4, 2020, and the same days in the previous four years revealed that total public attention to reconstructive urology significantly declined (-16.2%, p=0.035). In the comparison of the second 12-week duration (June 5 to August 29, 2020, vsJune 5 to August 29, 2016-2019), only the bladder augmentation term had significantly lower search frequency during COVID-19 (-46.3%, p=0.043), but buried penis (50.3%, p=0.001), urinary incontinence (15.3%, p=0.001), and stress urinary incontinence (21.7%, p=0.001) keywords had significantly higher inquiries. The comparison of the third 12-week period searches for only urinary incontinence significantly increased (p=0.001). CONCLUSION: Present study showed that public interest in reconstructive urology significantly reduced in the first 12 weeks after COVID-19 was declared a pandemic. However, public attention to reconstructive urology reached similar levels after 12 weeks from the beginning of COVID-19. Additionally, the term urinary incontinence was searched statistically more frequently during the COVID-19.

Parenchymal thickness: does it have an impact on outcomes of percutaneous nephrolithotomy?

OBJECTIVE: To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). METHODS: We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. RESULTS: The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m(2). The mean stone burden was 293 ± 126 (150-800 mm(2)). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). CONCLUSION: The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.

Is there a difference in percutaneous nephrolithotomy outcomes among various types of pelvicaliceal system?

PURPOSE: During PNL procedures, stone clearance can be achieved by single access or multiple accesses for same stone size and configuration. At this point, we believed that pelvicaliceal system type may play a significant role on stone clearance. In our study, we aimed to investigate the effect of pelvicaliceal system type on PNL outcomes. METHODS: A total of 498 patients who had preoperative intravenous urography were enrolled in our study. PCSs of the patients were classified as A1, A2, B1, and B2 according to Sampaio system after evaluation of IVU images. The exclusion criteria were unclassified pelvicaliceal system due to the presence of exaggerated renal hydronephrosis, IVUs with poor quality, radiolucent renal stones, and absence of CT or IVU in postoperative period. RESULTS: There was no clinically significant difference for patient gender, history of open surgery, and history of previous SWL. Success rates of PNL were 79.5, 82.0, 74.3, and 80.3 % in Sampaio type A1, A2, B1, and B2 PCS, respectively (p 0.61). Multiple accesses were required for 35 (18.8 %), 14 (17.9 %), 55 (30.1 %), and 6 (11.8 %) patients according to Sampaio classification type A1, A2, B1, and B2, respectively (p 0.008). There was no clinically significant difference for stone size, stone configuration (simple or complex), and complications. CONCLUSION: Sampaio type B1 PCSs require increased number of access for achieving stone clearance. Therefore, surgeons should be aware and also inform patients that treatment of patients with Sampaio type B1 PCS may need high number of access during PNL procedure.

Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: outcomes of a long-term followup.

PURPOSE: There are few studies of the long-term outcome of percutaneous nephrolithotomy for staghorn calculi. We report the long-term outcome of percutaneous nephrolithotomy in patients with staghorn calculi. MATERIAL AND METHODS: A total of 265 study patients (272 renal units) were followed in the long term for greater than 12 months. The estimated glomerular filtration rate was calculated using the 4-variable modification of diet in renal disease equation. Cases were staged for chronic kidney disease by National Kidney Foundation guidelines. The impact of patient and procedure related factors on renal function as well as stone recurrence was analyzed retrospectively. RESULTS: At a mean ± SD followup of 37.3 ± 25.4 months the chronic kidney disease stage classification was maintained in 177 patients (66.8%) while the classification of 34 (12.8%) and 54 (20.4%) had improved and deteriorated, respectively. Multivariate analysis revealed that an immediate postoperative change in the estimated glomerular filtration rate was the only factor predicting a change in renal function in the long term. Stones recurred in 73 of the 234 kidneys (31.2%) that were stone free 3 months after percutaneous nephrolithotomy. Stone size increased in 24 of the 38 kidneys (63.2%) with residual stones after intervention. Recurrent urinary infections during followup and diabetes were associated with stone recurrence and residual stone enlargement. CONCLUSIONS: In almost 80% of patients with staghorn stones renal function was improved or maintained after percutaneous nephrolithotomy, as documented during long-term followup. Stones recurred in a third of the patients with staghorn calculi.

Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis.

UNLABELLED: Study Type--Therapy (case control). Level of Evidence 3b. What's known on the subject? and What does the study add? Recently European Association of Urology 2011 guidelines on urolithiasis recommended retrograde intrarenal surgery as the second-line therapy for the treatment of kidney stones <10 mm in diameter. This study shows that retrograde intrarenal surgery may be an alternative therapy to percutaneous nephrolithotomy, with acceptable efficacy and low morbidity for 2-4 cm stones. OBJECTIVE: • Currently, the indications for retrograde intrarenal surgery (RIRS) have been extended due to recent improvements in endoscopic technology. In this study, we compare the outcomes of percutaneous nephrolithotomy (PCNL) and RIRS in the treatment of 2-4 cm kidney stones. MATERIALS AND METHODS: • Between September 2008 and January 2011, 34 patients who had renal stones ranging from 2 to 4 cm in diameter were treated with RIRS. The outcomes of these patients were compared with patients who underwent PCNL using matched-pair analysis (1:1 scenario). • The matching parameters were the size, number and location of the stones as well as age, gender, body mass index, solitary kidney, degree of hydronephrosis, presence of previous shock wave lithotripsy and open surgery. • Data were analysed using Fisher's exact test, Student's t test and the Mann-Whitney U test. RESULTS: • Stone-free rates after one session were 73.5% and 91.2% for RIRS and PCNL respectively (P= 0.05). Stone-free rate in the RIRS group improved to 88.2% after the second procedure. • Mean operation duration was 58.2 (±) 13.4 min in the RIRS group but 38.7 (±) 11.6 min in the PCNL group (P < 0.0001). Blood transfusions were required in two patients in the PCNL group. • Overall complication rates in the PCNL group were higher, but the differences were not statistically significant. Hospitalization time was significantly shorter in the RIRS group (30.0 + 37.4 vs 61.4 + 34.0 h, respectively; P < 0.001). CONCLUSION: • Satisfactory outcomes can be achieved with multi-session RIRS in the treatment of 2-4 cm renal stones. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones.

A rare anomaly of testicular descend: transverse testicular ectopia and review of the literature.

Crossed ectopia or transverse testicular ectopia (TTE) is an extremely rare anomaly of testicular descent in which both gonads migrate along the same inguinal canal to the hemiscrotum. Fewer than 100 cases have been reported in the literature. Most cases of TTE involve a concomitant inguinal hernia on the contralateral side. A radiological evaluation and laparoscopy are essential for appropriate diagnosis and treatment. Although a correct diagnosis is not preoperatively made in most cases, we present a 15-year-old boy in whom TTE was diagnosed by magnetic resonance imaging. A laparoscopic evaluation and treatment (orchiectomy) was uneventfully performed.

Variables that influence operative time during percutaneous nephrolithotomy: an analysis of 1897 cases.

BACKGROUND AND PURPOSE: Operative time is an important perioperative factor and is related to postoperative complications and procedural cost-effectiveness. There are few studies, however, investigating factors that affect operative time during percutaneous nephrolithotomy (PCNL). In this study, patient and kidney stone-related factors that influence operative time were analyzed. MATERIALS AND METHODS: Clinical records from 1897 patients with renal calculi who underwent PCNL were retrospectively reviewed, and these patients were divided into two groups based on their median operative time (group 1: ≤60 min; group 2: >60 min). Multivariate analyses as well as univariate analyses including chi-square, Fisher exact and Mann Whitney U tests were used to investigate the effects of independent variables on operative time, including patient and kidney stone-related factors such as age, sex, body mass index, history of ipsilateral open surgery, shockwave lithotripsy, presence of hydronephrosis, stone burden, stone type and opacity, and surgical experience. RESULTS: The mean operative time was 64.9±27.6 minutes (range 10-220 min). Univariate analyses determined that a history of open surgery, presence of hydronephrosis, stone type and size, and surgical experience correlated with operative time (P<0.05 for all). Multivariate analyses revealed that presence of hydronephrosis (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.17-1.78, P=0.002), stone type (OR: 2.12, 95% CI: 1.69-2.70, P<0.0001), stone burden (OR: 2.44, 95% CI: 1.85-3.12, P<0.0001), and surgical experience (OR: 0.56, 95% CI: 0.46-0.70, P<0.0001) were significant independent factors in influencing operative time. CONCLUSIONS: Presence of hydronephrosis, renal stone size and type significantly affect the operative time during PCNL. The duration of the operation was also observed to decrease with increased surgical experience.

Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy?

OBJECTIVE: To investigate the effect of the pelvicaliceal system (PCS) anatomy on the percutaneous nephrolithotomy (PCNL) success rate. Although the caliceal anatomy is effective for stone clearance after shock wave lithotripsy and retrograde intrarenal lithotripsy, the effect of the caliceal anatomy after PCNL has not been evaluated to date. METHODS: A total of 498 patients who had undergone PCNL and preoperative intravenous urography were enrolled in our study. Kidney-related anatomic factors, such as the PCS surface area and type, degree of hydronephrosis, infundibulopelvic angle, upper-lower calix angle, infundibular length, and infundibular width were calculated using intravenous urography. The association between the PCNL success rate and kidney-related anatomic factors was retrospectively analyzed using chi-square tests, Fisher's exact test, Mann-Whitney U test, and forward stepwise regression analysis. RESULTS: A success rate of 78.1% was achieved. No difference was seen the success rates among the PCS types. The mean PCS surface area was 20.1 ± 9.7 cm(2) in patients with successful outcomes and 24.5 ± 10.2 cm(2) in patients with remaining stones (P = .001). The mean infundibulopelvic angle, upper-lower calix angle, infundibular length, and infundibular width were similar in both groups. Multivariate binary logistic regression analysis showed that stone configuration and PCS surface area were independent factors affecting the PCNL success rates. CONCLUSION: The results of our study have shown that the PCS surface area is the only anatomic factor that affects the PCNL success rate and patients with a PCS surface area <20.5 cm(2) have greater PCNL success.

Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience.

OBJECTIVES: To evaluate the outcomes, complications, and early and late postoperative kidney function of percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys. METHODS: Between 2002 and 2009, 47 patients with a solitary kidney (congenital in 10 patients, 21.3%; contralateral nephrectomy in 22 patients, 46.8%; and nonfunctional kidney in 15 patients, 31.9%) underwent PCNL. Serum creatinine was measured preoperatively, on postoperative day 1, and at each follow-up visit at regular intervals. The 4-variable modification of diet in renal disease equation was used to calculate the estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation published guidelines. Of 47 patients, 44 were followed least 6 months, whereas 3 patients were lost to follow-up. RESULTS: Success was achieved in 84.5% (40/47) of patients after 1 session of PCNL. Complex stones were detected in 32 (68.1%) patients. Among all patients, 23.4% (n = 11) of them required multiple accesses. Complications developed in 5 (10.6%) patients. At a mean follow-up time of 18.7 ± 11.8 (6-60) months, the overall success rate improved to 97.7% after auxiliary treatments. eGFR was 76.4 ± 27.1, 73.4 ± 26.1, and 83.5 ± 29.4 per 1.73 m(2) during preoperative period, immediate postoperative period, and at the last follow-up visit (>6 months), respectively (P < .001). According to CKD classification, kidney function was stable, improved and worse in 63.6% (n = 28), 29.5% (n = 13), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels. CONCLUSIONS: PCNL is safe and has an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, renal function had stabilized or improved in more than 90% of patients with a solitary kidney after PCNL.