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.

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.

Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study.

PURPOSE: We investigated possible predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein and white blood count in patients with 4 to 10 mm distal ureteral stones. MATERIALS AND METHODS: A total of 251 patients who presented with renal colic secondary to distal ureteral stone were included in study. Patients were grouped according to spontaneous stone passage. Serum C-reactive protein, white blood count and other possible factors were investigated for their potential predictive value for spontaneous stone passage at a followup of 5 weeks. Potential predictive factors for spontaneous stone passage were evaluated with univariate and multivariate analyses. ROC curve analysis was performed to find an optimal cutoff value for serum C-reactive protein according to spontaneous stone passage. Statistical significance was considered at p <0.05. RESULTS: Spontaneous stone passage was observed in 135 patients (53.8%) in group 1 while 116 (46.2%) in group 2 did not expel the stone spontaneously. Median stone size was 5.7 mm. Stone size, serum C-reactive protein and white blood count were significantly higher in group 2 than in group 1. The number of patients with hydronephrosis and the number with spontaneous stone passage history were significantly lower in group 2 compared to group 1. The cutoff value of serum C-reactive protein provided by ROC analysis was 0.506 mg/l. Time to spontaneous stone passage was significantly higher in patients with serum C-reactive protein above the threshold and in patients with ureteral stones greater than 6 mm. CONCLUSIONS: Stone size, previous spontaneous passage, hydronephrosis, serum C-reactive protein and white blood count can be used to predict spontaneous stone passage in patients with 4 to 10 mm distal ureteral stones. A serum C-reactive protein level of 0.506 mg/l can serve as a cutoff value to predict spontaneous stone passage.

The Time of Spontaneous Resolution of Monosymptomatic Nocturnal Enuresis (MNE) Is Familial.

PURPOSE: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. PATIENTS AND METHODS: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. RESULTS: The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p < 0.05). In addition, it was revealed that familial MNE history based on first- and second-degree relatives, in addition to their parents, was also associated with the increased spontaneous resolution age of MNE (p < 0.05). According to our results, gender and parents' education status were not statistically associated with the spontaneous resolution (p > 0.05). CONCLUSION: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery.

Is routine ureteral stenting really necessary after retrograde intrarenal surgery?

OBJECTIVES: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). PATIENTS AND METHODS: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double- J stent after RIRS constituted Group 2. Patients' age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. RESULTS: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. CONCLUSIONS: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones.

PURPOSE: To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. MATERIALS AND METHODS: A retrospective analysis was made of pediatric patients aged <18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. RESULTS: In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. CONCLUSION: The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.

An extraordinary masturbation instrument: intravesical electrical wire cable / Un instrumento para la masturbación excepcional: cable eléctrico intravesical

There are several unusual cases in the literature with foreign bodies in bladder or urethra such as candle, needle, thermometer, animal feather, chicken bone, and wooden stick. Because of these foreign bodies there would be several complications. Pain, infection, urosepsis, and hematuria are the usually seen complications in these cases. Cases with electrical wire cables are also rarely seen. Some of the reasons for inserting foreign bodies are masturbation, feeling or presence of urethral obstruction. In this case, we aimed to present a 21-year-old male patient who was admitted to emergency clinic of Keçiören Research and Training Hospital in September 2014 with a urethral foreign body that was extending into the bladder and was used for masturbation (AU)

Hay varios casos inusuales en la literatura con cuerpos extraños en la vejiga o en la uretra tales como velas, agujas, termómetros, plumas animales, huesos de pollo, palos de madera etc. Estos objetos pueden general diversas complicaciones; las más comunes son dolor, infecciones, urosepsis o hematuria. Los casos con cables eléctricos se presentan en raras ocasiones. Alguno de los motivos por lo que se insertan cuerpos extraños pueden ser la masturbación o la sensación de obstrucción en la uretra. En esta ocasion se presenta el caso de un paciente varón de 21 años de edad que fue ingresado a la clínica de emergencia de Investigación Keçiören y el Hospital de Formación en septiembre de 2014 con un cuerpo extraño uretral que se extendía hasta la vejiga y se utilizó para la masturbación (AU)