Optimal patient position for percutaneous nephrolithotomy in horseshoe kidneys: Traditional prone or supine?

OBJECTIVE: Although it was stated that supine percutaneous nephrolithotomy (PCNL) was associated with relatively shorter surgical times and comparable success and complication rates, there is no consensus in the current literature concerning the safety and efficacy of supine PCNL in patients with horseshoe kidneys. We aimed to compare supine and prone PCNL regarding safety and efficacy in patients with horseshoe kidneys. METHODS: Data of the patients with horseshoe kidneys who underwent PCNL for renal stones larger than 2 cm between January 2010 and May 2021 were retrospectively reviewed. The study patients were categorized as Group 1 (i.e., supine PCNL-SPCNL) and Group 2 (i.e., prone PCNL-PPCNL). Both groups were compared regarding demographic, clinical, and surgical data. RESULTS: Sixty-five patients were included. Among these patients, 31 (47.7%) were in Group 1, while 34 (52.3%) were in Group 2. Both groups were statistically similar in terms of demographic data, stone characteristics, perioperative parameters, and complication rates (p > 0.05). There was no statistical difference in terms of additional treatment rates, stone-free rates in the postoperative second-day and third-month evaluations (p > 0.05). Mean surgical time was significantly longer in Group 2 (113 ±â€¯17.1 min) than in Group 1 (90.6 ±â€¯11.3 min) (p = 0.000). CONCLUSION: Although it is traditionally performed in the prone position, the supine approach is as safe and effective as the prone approach. In addition, the supine approach is associated with significantly shorter surgical times.

¿Existe asociación del tiempo entre el urocultivo y la cirugía intrarrenal retrógrada y la tasa de síndrome de respuesta inflamatoria sistémica? / Does time elapsed between urine culture and retrograde intrarenal surgery affect the rate of systemic inflammatory response syndrome?

Objetivo: Identificar los factores preoperatorios e intraoperatorios que podrían causar el síndrome de respuesta inflamatoria sistémica (SRIS) tras la cirugía intrarrenal retrógrada (CRIR) y estudiar el efecto del tiempo de espera entre la fecha del urocultivo vesical preoperatorio (UCVP) y la fecha de la cirugía en el SRIS postoperatorio.Materiales y métodos: La población objetivo la constituyeron 467 pacientes intervenidos mediante CRIR entre enero de 2013 y junio de 2020. Se obtuvieron UCVP de todos los pacientes antes de la cirugía. En el postoperatorio, los pacientes recibieron seguimiento estrecho en busca de fiebre y otros signos de SRIS. Se realizaron análisis de regresión logística univariante y multivariante para revelar los factores predictivos de SRIS después de CRIR.Resultados: La cohorte completa del estudio estaba formada por 467 pacientes. La tasa de SRIS fue del 5,6%. En el análisis univariante, la tasa de diabetes mellitus, los antecedentes de infección urinaria recurrente, el tiempo quirúrgico y la carga litiásica fueron factores predictivos significativos de SRIS. Según el análisis multivariante, la tasa de antecedentes de infección urinaria recurrente, el tiempo quirúrgico y la carga litiásica eran factores predictivos estadísticamente significativos. El tiempo transcurrido entre la fecha de realización del UCVP y la fecha de la cirugía fue el mismo en el grupo con SRIS y en el grupo normal.Conclusión: El intervalo de tiempo entre la fecha de realización del UCVP y la fecha de la cirugía no es un factor influyente para el SRIS. Aclarar esta cuestión mediante estudios prospectivos puede ayudar a resolver este problema con el que los endourólogos se enfrentan con frecuencia en la práctica diaria. (AU)

Objective: To identify the preoperative and intraoperative factors that might cause systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS), and to investigate the effect of time elapsed between the date of performing preoperative bladder urine culture (PBUC) and surgery date on postoperative SIRS.Materials and methods: Four hundred sixty-seven patients who had RIRS between January 2013 and June 2020 constituted the target population of this study. PBUC were obtained from all patients before undergoing surgery. Postoperatively, patients were closely monitored for fever and other signs of SIRS. Univariate and multivariate logistic regression analysis were performed to reveal the predictive factors for SIRS after RIRS.Results: The entire study cohort consisted of 467 patients. The rate of SIRS was 5.6%. In univariate analysis, the rate of diabetes mellitus, recurrent urinary tract infection history, surgical time, and stone burden were significant predictive factors for SIRS. In multivariate analysis, the rate of recurrent urinary tract infection history, surgical time and stone burden were observed to be statistically significant predictive factors. Time elapsed between the date of performing PBUC and surgery date was not different between the SIRS group and the normal group.Conclusion: We conclude that the time between the date of performing PBUC and surgery date is not an influential factor for SIRS. Clarifying this issue with prospective studies may be useful, as endourologists frequently encounter this situation in daily practice. (AU)

Comparison of computed tomography and magnetic resonance imaging in the assessment of complex renal cysts by using the Bosniak classification. / Comparación entre tomografía computarizada y resonancia magnética en la evaluación de quistes renales complejos empleando la clasificación de Bosniak.

INTRODUCTION AND OBJECTIVES: The Bosniak classification of cystic renal lesions was first published in 1986 based on computed tomography (CT). In the present study, we aimed to investigate the effect of magnetic resonance imaging (MRI) on Bosniak category compared with CT, and to determine how this effect changed the treatment modality in the evaluation of complex renal cysts. MATERIAL AND METHODS: Data of 144 patients were collected retrospectively. After exclusion criteria, 102 cystic renal lesions with a Bosniak category of at least IIF on CT or MRI between 2013 and 2016 were evaluated by 2abdominal radiologists. The demographic data, Bosniak category, interobserver agreement, and pathologic data of patients who underwent surgery were recorded. RESULTS: The coherence between MRI and CT was 75.5%. The Bosniak classification of 17 patients was upgraded with MRI, and the treatment modality changed in 10 patients, and they underwent surgery. The Bosniak category was downgraded from III to IIF in 6 patients out of 8 whose Bosniak category was downgraded with MRI and the treatment modality changed. Surgery was performed in one patient out of these 6 patients, and the pathology was reported as benign. Progression was detected in the follow-up at month 18 of 1 patient out of 5, and surgery was performed. The pathology was reported as renal cell carcinoma. The pathology result was reported as RCC in 35 (68.6%) patients out of 51 who underwent surgery. Progression was detected in 7 patients out of 51 who were followed up (13.7%), and the pathology results were reported as RCC. The majority of the malignant tumors were low stage and grade. CONCLUSIONS: MRI may be successfully used in the evaluation of renal cystic lesions. In particular, the challenging Bosniak IIF and all Bosniak III lesions must be evaluated using MRI before making the decision for surgery. The upgrading of Bosniak category with MRI is more possible compared with CT due to its high-contrast resolution, therefore further studies are required to identify whether it was the cause of overtreatment of Bosniak III lesions.