Changes in percutaneous approach to kidney stones in children: A single institute experience over 500 cases.

PURPOSE: The aim of this study is to identify the changes in patient age and stone sizes with technological advancement over time. METHODS: This study was conducted retrospectively with 404 patients (504 renal units) who underwent percutaneous nephrolithotomy (PCNL) between January 1997 and June 2020. Patient characteristics and trends on instrument preferences were investigated. RESULTS: Median age was 7 (1-18) years. Male to female ratio was 1.48:1 (301/203). Median stone burden was 2 cm2 (0.20-25) and median operative time was 90 minutes (20-240). The stone-free rate was 74.6%. Patients were divided into four groups according to the size of the instrument. It was found that the size of sheath used increased significantly with increasing age and stone burden. The micro-PCNL group had the shortest hospitalisation and lowest blood transfusion rate. Chronologically categorised four equal groups were compared to analyse changing patient profiles and trends. Median patient age, stone burden, operation time, sheath size, blood transfusion and complication rates decreased significantly with time. However, the use of tracts smaller than 20F and the number of patients with previous intervention increased significantly. CONCLUSION: Our study demonstrated that the patient's age and stone size at the time of initial diagnosis decrease over time while miniaturisation techniques increase in paediatric urology.

Can serum matrix metalloproteinase-9 and SMAD-2 levels predict lamina propria invasion in bladder urothelial carcinoma?

INTRODUCTION: Matrix metalloproteinase-9 (MMP-9) has a role in the destruction of lamina propria (LP) of the bladder wall and SMAD-2 promotes cell-to-cell adhesion. This study aimed to investigate the association between LP invasion and serum protein and mRNA expression levels of MMP-9 and SMAD-2 in bladder cancer (BC) patients. METHODS: Serum samples were taken from 57 patients with suspicious BC before TUR-BT (Group 1) and 20 patients with benign diseases as control (Group 2). The mRNA expression and serum protein levels of MMP-9 and SMAD-2 were analyzed using Real-Time PCR and ELISA methods, respectively. The comparison of protein and mRNA expression levels of MMP-9 and SMAD-2 were done statistically between Group 1 and 2, as well as for different T stages of BC. RESULTS: The protein levels of MMP-9 (2448 vs 637.5 pg/mL, P = .0001) and SMAD-2 (6.85 vs 1.61 P = .0001) were significantly higher in Group 1 compared to Group 2. The mRNA expression levels of MMP-9 (P = .89) and SMAD-2 (P = .99) did not significantly differ between the groups. The protein levels of MMP-9 in T1 patients were significantly higher from both of pTa patients (P = .018) and pT2 (P = .02). The protein levels of SMAD-2 were not statistically different between T stages. Similarly, the mRNA expression levels of MMP-9 and SMAD-2 were not different between T stages. CONCLUSIONS: The protein levels of MMP-9 and SMAD-2 were increased in BC patients while mRNA expressions were not different. Furthermore, the increased protein level of MMP-9 in T1 patients was more pronounced which may be related to LP invasion of the tumor.

Is Access Sheath Essential for Safety and Effective Retrograde Intrarenal Stone Surgery?

OBJECTIVE: To evaluate the results of retrograde intrarenal surgery (RIRS) with flexible ureteroscope (f-URS), using ureteral access sheath and without the sheath. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Kesan State Hospital, Edirne, Turkey, between February 2019 and May 2020. METHODOLOGY: Patients treated with RIRS for renal and proximal ureteral stone were evaluated. Two groups were formed that used ureteral access sheath or not. Operation and fluoroscopy times, postoperative complications and stone-free rates were compared. RESULTS: Group 1 consisted of 51 patients were operated with, using ureteral access sheath; and Group 2 having 62 patients, were operated without using ureteral access sheath. The mean volume of the stones was 1135 mm3 (73-7491 mm3) in the group without access sheath and 1273 mm3 (251-3635 mm3) in the group with access sheath. The mean operation time was 55 minutes (20-115 min) in the group without access sheath, and 70 minutes (30-125 min) in the group with access sheath. Postoperative febrile UTI was found in 5 (8%) of the patients without access sheath, and in 4 (8%) of the patients with access sheath (p=0.733). The stone-free rate of the patients with radiological controls was 58 (93%) in the group without access sheath and 46 (90%) in the group with access sheath (p=0.306). Fluoroscopy timings were 2.7 seconds (0-8 sec) in the group without access sheath and 8.4 seconds (2-20 sec) in the group with access sheath (p=0.001). CONCLUSION: UAS usage has no marked impact on SFR, complication rate and operation time. RIRS can be performed safely and effectively without using UAS. Key Words: Flexible ureteroscope, ITO score, Ureteral access sheath, Intrarenal stones.

Comparison of Efficiency and Safety of Retrograde Intrarenal Surgery and Micropercutaneous Nephrolithotomy in Pediatric Kidney Stones Smaller than 2 cm: A Prospective Cohort Study.

Objective: To compare the safety and efficacy of two minimally invasive surgical techniques used for pediatric stone disease: retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-PCNL). Materials and Methods: A prospective study was designed to include children aged <15 years with a single stone <20 mm. Sixty-four patients were assigned to undergo either an RIRS or a micro-PCNL (1:1 ratio). Demographic parameters, stone size, location, operative data, complications, stone-free status, and efficacy quotient were compared. Results: Due to anatomic considerations, seven patients were shifted to the micro-PCNL arm, thus resulting in 39 micro-PCNLs performed vs 25 RIRS in the end. Because of the deviation from planned surgery that was significantly higher in the RIRS group (p = 0.011), the analysis was done in a prospective cohort comparison. Stone-free rates were similar for micro-PCNL and RIRS groups (80% vs 82.2%). The operative (median 60 vs 90 minutes, p < 0.001), fluoroscopy (median 15 vs 30 seconds, p = 0.004), and lithotripsy times (median 15 vs 25 minutes, p = 0.007) were shorter in the RIRS group. However, despite the larger stone size, the efficiency quotient was significantly higher in the micro-PCNL group (82.1% vs 54.1%; p = 0.009). None of the patients experienced significant hematuria requiring blood transfusion, as well as no ureteral orifice obstructive complication was detected within the follow-up period. Conclusion: RIRS and micro-PCNL techniques in children have similar stone-free and complication rates. The operative, fluoroscopy, and lithotripsy times were shorter, deviation from the planned surgery, and the number of sessions under anesthesia was higher in the RIRS group. Despite the larger stone size, efficacy quotient was significantly higher in the micro-PCNL group.