ABSTRACT
Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [-] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS- patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS- patients (27.6%) (p=0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.
ABSTRACT
INTRODUCTION: Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. MATERIAL AND METHODS: Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. RESULTS: A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. CONCLUSIONS: Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.