Effects of Klotho protein, vitamin D, and oxidative stress parameters on urinary stone formation and recurrence.

PURPOSE: The present study aimed to investigate the effects of α-Klotho and oxidative stress markers on urinary stone disease (USD) and demonstrate their use as biochemical markers in USD. METHODS: Among the 90 individuals included, 30 individuals were healthy controls (Group 1), 30 individuals presented with USD for the first time (Group 2), and 30 individuals demonstrated recurrent USD (Group 3). Serum levels of α-Klotho, vitamin D, malondialdehyde (MDA), total oxidant status, and total antioxidant status were determined using spectrophotometry analysis. Serum calcium and parathormone levels and 24-h urine calcium levels were measured via biochemical analysis. RESULTS: No significant intergroup difference was noted in terms of age and sex. The groups had significant differences regarding α-Klotho, oxidative stress index (OSI), MDA, and 24-h urine calcium levels. α-Klotho was a determinant of 24-h urine calcium level and OSI. An increase of 1 pg/mL in α-Klotho level appeared to result in a decrease of 8.55 mg in 24-h urine calcium level and a decrease of 0.04 Arbitrary Unit in OSI. In patients experiencing USD for the first time, α-Klotho values were < 21.83 pg/mL and showed 66% sensitivity and 64% specificity. In individuals with recurrent stone formation, α-Klotho values below 19.41 pg/mL had 60% sensitivity and 77% specificity. CONCLUSIONS: The biochemical markers investigated herein, i.e., α-Klotho, OSI, and MDA, were involved in the pathogenesis of stone formation and can be used in day-to-day clinical practices of urology clinics to identify patients at risk for both first time and recurrent USD.

Evaluation of male sexual parameters in infertile couples with a history of abortion.

INTRODUCTION: It is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component. METHODS: Five hundred forty-seven male patients' data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI). RESULTS: There were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history. CONCLUSION: Man is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.

Can Annual Daylight Cycles and Seasons Have an Effect on Male Sexual Functions?

Introduction Mammals' sexual functions exhibit seasonal variations that have been attributed to changes in the daylight. In this study, taking into consideration endocrine and psychogenic status, we aimed to investigate whether human males experience changes in erectile functions and sexual desire depending on daylight periods and seasons, and whether periodicity exists in human sexual behavior. Materials and methods International Index of Erectile Function (IIEF) and psychiatric scale scores of 221 male patients were evaluated. In addition, hormonal parameters of the patients were examined. These data were first evaluated in two groups (summer and winter) according to local daylight amounts the participants received. Then IIEF scores were also analyzed according to four conventional seasons (winter, spring, summer, and autumn). Results There was no significant difference in laboratory data, psychiatric scale scores and IIEF evaluations between summer and winter groups. Moreover, no significant difference was found in terms of sexual desire and erectile functions in terms of four seasons (p > 0.05). Conclusion According to the results of this study, there is no periodicity in human sexual functions both in relation to daylight and four seasons.

The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: A prospective 1-year follow-up study. / El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: Un estudio prospectivo de seguimiento de 1 año.

OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.

OBJETIVOS: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentos residuales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer las diferencias en el destino del FRCI según esten en el polo inferior u otras localizaciones renales.MATERIAL Y MÉTODOS: 81 pacientes cuyos cálculos se fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41 pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales, urocultivo y cribado de cálculos renales se evaluaron antes y un año después de la cirugía. RESULTADOS: Mientras que el número de pacientes sin cálculos fue menor y los pacientes con FRCI ≤4 mm fue mayor en el grupo de cálculos del polo inferior 1 año después de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número de pacientes cuyo FRCI volvió a crecer fue del 46,3% en el grupo 1 y del 52,5% en el grupo 2. Se detectó una correlación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual del primer año en el grupo 1. El análisis de regresión lineal sugirió que el tamaño del cálculo preoperatorio es un predictor del tamaño del fragmento residual del primer año posoperatorio en el grupo 1. CONCLUSIÓNES: Observamos que casi la mitad de los FRCI en todas las localizaciones renales volvieron a aparecer y se volvieron sintomáticos. Hay un efecto del tamaño del cálculo sobre el tamaño del fragmento residual mientras se realiza la CRIR, en particular, para los cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes con FRCI independientemente de la localización renal para evaluar la necesidad de retratamiento.

El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: un estudio prospectivo de seguimientode 1 año / The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: a prospective follow-up study 1 year

Objetivos: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentosresiduales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer lasdiferencias en el destino del FRCI según esten en el poloinferior u otras localizaciones renales.Material y métodos: 81 pacientes cuyos cálculosse fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales,urocultivo y cribado de cálculos renales se evaluaronantes y un año después de la cirugía.Resultados: Mientras que el número de pacientes sincálculos fue menor y los pacientes con FRCI ≤4 mm fuemayor en el grupo de cálculos del polo inferior 1 añodespués de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número depacientes cuyo FRCI volvió a crecer fue del 46,3% enel grupo 1 y del 52,5% en el grupo 2. Se detectó unacorrelación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual delprimer año en el grupo 1. El análisis de regresión linealsugirió que el tamaño del cálculo preoperatorio es unpredictor del tamaño del fragmento residual del primeraño posoperatorio en el grupo 1.Conclusiones: Observamos que casi la mitad delos FRCI en todas las localizaciones renales volvierona aparecer y se volvieron sintomáticos. Hay un efectodel tamaño del cálculo sobre el tamaño del fragmentoresidual mientras se realiza la CRIR, en particular, paralos cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes conFRCI independientemente de la localización renal paraevaluar la necesidad de retratamiento.(AU)

Objetives: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificantresidual fragments (CIRF) could not pass from the kidney.We aimed to find out the differences on the fate of CIRFaccording to being in the lower pole or other renal localizations.Methods: 81 patients whose stones were fragmentedcompletely by RIRS were subdivided into two groups asgroup 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients).Basal characteristics, urine culture, and renal stonescreening were evaluated before and 1-year later fromthe surgery.Results: While the number of stone-free patients wasless and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, therewas no statistical difference between the two groups(p=0.158, p=0.136). The number of patients whoseCIRFs regrew was 46.3% in group 1 and, 52.5% ingroup 2. A positive correlation was detected betweenpreoperative stone size and first-year maximal residualfragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of thepostoperative first-year residual fragment size in group 1.Conclsions: We observed that almost the half ofthe CIRFs in all renal localizations regrew and becamesymptomatic. There is an effect of the stone size on theresidual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF areneeded to be followed-up more closely regardless of therenal localization in order to assess the requirement ofretreatment.(AU)

Efficacy of various laser devices on lithotripsy in retrograde intrarenal surgery used to treat 1-2 cm kidney stones: A prospective randomized study.

AIMS: To compare the efficacy of different laser devices and power ranges on lithotripsy in retrograde intrarenal surgery (RIRS) for 1-2 cm kidney stones. METHODS: A total of 223 participants undergoing RIRS for 1-2 cm kidney stones at our clinic between January 2015 and January 2017 were recruited for this prospective study (NCT02451319). Two hundred and four participants included in our study were randomly allocated into either ≤20 W with 20 W laser device (group 1) or ≤20 W with 30 W laser device (group 2) or >20 W with 30 W laser device (group 3). RESULTS: There was no significant difference between the groups in terms of demographic and stone characteristics. Operation and fluoroscopy times were significantly longer (P = .003 and P < .001, respectively) and stone-free rate (SFR) was significantly lower in group 1 (P = .002). Complications were similar in all three groups (P = .512). However, post-operative pain scores were significantly higher in group 1 (P < .001). The multivariate analysis revealed that stone size (95% CI: 0.654-0.878, OR = 0.758, P < .001), ureteral access sheath use (95% CI: 1.003-20.725, OR = 4.560, P = .049), and lithotripsy with 30 W laser device (95% CI: 1.304-11.632, OR = 3.895, P = .015; 95% CI: 1.738-17.281, OR = 5.480, P = .004, groups 2 and 3, respectively) were independent factors predicting SFR for RIRS used in 1-2 cm kidney stones. CONCLUSION: The 30 W laser device used in RIRS for 1-2 cm kidney stones had shorter operation times, higher SFRs, and lower post-operative pain scores compared with the 20 W device. The 30 W laser device is safe and more efficient in RIRS for treatment of 1-2 cm kidney stones.

Effect of Endoscopic Ureteral Stone Treatment on Kidney Function.

INTRODUCTION: Ureteral stones may have an influence on kidney functions due to postrenal obstruction or urinary infections. Urgent decompression or stone removal is necessary and recommended to prevent further complications in case of severe conditions such as anuria and urosepsis. Although it is believed that ureteral stone removal would result in renal function improvement, there are still unclear points on whether ureteroscopy (URS) can provide benefit as expected and has some adverse effects. In this study, we aimed to evaluate the alteration of kidney functions of patients who undergo rigid or flexible URS for ureteral stones and find if there are any influencing factors on kidney function alteration. MATERIALS AND METHOD: We analyzed 126 patients who underwent retrograde intrarenal surgery (RIRS) for renal stones between May 2018 and February 2020 prospectively. The estimated glomerular filtration rate (eGFR) was calculated on the day before the surgery, by modification of diet in renal disease (MDRD) formula. The calculation was repeated and saved three times during follow-up for the same patient; on the day after the operation, on the postoperative 30th day, and the postoperative 90th day. Then, we evaluated the renal function by comparing eGFR and assessed the predicting factors affecting the kidney function. RESULTS: Preoperative mean eGFR was 82.28 ± 25.20 mL/min/1.73 m2 for the study group. Mean eGFR was calculated 90.92 ± 22.97 mL/min/1.73 m2 on the first postoperative day, and 94.54 ± 21.95 mL/min/1.73 m2 on the third-month follow-up. The mean change in eGFR was 8.63 ± 16.68 mL/min/1.73 m2 in the early period and 12.26 ± 21.09 mL/min/1.73 m2 in the long-term follow-up period. Fifty-one patients improved on chronic kidney disease (CKD) stage, and 13 deteriorated in three months follow-up. CONCLUSION: Removing the stone and relieving the obstruction by ureteroscopic treatment have an alteration on eGFR. Although eGFR improves in the short-term follow-up, amelioration is evident in long-term follow-up, especially in female patients. The other predictive factors for eGFR improvement after URS are the presence of ureteral obstruction and high preoperative serum creatinine levels.

External Validation and Comparison of Nephrolithometric Scoring Systems Predicting Outcomes of Retrograde Intrarenal Surgery.

Introduction: Preoperative assessment of renal stones is essential to selecting treatment options and achieving high success rates; thus, some nephrolithometric scoring systems have been developed by using preoperative clinical data and stone characteristics. Initially, nomograms predicting stone-free rates (SFRs) were designed for percutaneous nephrolithotomy. After this, some were modified, and new scoring systems were developed for retrograde intrarenal surgery (RIRS). In this study, we aimed at validating and comparing the accuracy of four scoring systems predicting the SFR of RIRS. Materials and Methods: We conducted a prospective study. The data of 110 consecutive patients who required RIRS for renal stones between May 2018 and February 2020 were evaluated. The patients were divided into four groups regarding total score: 0, 1, 2, ≥3 according to the Resorlu-Unsal Stone Score (RUSS). The scores were calculated between 5 and 15 for the size of the stone, topography or location, degree of obstruction of the urinary system, number of stones, and evaluation of Hounsfield units (S.T.O.N.E.) scoring system. Modified Seoul National University Renal Stone Complexity (S-ReSC) scores of the patients were between 1 and 12. Finally, the patients were classified between 4 and 10 points with the R.I.R.S. scoring system. Results: The mean RUSS, S.T.O.N.E., R.I.R.S., and modified S-ReSC scores were 1.14 (±0.818), 10.78 (±1.499), 6.50 (±1.305), and 2.29 (±1.710), respectively. The area under curve values of RUSS, S.T.O.N.E., R.I.R.S., and S-ReSC were 0.735 (95% confidence interval [CI] 0.623-0.826), 0.725 (95% CI 0.626-0.823), 0.752 (95% CI 0.646-0.857), and 0.755 (95% CI 0.660-0.849), respectively. Logistic regression analysis revealed that the RUSS was an independent predictive factor for SFR (p = 0.028). Conclusion: The results showed that all four scoring systems predict the SFRs for RIRS accurately. However, surgeons should prefer RUSS when all four nomograms are available, except when assessing single renal stones. In that case, S-ReSC should be used for assessment. Three other nomograms except the S.T.O.N.E. scoring system can be suitable for the assessment of lower caliceal stones.

Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis.

BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.

The impact of body mass index on reproductive hormones, testosterone/estradiol ratio and semen parameters.

INTRODUCTION: The aim of this study was to evaluate the relationship between body mass index (BMI) and sperm parameters and reproductive hormone levels in patients with no known risk factors for infertility. MATERIAL AND METHODS: Four hundred patients who met the study's inclusion criteria were divided into three groups according to their BMI values as normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and obese (BMI ≥30 kg/m2). Semen parameters, reproductive hormone levels and testosterone/estradiol ratio were compared retrospectively between the groups. RESULTS: There was no significant difference between the groups in terms of age and infertility period. The mean BMI of all the patients was 26.6 ±4.08, and the BMI in the normal, overweight and obese groups were 22.6 ±1.7, 27.4 ±1.3, and 33.4 ±2.9, respectively (p <0.001). There was no significant difference between the groups in terms of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, semen volume, sperm concentration, total sperm count, and progressive and total motility. Serum testosterone (T) level and testosterone/estradiol (T/E2) ratio were significantly higher in the normal BMI group (p <0.001). CONCLUSIONS: Adipose tissue increase was not significantly correlated with change in the semen parameters and it was negatively correlated with T levels and T/E2 ratio.

Evaluation of the influence of subinguinal varicocelectomy procedure on seminal parameters, reproductive hormones and testosterone/estradiol ratio.

OBJECTIVE: Varicocele is the most commonly surgically curable cause of male infertility. However, the mechanisms related to the effect of reducing fertility potential have not been clearly identified. The aim of this study was to investigate the effects of varicocelectomy on semen parameters, reproductive hormones and testosterone / estradiol ratio. Matherial and methods: Fifty seven patients outcomes were evaluated before and 6 months after subinguinal microsurgical varicocelectomy. Semen parameters, reproductice hormones and testosteron/estradiol ratio results of patients were compared retrospectively. RESULTS: The mean age was 26.8 years. Fifty four (94.7%) patients had grade 3 and 3 (5.3%) patients had grade 2 varicocele. There was a significant increase in semen parameters except semen volume. There was a statistically significant increase in serum testosterone levels, but not on testosterone/ estradiol ratio. CONCLUSIONS: According to our results, microsurgical subinguinal varicocelectomy can be recommended for both improving semen parameters and hormonal recovery.

Comparison of the efficiency, safety and pain scores of holmium laser devices working with 20 watt and 30 watt using in retrograde intrarenal surgery: One center prospective study.

OBJECTIVES: Holmium:Yttrium Aluminum Garnet laser lithotripsy is used in Retrograde Intrarenal Surgery. Fragmentation is made with a certain value of pulse energy (Joule) and frequency (Hertz) in Holmium laser lithotripsy and the multiplication of these values gives us total power (Watt). Devices with maximum power of 20 Watt and 30 Watt are used in clinical practice. We want to compare the efficiency, safety and pain scores of the lithotripsy made below 20 Watt and over 30 Watt with 30 Watt laser device. MATERIALS AND METHODS: 60 patients who had 2-3 cm sized kidney stones and operation planned were prospectively divided into three groups. Groups were random identified. In the first group, fragmentation was performed below 20 Watt power with 20 Watt laser device. In the second group, fragmentation was performed below 20 Watt power with 30 Watt laser device. In the third group, fragmentation was performed over 20 Watt power with 30 Watt laser device. Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency, safety and pain score. RESULTS: For demographic and stone data, there was a statistically significant difference only for stone number. For intraoperative and postoperative data, there was a statistically significant difference only for ureteral access sheath usage between the groups. Success was lower than the other groups in Group 1. CONCLUSIONS: Success was higher in groups using 30 Watt laser device. There was not statistically significantly difference between complications and pain. 30 Watt laser device is safe and efficient in Retrograde Intrarenal Surgery.

Ureteral Access Sheath Application Without Fluoroscopy in Retrograde Intrarenal Surgery.

OBJECTIVE: To compare the results and complications of the two techniques of ureteral access sheath application, with and without using fluoroscopy. STUDY DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Department of Urology, Karabuk University Medical Faculty Training and Research Hospital and Ankara Diskapi Yildirim Beyazid Training and Research Hospital between April 2014 and January 2018. METHODOLOGY: Retrospective evaluation was made of patients applied with retrograde intrarenal surgery using ureteral access sheath (UAS). In Group 1, defined method were used for UAS application without using scopy. In Group 2, following semi-rigid ureterorenoscopy, localisation of guidewire was checked with fluoroscopy. UAS was advanced to ureter over guidewire under fluoroscopy imaging. RESULTS: Success rate of UAS placement was similar in both groups (p=0.747). The time of UAS placement was 14.75 secs in Group 1 and 14.99 secs in group 2 (p=0.073). Fluoroscopy was not used at all during UAS placement in Group 1. In Group 2, the mean duration of fluoroscopy use was 9.93±3.89 secs. Total stone-free rate was 82.09% and 83.28% in Group 1 and 2, respectively. (p=0.653). CONCLUSION: The method described in this paper provides protection against radiation exposure for both the patient and the operating team; and prevents potential complications by enabling clear evaluation of ureteral orifice. Key Words: Renal stone surgery, Retrograde intrarenal surgery, Radiation protection, Flouroscopy, Radiation free.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Used in the Treatment of 2-4 cm Kidney Stones in Terms of Pain and Need for Additional Analgesics: A Prospective Randomized Study.

Purpose: To compare the effects of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) on postoperative pain and their differences in terms of the postoperative need for analgesics in the treatment of 2-4 cm kidney stones. Methods: A total of 132 patients who suffered from renal stones 2-4 cm in size and had surgery at our urology clinic between April 2015 and April 2017 were enrolled in this prospective study (NCT02430168). Patients were randomized into either the RIRS group (Group 1) or PNL group (Group 2) in a ratio of 1:1. Postoperative visual analog scale (VAS) values at 8 and 24 hours postoperatively and analgesic treatments of patients were recorded. Results: Patients from both groups had similar demographic characteristics. Stone-free states were achieved in 37 (74%) patients in the RIRS group and 45 (90%) patients in the PNL group. Postoperative complication rates were similar in two groups. Moreover, there was no statistically significant difference between the groups in terms of the postoperative need for analgesics (P = .309). However, the PNL group had higher VAS values (P < .001). Conclusion: Although the early postoperative pain scales were high in the PNL group, there was no significant difference between the groups in terms of the standard analgesic treatments for achieving patient's comfort. PNL, which has similar complications, but with higher success rates, compared with RIRS, did not require additional analgesic treatment during postoperative pain management. Thus, in our opinion, PNL should still remain as a first choice in treatment of 2-4 cm renal stones.

Factors Affecting Retrograde Intrarenal Surgery Success: 6 Years Experience of a Clinic in Central Anatolia.

Background: Urinary system stone disease is an important health problem. It has been reported to have a prevalence of 14.8% in Turkey. The aim of the renal stone removal surgery is to clear the stones with minimal complications. Retrograde intrarenal surgery (RIRS) is a safe method due to the fewer and minor complications. As a clinic in central Anatolia, we aimed at researching the factors affecting RIRS success in our area. Methods: After local ethics committee's approval, the data of the patients who had undergone RIRS between 2014 and 2019 were reviewed. Patients who were <18 years old, had kidney anomalies, and had both ureter and kidney stones were excluded from the study. The patients who were defined as successful were named as Group 1 and the others were named as Group 2. The demographic, intraoperative, and postoperative data of the two groups were compared. Results: There were a total of 416 patients in our study. Group 1 consisted of 332 patients, whereas Group 2 had 84 patients. Opacity was significantly different between the groups (P = .004). Stone size, stone volume, and operation time were significantly higher in Group 2. After logistic regression analysis, we found that stone size, opacity, and operation time affected the success of RIRS significantly (P < .05). There was a reverse relationship with stone size, operation time, and opacity. Conclusions: We believe that in patients who have large lower calix stones and who want effective treatment, percutaneous nephrolithotomy should still be an option for treatment.

Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones.

OBJECTIVE: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter. MATERIALS AND METHODS: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes. RESULTS: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients' demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones. CONCLUSIONS: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.

Do Anesthesia Methods in Retrograde Intrarenal Surgery Make Difference Regarding the Success of Ureteral Access and Surgical Outcomes?

Background: Retrograde intrarenal surgery (RIRS) is a safe and minimally invasive method for the endoscopic treatment of upper urinary system stones especially sized <2 cm. Ureteral entrance is an important stage of RIRS. General anesthesia (GA) is usually used for RIRS. There is not enough data about the effect of anesthesia methods on the success of ureteral entrance and RIRS. We aimed to evaluate the effects of anesthesia methods (spinal anesthesia [SA], epidural anesthesia [EA], and GA) on the ureteral access and RIRS outcomes in primary surgery. Methods: After local ethical approval, 105 patients were prospectively randomized into three groups according to the anesthesia methods. GA, SA, and EA were defined as Group 1, 2, and 3, respectively. Results: Stone density was statistically significantly different between three groups (P = .008). Lithotripsy and operation time were significantly lower in Group 3 (P = .001). Dilatation and stone access time were significantly lower in Group 1. There was no statistically significant difference for scopy time, success, Visual Analog Scale score at 8th and 24th hours, and intraoperative and postoperative complications. Conclusions: GA may be recommended to decrease manipulations for the success of first ureteral access and time to reach the stone if there is not any contraindication.

Is RIRS Safe and Efficient In Patients With Kidney Stones Who Had Previous Open, Endoscopic, or Percutaneous Kidney Stone Surgery? One Center Retrospective Study.

PURPOSE: In our study, we assessed the efficiency and reliability of retrograde intrarenal surgery secondary to open surgery for kidney stone treatment. Moreover, we compared the efficiency and safety of retrograde intrarenal surgery for the patients with previous history of open surgery, percutaneous nephrolithotomy, secondary retrograde intrarenal surgery (RIRS) and primary RIRS. MATERIALS AND METHODS: Data was retrospectively reviewed. Patients who had kidney anomalies, who had been stented due to ureteral stricture in the operation and who were < 18 years old, were excluded. There were 30 patients who underwent RIRS secondary to open surgery. The demographic and stone characteristic as well as intraoperative and postoperative data of the patients were recorded. 30 patients with similar demographic and stone characteristics to those patients were selected by match pairing method from patients who had previous PNL, RIRS history and had undergone primary RIRS. A total of 120 patients, in total 4 groups, were included in the study. RESULTS: Statistically significant difference was detected among the groups with regards to shock wave lithotripsy history and preoperative JJ stent rate. There was no statistically significant difference in terms of stone characteristics, intraoperative and postoperative data. CONCLUSION: RIRS is an efficient and safe method for kidney stone treatment of the patients with previous history of open surgery, percutaneous nephrolithotomy and retrograde intrarenal surgery. It has a similar efficiency and safety for the patients who have undergone retrograde intrarenal surgery. This is the first study that compares the patients especially  with different previous surgery methods.

Are There Any Relationships Between Abnormal Seminal Parameters and Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Red Blood Cell Distribution-Platelet Ratio?

Objective The aim of this study is to determine the relationship between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and red blood cell distribution width (RDW)/platelet ratio (RPR) values, which are pro-inflammatory markers, with abnormal sperm parameters, and to evaluate their availability as predictive markers. Materials and methods A total of 160 patients, 80 of whom were the control group, formed with match-pair analysis (Group 1), and 80 patients with abnormal sperm analysis, who met the study criteria (Group 2), were included in the study. Complete blood count results were recorded. NLR, PLR, and RPR values were calculated using hematological parameters, and a comparison was made between the two groups. Results The mean age was 31.23 ± 5.1 years in Group 1 and 31.33 ± 6.4 years in Group 2. NLR values were 1.84 ± 0.57-1.87 ± 0.65 (P =0.77), PLR values were 105.42 ± 23.89-111.42 ± 34.54 (P = 0.62) and RPR values were 0.05 ± 0.009-0.05 ± 0.01 (P =0.45), respectively. There was no statistically significant difference between the groups. Conclusions We investigated whether NLR, PLR, and RPR results can be used as a predictive marker on abnormal sperm parameters. We do not recommend the use of these parameters as a predictive marker.

Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in horseshoe kidney; what are the advantages and disadvantages compared to each other?

INTRODUCTION: Kidney stones occur more frequently in patients with a horseshoe kidney (HSK) anomaly. Abnormal anatomy may make the stone removal procedures more difficult. Therefore we aimed to evaluate and compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) for the treatment of renal stones in the HSK anomaly. MATERIAL AND METHODS: In this descriptive study, patients with HSK anomaly who underwent RIRS and PCNL procedures were retrospectively evaluated. Demographic and renal stone characteristics, success and complications associated with the surgical methods were compared across patients. RESULTS: A total of 49 patients were evaluated, 28 underwent RIRS and 21 underwent PCNL. No differences were determined between the groups concerning the demographics of patients and stone characteristics. A single session and final stone-free rate was 71.4% and 85.7% in RIRS, 81% and 90.5% in PCNL (both p ≥0.05). However, RIRS had more re-treatment rate, while its mean length of hospital stay was shorter than PCNL (p = 0.035, p = 0.001). While no differences were detected between the associated complication rates, more of the complications encountered in the PCNL group were of a serious nature. CONCLUSIONS: In the HSK anomaly, renal stones can be treated with RIRS and PCNL procedures with high success. With its minimal morbidity, low complication rates and the minor character of the associated complications, the RIRS procedure can sometimes be preferred to avoid complications related to PCNL in HSK anomaly with big sized kidney stones.