Exploring the competency of the comprehensive complication index over the clavien-dindo classification in standard percutaneous nephrolithotomy: a call for better complication reporting.

PURPOSE: The Comprehensive Complication Index (CCI) was introduced in 2013 to overcome the limitations of the Clavien-Dindo Classification (CDC) in grading postoperative complications. The objective of this study to assess the predictive value of the CDC and the CCI for postoperative course in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). METHODS: A retrospective analysis of 320 renal units that underwent standard PCNL between July 2021 - April 2023 was conducted. The CDC and CCI systems assessed complications occurring within the first 30 days after surgery. A second CCI score was calculated only on the highest CDC grade, and this score was referred to as the noncumulative CCI. A comparative analysis was conducted to determine the predictive efficacy of both evaluation methods regarding the postoperative course. RESULTS: The postoperative complication rate was 23.1% (74/320). Eight patients (2.5%) experienced multiple complications, resulting in a higher total CCI score than the noncumulative CCI (p = 0.010). Correlation analysis revealed that the CCI correlated with the length of hospital stay (LOS) more precisely than the noncumulative CCI (CCI: r = 0.335; p = 0.004 vs. noncumulative CCI: r = 0.325; p = 0.005). Compared with patients with a single complication, those with multiple complications had similar demographics, preoperative stone characteristics, and intraoperative features. CONCLUSION: Cumulative CCI proves to be a more effective predictor of LOS and complication burden in standard PCNL than CDC. Hence, using CCI to evaluate complications after PCNL may be a more appropriate approach.

Validation of stone-kidney size score to predict outcome and complications of pediatric percutaneous nephrolithotomy.

INTRODUCTION: The prevelance of urinary system stone disease in children is emphasizing the need for minimally invasive treatments to decrease morbidity and recurrence risk. Percutaneous nephrolithotomy (PCNL) has emerged as a preferred approach for pediatric patients with complex stones due to its minimally invasive nature, including miniaturized and vacuum-assisted access sheaths, advanced laser technology and tubeless and outpatient procedures. However, adult scoring systems have proven ineffective in predicting success and complications in pediatric PCNL. This highlights the need for specialized scoring systems, such as the Stone-Kidney Size (SKS) scoring system, tailored to pediatric patients and will be evaluated in our study for its association with the stone-free rate (SFR) and complications. MATERIALS AND METHODS: The data of 144 patients aged <17 years who had undergone PCNL between January 2008 and December 2019 were evaluated retrospectively. Demographics, stone characteristics, perioperative/postoperative outcomes were recorded for each patient. The SKS scoring system comprises the stone kidney index (SKI) and the number of stones, assigns one or two points based on single or multiple stones and an SKI value of <0.3 or ≥0.3, respectively. The SKI is computed by dividing the stone's longest axis by the kidney's longest axis. Residual stones less than 4 mm on non-contrast computed tomography are considered clinically insignificant residual fragments (CIRFs). Stone-free and CIRF patients were considered successful results. The relationship between the SKS scoring system and SFR, success, and complication rates after surgery was investigated. Statistical analyses were conducted using SPSS 22.0 software. RESULTS: The SFR was 67.36% and 74.31% when CIRF patients were included, respectively, with a complication rate of 27%. In multivariate analysis, stone treatment history, stone burden, and SKS score were statistically significantly associated with SFR (p < 0.001, p = 0.032, p < 0.001, respectively). Furthermore, the SKS score was the only variable that showed a statistically significant relationship with success. No significant association was found between SKS score and complications (p = 0.342). DISCUSSION: Our study demonstrates a relationship between the SKS scoring system and SFR in pediatric PCNL patients. However, shortcomings have been observed in its capacity to accurately predict post-PCNL complications. Despite being a retrospective analysis and having a single-center design, our study externally validates the relationship between the SKS scoring system and SFR after pediatric PCNL. CONCLUSIONS: The SKS scoring system is associated with SFR in pediatric patients undergoing PCNL; however, this relationship has not been established for complications.

Comparative analysis of scoring systems for patients undergoing retrograde intrarenal surgery with isolated lower calyx stones.

PURPOSE: It is critical to provide patients with accurate information on potential surgical outcomes during the preoperative phase. Several scoring systems have been developed for this specific purpose. This study aimed to examine the predicted efficacy of scoring systems in patients with isolated lower calyx stones who underwent retrograde intrarenal surgery (RIRS). METHODS: We performed a retrospective analysis of 85 patients who underwent RIRS for lower calyx stones between 2016 and 2023. The study computed each participant's Resorlu-Unsal Stone score (RUSS), R.I.R.S. scoring system score, Modified Seoul National University Renal Stone Complexity (S-ReSC) score, S.T.O.N.E. score, Ito's nomogram, and T.O.HO score. Residual stones less than 4 mm were classified as clinically insignificant residual fragments (CIRFs) and regarded as successful. Following that, we used receiver-operating characteristic (ROC) curves to compare various scoring systems' success predictions. RESULTS: The median scores for RUSS, R.I.R.S. scoring system, Modified S-ReSC, S.T.O.N.E., Ito's nomogram, and T.O.HO score were 1 (1), 7 (2), 2 (0), 11 (1), 18 (4), and 7 (1), respectively. When CIRF cases were included, the stone-free rate increased to 80%. Only Ito's nomogram from scoring systems has a statistically significant cut-off value for success in ROC analysis (p = 0.021). In multivariate analysis, stone volume and preoperative hydronephrosis were associated with success (p = 0.004 and p = 0.035, respectively). CONCLUSION: In the multivariate analysis, none of the scoring systems were significantly associated with success. Hence, a new scoring system must be developed exclusively for patients with isolated lower pole stones undergoing RIRS.

Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood?

OBJECTIVE: To compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood. MATERIALS AND METHODS: Forty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups. RESULTS: Mean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047). CONCLUSION: The use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study.

OBJECTIVES: To evaluate whether or not using a ureteral access sheath (UAS) affects the perioperative outcomes after retrograde intrarenal surgery (RIRS) performed in patients with renal stones. MATERIAL AND METHODS: An observational study was carried out using data of 60 patients who underwent RIRS with the diagnosis of renal stones <2 cm between February 2017 and November 2017 at our institution. The data of the 60 patients were registered prospectively during the study period. Patients were divided into two groups based on whether a UAS was used (Group 1-30 patients) or not (Group 2-30 patients) during RIRS. Perioperative outcomes and complications were collected and analyzed. RESULTS: The stone burdens of the patients in Group 1 and in Group 2 were 76.59 mm2 and 62.19 mm2, respectively (p = .160). There was no statistically significant difference in SFR (p = 1.000), complication rates (p = .418), and operation time (p = .411) between both groups, except for the fact that postoperative pain intensity levels using the VAS were slightly higher in Group 2 (4.13 ± 2.37 vs. 5.33 ± 1.89, p = .064). CONCLUSIONS: In the present study, we showed that similar success and acceptable complication rates can be achieved without using UAS compared to using UAS during RIRS. However, using UAS may provide an advantage in reducing postoperative pain after RIRS.

Early surgical repair or conservative treatment? Comparing patients with penile fracture concerning long-term sexual functions.

BACKGROUND: To compare the patients who underwent early surgical repair of penile fracture, which is one of the urological emergencies, and patients who recovered with conservative treatment concerning long-term sexual functions. METHODS: The data of 42 patients who applied to our clinic with penile fracture between January 2010 and January 2020 were retrospectively analyzed. The patients were categorized into two groups as early operated and followed-up conservatively. The preoperative and postoperative findings of the patients were compared with the International Erectile Function Scale (IIEF-6) scores in the long-term follow-up. RESULTS: The median age of the patients was 35 (20-65) years and the median follow-up period was 52 (8-120) months. The postoperative mean IIEF-6 score of the patients was 22.98±6.52. There was no significant difference between the surgical and the conservative groups concerning postoperative complications (p=0.460). In the follow-up period, the presence of palpable plaque on the rupture area was significantly higher in the conservative group (p=0.041). However, there was no significant difference between the groups concerning IIEF-6 scores (p=0.085). CONCLUSION: Although there is no significant difference in long-term IIEF-6 scores between the two groups, the rate of palpable plaque formation is higher in patients followed-up conservatively. Therefore, early surgical repair should be considered in the foreground, especially in patients with a large rupture area.

Is combined topical-local anesthesia technique adequate for visual internal urethrotomy in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses?

BACKGROUND: To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses. METHODS: In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups. RESULTS: The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively). CONCLUSION: Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.

Comparison of scoring systems for predicting stone-free status and complications after retrograde intrarenal surgery.

PURPOSE: To compare the effectiveness of scoring systems in predicting stone-free rates (SFR) and complications following retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: We retrospectively analyzed 280 patients who underwent RIRS for kidney stones between 2016 and 2019. The Resorlu-Unsal Stone score (RUSS), Modified Seoul National University Renal Stone Complexity (S-ReSC) score, and R.I.R.S. scoring system score were calculated for each patient who was enrolled in the study. Subsequently, stone scoring systems were compared as to their predictive capability for SFR using receiver-operating characteristic curves. Furthermore, multivariate analysis was done to determine whether the scoring systems associated with SFR and complications. RESULTS: The median patient age was 44 (35--56). The median RUSS, S-ReSC, and R.I.R.S scores were 0 (0-1), 1(1-2), and 6 (5-7), respectively. The overall SFR was 76.7%. The R.I.R.S. scoring system was found to have a higher predictive value in predicting postoperative SFR than the other two scoring systems (p < 0.001, AUC = 0,816). RUSS, R.I.R.S. score, and stone size were found to be independent predictive factors for SFR (p = 0.049, p = 0.024, p = 0.033, respectively). Complications were observed in 3.2%(9/280) of patients. Stone scoring systems were not statistically associated with complications. Operation duration was the only independent risk factor for complications (p = 0.010). CONCLUSIONS: The R.I.R.S. scoring system was found to have a higher predictive value than RUSS and S-ReSC to predict SFR following RIRS in our study. However, none of the stone scoring systems was directly proportional to complications of RIRS.