Healthcare costs and effects of post-COVID-19 condition in Canada.

Background: As evidence of the long-term health impacts of coronavirus disease 2019 (COVID-19) continues to grow across Canada, a key concern is the costs and health impacts of post-COVID-19 condition (PCC), especially while the healthcare system remains under substantial strain. The objective of this study is to estimate healthcare costs and quality-adjusted life year (QALY) decrements per PCC case and per acute COVID-19 case by vaccination status. Methods: First, we conducted a rapid review of the literature to estimate 1) the probability of developing PCC following COVID-19 infection by vaccination status, 2) the probability of each condition commonly associated with PCC, 3) healthcare costs and QALY decrements associated with each condition and 4) the number of PCC cases currently in Canada. Second, using the data gathered from the literature, we built a tool to estimate the cost and QALY decrements per PCC and COVID-19 case. Results: Post-COVID-19 condition costs per COVID-19 case ranged from CAD 1,675 to CAD 7,340, and QALY decrements ranged between 0.047 to 0.206, in the first year following COVID-19 infection. Overall, individuals who were unvaccinated when they were infected had higher costs and QALY decrements. We estimated the total burden of PCC to the Canadian healthcare system based on PCC estimates up until spring 2023 would be between CAD 7.8 and CAD 50.6 billion. Conclusion: This article demonstrates the large potential health and economic burden of PCC for Canadians, and the importance of vaccination and other infection control strategies in reducing the longer-term costs and effects.

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success. / Eficiencia de la cirugía intrarenal retrograda sin radiación en niños y evaluación de los factores que afectan el éxito quirúrgico.

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.

OBJETIVO: Investigar los factores que afectan el éxito quirúrgico y la duración de la cirugía retrógrada intrarenal sin fluoroscopia en niños. El objetivo de este estudio fue demostrar la eficacia de la cirugía retrógrada intrarenal sin fluorosocopia en el tratamiento de litiasis en niños. MÉTODOS: Todos los procedimientos de cirugía retrógrada intrarenal fueron realizados en pacientes pediátricos en nuestra clínica entre agosto 2013 y enero 2017. Estudiamos 52 casos pediátricos con 1 litiasis en 1 riñón y recibieron una sesión. Marcamos el sistema colector renal y la litiasis se definió según ese marcaje. El tamaño y la localización de la piedra, colocación preoperatoria del doble J, la vaina de acceso y la tasa de éxito quirúrgico fueron reportadas. Los efectos de estos factores en el éxito quirúrgico y la duración de las cirugías fueron analizados. RESULTADOS: Cada paciente recibió cirugía retrógrada una vez. De éstos 52 pacientes pediátricos, 23 (44%) tenían entre 0 y 5 años (grupo 1), 12 (25%) entre 6 y 11 años (grupo 2), 16 (31%) entre11 y 17 años (Grupo 3). El éxito quirúrgico en cada grupo fue de 65%, 77% y 81% respectivamente (73% en general). El éxito quirúrgico se vió afectado sólo por el tamaño de la litiasis (p<0,01). La duración de las cirugías se vió afectada por el tamaño de la litiasis, localización de la litiasis, dilatación pasiva del uréter, y uso de la vaina de acceso (p<0,05).CONCLUSIÓN: La cirugía intrarenal retrógrada es segura y efectiva en el tratamiento de litiasis intrarenales en el paciente pediátrico. Altas tasas de éxito se consiguen con el mapeo renal sin fluoroscopia.

Es importante la homeostasis del Tiol/Disulfito en el diagnóstico del cáncer de próstata? / Is Thiol/Disulphide homeostasis important in prostate cancer diagnosis?

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under- went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p < 0.001). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p < 0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy

OBJETIVO: Investigar los factores que afectan el éxito quirúrgico y la duración de la cirugía retrógrada intrarenal sin fluoroscopia en niños El objetivo de este estudio fue demostrar la eficacia de la cirugía retrógrada intrarenal sin fluorosocopia en el tratamiento de litiasis en niños. MÉTODOS: Todos los procedimientos de cirugía retrógrada intrarenal fueron realizados en pacientes pediátricos en nuestra clínica entre agosto 2013 y enero 2017. Estudiamos 52 casos pediátricos con 1 litiasis en 1 riñón y recibieron una sesión. Marcamos el sistema colector renal y la litiasis se definió según ese marcaje. El tamaño y la localización de la piedra, colocación preoperatoria del doble J, la vaina de acceso y la tasa de éxito quirúrgico fueron reportadas. Los efectos de estos factores en el éxito quirúrgico y la duración de las cirugías fueron analizados. RESULTADOS: Cada paciente recibió cirugía retrógrada una vez. De éstos 52 pacientes pediátricos, 23 (44%) tenían entre 0 y 5 años (grupo 1), 12 (25%) entre 6 y 11 años (grupo 2), 16 (31%) entre 11 y 17 años (Grupo 3). El éxito quirúrgico en cada grupo fue de 65%, 77% y 81% respectivamente (73% en general). El éxito quirúrgico se vió afectado sólo por el tamaño de la litiasis (p < 0,001). La duración de las cirugías se vió afectada por el tamaño de la litiasis, localización de la litiasis, dilatación pasiva del uréter, y uso de la vaina de acceso (p < 0,05). CONCLUSIÓN: La cirugía intrarenal retrógrada es segura y efectiva en el tratamiento de litiasis intrarenales en el paciente pediátrico. Altas tasas de éxito se consiguen con el mapeo renal sin fluoroscopia

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success / Eficiencia de la cirugía intrarenal retrograda sin radiación en niños y evaluación de los factores que afectan el éxito quirúrgico

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by Stone size (p < 0.001). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p < 0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy

OBJETIVO: Investigar los factores que afectan el éxito quirúrgico y la duración de la cirugía retrógrada intrarenal sin fluoroscopia en niños El objetivo de este estudio fue demostrar la eficacia de la cirugía retrógrada intrarenal sin fluorosocopia en el tratamiento de litiasis en niños. MÉTODOS: Todos los procedimientos de cirugía retrógrada intrarenal fueron realizados en pacientes pediátricos en nuestra clínica entre agosto 2013 y enero 2017. Estudiamos 52 casos pediátricos con 1 litiasis en 1 riñón y recibieron una sesión. Marcamos el sistema colector renal y la litiasis se definió según ese marcaje. El tamaño y la localización de la piedra, colocación preoperatoria del doble J, la vaina de acceso y la tasa de éxito quirúrgico fueron reportadas. Los efectos de estos factores en el éxito quirúrgico y la duración de las cirugías fueron analizados. RESULTADOS: Cada paciente recibió cirugía retrógrada una vez. De éstos 52 pacientes pediátricos, 23 (44%) tenían entre 0 y 5 años (grupo 1), 12 (25%) entre 6 y 11 años (grupo 2), 16 (31%) entre 11 y 17 años (Grupo 3). El éxito quirúrgico en cada grupo fue de 65%, 77% y 81% respectivamente (73% en general). El éxito quirúrgico se vió afectado sólo por el tamaño de la litiasis (p < 0,001). La duración de las cirugías se vió afectada por el tamaño de la litiasis, localización de la litiasis, dilatación pasiva del uréter, y uso de la vaina de acceso (p < 0,05). CONCLUSIÓN: La cirugía intrarenal retrógrada es segura y efectiva en el tratamiento de litiasis intrarenales en el paciente pediátrico. Altas tasas de éxito se consiguen con el mapeo renal sin fluoroscopia

Modified Makuuchi incision in the surgical treatment of renal tumors: Initial results.

OBJECTIVE: To evaluate the modified Makuuchi incision in the surgical treatment of renal tumors. MATERIAL AND METHODS: A total of 29 patients with renal tumors were operated using the modified Makuuchi incision. Patients' age ranged from 48 to 72 years. Twenty-three patients were male, and 6 patients were female. Renal tumors affected the right side in 22 patients and the left side in 7 patients. Twenty-six patients underwent radical nephrectomy, while 3 patients underwent partial nephrectomy. RESULTS: A perfect exposure was achieved with this incision in the surgical field. No serious complications such as bleeding or other organ injuries happened during the surgery. Blood transfusion during surgery was unnecessary. Additional use of analgesics due to wound pain during the postoperative period was not required. Incision-related complications, such as wound infection and wound dehiscence, did not occur in the early postoperative period. Patients had no complaints about the cosmetic appearance of their abdomen due to the incision. Incisional hernia was not observed in patients. CONCLUSION: This type of incision provided a perfect exposure of the field in the surgical treatment of renal tumors.

The efficacy of Tadalafil 5mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms. / Eficacia de Tadalafilo 5 mg en el tratamiento de los síntomas del tracto urinario inferior en pacientes tras fallo de los alfabloqueantes.

OBJECTIVES: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment. PATIENTS AND METHODS: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant. CONCLUSION: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment.

OBJETIVOS: Investigar la eficacia de tadalafilo 5 mg en pacientes con síntomas del tracto urinario inferior (STUI) tras fallo de los alfabloqueantes. PACIENTES Y MÉTODOS: Treinta y tres pacientes fueron incluidos. Se obtuvo consentimiento informado en todos los casos tras explicarles la eficacia del tadalafilo 5 mg en el tratamiento de los STUI. Antes de iniciar el tratamiento se descartaron cáncer de próstata e infección urinaria. Se evaluaron los valores de los cuestionarios IPSS, IIEF-5 y el Q max antes del tratamiento y al mes del tratamiento. Las diferencias entre los grupos se evaluaron utilizando el método de Wilcoxon.    RESULTADOS: Después de un mes con tadalafilo 5 mg, el IPSS disminuyó, y el IIEF-5 y el Q max aumentaron. Las diferencias fueron estadísticamente significativas. CONCLUSIONES: Se ha visto que el tadalafilo 5 mg una vez al día es eficaz en el tratamiento de los STUI/HBP en pacientes con fallo previo del tratamiento con alfabloqueantes.

Eficacia de Tadalafilo 5 mg en el tratamiento de los síntomas del tracto urinario inferior en pacientes tras fallo de los alfabloqueantes / The efficacy of Tadalafil 5 mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms

Objetivos: Investigar la eficacia de tadalafilo 5 mg en pacientes con síntomas del tracto urinario inferior (STUI) tras fallo de los alfabloqueantes. Pacientes y métodos: Treinta y tres pacientes fueron incluidos. Se obtuvo consentimiento informado en todos los casos tras explicarles la eficacia del tadalafilo 5 mg en el tratamiento de los STUI. Antes de iniciar el tratamiento se descartaron cáncer de próstata e infección urinaria. Se evaluaron los valores de los cuestionarios IPSS, IIEF-5 y el Q max antes del tratamiento y al mes del tratamiento. Las diferencias entre los grupos se evaluaron utilizando el método de Wilcoxon. Resultados: Después de un mes con tadalafilo 5 mg, el IPSS disminuyó, y el IIEF-5 y el Q max aumentaron. Las diferencias fueron estadísticamente significativas. Conclusiones: Se ha visto que el tadalafilo 5 mg una vez al día es eficaz en el tratamiento de los STUI/HBP en pacientes con fallo previo del tratamiento con alfabloqueantes

Objectives: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment. Patients and mehods: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant. Conclusion: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment

Is retrograde intrarenal surgery replacing percutaneous nephrolithotomy as surgical treatment of stone disease: Our clinical experience.

OBJECTIVE: Urolithiasis prevalence is 2-20% according to different geographic characteristics in different populations. In this study, we aimed to present the distribution of operation numbers for both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in terms of age and stone size in order to reveal the changes over the years. METHOD: Between January 2010 and March 2016, 1814 patients were operated for the treatment of renal stones. Patients were directed to the two different operations according to the surgeons' choices: RIRS or PCNL. Prospectively collected data was retrospectively reviewed. RESULTS: In the years 2010, 2011, 2012, 2013, 2014, 2015, and 2016, the number of RIRS applied for the treatment of renal stones was 25, 87, 96, 147, 166, 174, and 66, respectively. RIRS was significantly preferred more than PCNL for stones <1.5cm. Examining the ages, there was no different data described as above for stone sizes. CONCLUSION: Despite RIRS is the new trend for treating stone disease, PCNL remains its important role for especially the larger stone sizes. RIRS is the raising trend for small sizes.

Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy.

PURPOSE: To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated. MATERIALS AND METHODS: We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL. RESULTS: 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy. CONCLUSION: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy.

The purpose of this study is to determine the perioperative risk factors for increased blood loss in children undergoing percutaneous nephrolithotomy (PCNL).We retrospectively reviewed the data on pediatric patients who had undergone PCNL for stone disease in our department. Blood loss estimation was quantified by measuring the changes in hematocrit plus the volume of red blood cells transfused. Univariate and multivariate linear regression analyses were performed to evaluate risk factors associated with increased blood loss after pediatric PCNL. Variables included patient, stone, and treatment parameters. The study group consisted of 105 renal units in 97 children with a median (interquartile range) age of 5 (3-9) years. On univariate linear regression analysis female gender (p = 0.030), absence of hydronephrosis (p = 0.013), increasing stone burden (p = 0.002), staghorn stone type (p = 0.013), multi-tract access (p < 0.001), and prolonged operative time (p < 0.001) were significantly associated with increased blood loss after pediatric PCNL. However, multivariate linear regression analysis demonstrated that the only independent risk factors for increased blood loss following pediatric PCNL were degree of hydronephrosis (B -1.329, 95% CI -2.451 to -0.208, p = 0.021), number of tracts (B 2.545, 95% CI 0.221-4.869, p = 0.032), and operative time (B 0.031, 95% CI 0.008-0.053, p = 0.007). Identifying pediatric patients at increased risk of bleeding following PCNL is crucial to minimize morbidity and hospital stay, and thus, the cost of treatment. Our study demonstrated that degree of hydronephrosis, number of tracts and operative time are important factors in reducing blood loss during pediatric PCNL.

Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones.

OBJECTIVE: We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated. RESULTS: Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain. CONCLUSION: According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.

Surgical management of urinary stones with abnormal kidney anatomy.

In spite of the fact that urologic surgical techniques used by urologists are becoming more and more minimally invasive and easier because of developing technologies, surgical approaches for the urinary stones in kidneys with abnormal anatomy are still confusing. The objective of this article is to determine the treatment options in these kidneys. For this purpose, between 2005 and 2015, we retrospectively evaluated patients operated for urolithiasis with various congenital renal anomalies in five referral urology clinics in our country. Of the 178 patients (110 male, 60 female), 96 had horseshoe kidneys, 42 had pelvic ectopic kidneys (PEKs), and 40 had isolated rotation anomalies (IRAs) of the kidney. We evaluated the patients for stone-free rate (SFR), mean operation time, mean hospitalization time, and complication rate. In horseshoe kidney, SFRs for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups were 72.2% and 90%, respectively. In PEKs, these rates were 83.6% and 100% for RIRS and laparoscopic pyelolithotomy, respectively. SFRs in kidneys with IRA were 75% for RIRS and 83.3% for PNL. The mean operation time for RIRS and PNL groups in horseshoe kidney was 40.5±11.2 minutes and 74.5±19.3 minutes, respectively. In PEKs, these times were 52.1±19.3 minutes and 53.1±24.3 minutes for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 48.7±14.4 minutes for RIRS and 53.2±11.3 minutes for PNL. Mean hospitalization times for RIRS and PNL groups in horseshoe kidneys were 1.4±0.7 days and 2.2±1.4 days, respectively. In PEKs, these times were 2.7±1.8 days and 1.9±0.4 days for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 1.5±0.9 days for RIRS and 1.8±0.6 days for PNL. The results of our study showed that RIRS could be used in all of types of abnormal kidneys with small- and medium-sized renal calculi safely and satisfactorily.

Do the urolithiasis scoring systems predict the success of percutaneous nephrolithotomy in cases with anatomical abnormalities?

The objective of this study is to assess the utility of the Guy, S.T.O.N.E., and CROES nephrolithometry scoring systems (SS), and compare the capability of each system to predict percutaneous nephrolithotomy (PNL) outcome in patients with anatomical abnormalities. We retrospectively collected medical records of patients with anatomical abnormalities who underwent PNL for the treatment of renal calculi by experienced surgical teams in four referral centers. All of the patients were graded by a single observer from each department based on preoperative computed tomography images using each SS. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. A total of 137 cases with anatomical abnormalities [horseshoe kidney (n = 46), malrotation (n = 33), kypho and/or scoliosis (n = 31) and ectopic kidney (n = 27)] were assessed retrospectively. The mean stone burden, number, and density were 708.5 mm2, 1.7, and 791.8 HU, respectively. The mean procedure, fluoroscopy, and hospitalization times were 75.2 ± 35.3 min, 133.4 ± 92.3 s, and 3.5 ± 2.1 days, respectively. Stone-free status was achieved in 106 cases (77.4 %). A total of 17 (13.6 %) complications occurred postoperatively. The mean scores were 2.7, 7.2, and 219.1, for the Guy, S.T.O.N.E., and CROES systems, respectively. CROES score was the independent predictor of PNL success in cases with anatomical abnormalities [p: 0.001, OR 1.01, (95 % CI 1005-1021)]. The CROES scoring system is well correlated with the success of PNL in cases with anatomical abnormalities; the S.T.O.N.E. and Guy scoring systems failed to predict the outcomes of PNL in this specific patient population.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis.

PURPOSE: to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. PATIENTS AND METHODS: We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. RESULTS: Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another importante finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). CONCLUSION: According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone?

PURPOSE: To investigate patient- and procedure-related factors associated with hospital re-admission (HR) and re-hospitalization following flexible ureteroscopy (f-URS). PATIENTS AND METHODS: The records of patients who underwent f-URS for renal stones in two reference centers between 2011 and 2015 were examined retrospectively. Patients who were re-admitted to the hospital or re-hospitalized for any reason within 30 days after hospital discharge related to the f-URS procedure were evaluated. The patient- and procedure-related factors affecting the re-admission and re-hospitalization rates were revealed using backward stepwise multiple binary logistic regression analysis. RESULTS: The study included 647 patients with a mean age of 46.1 ± 13.7 years. The mean BMI was 27.3 ± 4.6 kg/m(2), and the median ASA score was 1.85. The mean stone diameter was 14.2 ± 5.3 mm. The mean operation and fluoroscopy times were 50.2 ± 16.9 min and 43.1 ± 37.6 s, respectively. The mean hospitalization time was 1.42 ± 0.84 days, and the complication rate was 12.8 % (83/647). Overall, 523 (80.3 %) patients became stone-free, while residual fragments <4 mm were detected in 73 (11.3 %) patients. The procedure failed in 7.9 % of the cases. While 82 (12.7 %) patients were re-admitted, 31 (4.8 %) patients were re-hospitalized for further treatment. Stone-free status was an independent predictor of HR, while the stone-free status, hospitalization time, and postoperative complications all predicted re-hospitalization. CONCLUSIONS: We found that inability to achieve stone-free status predicted HR and re-hospitalization, while postoperative complication and prolonged hospitalization also predicted re-hospitalization.

Factors affecting hospital readmission and rehospitalization following percutaneous nephrolithotomy.

PURPOSE: To identify patient- and procedure-related factors that increase the risk of hospital readmission and emergency room (ER) visits after percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: We retrospectively reviewed the records of patients with kidney stones treated via PNL in two tertiary referral hospitals between 2008 and 2014. Patient demographics including age, body mass indices, ASA score, stone size, presence of anatomic abnormality and comorbidity, operative and postoperative measures, and ER visit and rehospitalization rates were reviewed. Unplanned readmission to the hospital, including elective, and ER visits due to any reason related to the PNL procedure were primarily examined. The factors affecting ER visit and rehospitalization rate were analyzed using logistic regression analysis. RESULTS: A total of 1024 patients (mean age 46.57 years) were enrolled into the study. Mean stone size was 28.5 mm. Stone-free status was achieved in 81.7 % of the procedures. Complications occurred at a rate of 6.44 % in the postoperative period. ER visit and rehospitalization rates were 5.76 and 5.27 %, respectively. While stone complexity, anatomic abnormalities, and postoperative course were found to be factors affecting ER visit, postoperative course and hospitalization time were main predictors for rehospitalization rate. CONCLUSIONS: Our outcomes demonstrate that patients, who had an anatomic abnormality and complex kidney stone, were more likely to have an unplanned hospital readmission. Patients with a history of perioperative and/or postoperative complication seem to have a tendency to unplanned readmission and rehospitalization.

Effect of percutaneous nephrolithotomy on renal functions in children: assessment by quantitative SPECT of (99m)Tc-DMSA uptake by the kidneys.

OBJECTIVE: To determine the impact of percutaneous nephrolithotomy (PNL) on global and regional renal function in children. METHODS: In total, 40 children (41 renal units) undergoing PNL were included in this prospective study. All patients were evaluated using quantitative single-photon emission computed tomography (QSPECT) with technetium-99 m-dimercaptosuccinic acid ((99m)Tc-DMSA) examinations before and 3 months after surgery. RESULTS: The mean age was 9.5 years (range, 3-16), and the mean stone size was 3.4 cm (range, 2-6.5). Of the cases, 39 (95%) were managed as being stone-free after a single session of PNL. After additional treatment procedures, 40 (97.5%) of the cases were managed as being stone-free. Of the 41 renal units, new focal cortical defects on (99m)Tc-DMSA scans were seen in 4 (9.7%) patients. Total relative uptake in the treated kidneys increased from 42.3% to 44.1%. The mean creatinine level before PNL was 1.18 ± 0.45 (0.8-1.6) mg/dL compared with 1.16 (0.7-1.5) mg/dL by the end of the follow-up period (not statistically significantly different, p > 0.05). CONCLUSIONS: PNL in children is a safe and feasible method for the maximal clearance of stones. QSPECT of (99m)Tc-DMSA confirmed that renal function is preserved or even improved after percutaneous stone removal.

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.

Postoperative infection rates in patients with a negative baseline urine culture undergoing ureteroscopic stone removal: a matched case-control analysis on antibiotic prophylaxis from the CROES URS global study.

PURPOSE: To examine the effects of antibiotic prophylaxis on postoperative infection rate in patients with negative urine cultures undergoing ureteroscopy (URS). PATIENTS AND METHODS: Using the Clinical Research Office of the Endourological Society (CROES) URS Global Study database, patients with a negative baseline urine culture undergoing URS for ureteral stones (n=1141) or kidney stones (n=184) not receiving antibiotic prophylaxis were matched with those who were predefined by risk factors, including gender, American Society of Anesthesiologists (ASA) score, and ureteral stent placement. Patient characteristics, operative data, and postoperative outcomes, including the development of urinary tract infection (UTI) and fever, in the two groups were compared. RESULTS: Antibiotic prophylaxis use differed widely across participating countries (13%-100%). Differences were found between patients who did or did not receive antibiotic prophylaxis regarding the frequency of anticoagulation medication, previous treatment with URS, stone burden, previous presence of kidney stones, duration of current URS, and complications post-URS. The prevalence of fever and UTI was low (≤2.2%) and similar in both groups. Factors predictive of postoperative UTI or fever were female gender, Crohn's and cardiovascular disease, a high stone burden, and an ASA score of II or higher. CONCLUSIONS: In patients with a negative baseline urine culture undergoing URS for ureteral or renal stones, rates of postoperative UTI and fever were not reduced by preoperative antibiotic prophylaxis. Female gender and a high ASA score were specific risk factors for postoperative infection in this patient group.