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Öğe Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods For Management of Big- Sized Kidney Stones(?4 cm): Single Center Retrospective Study(Urol & Nephrol Res Ctr-Unrc, 2019) Karakoyunlu, Ahmet Nihat; Cakici, Mehmet Caglar; Sari, Sercan; Hepsen, Emre; Ozok, Hakki Ugur; Sagnak, Azmi Levent; Topaloglu, HikmetPurpose: Management of >= 4 cm sized kidney stone is a rarely seen problem in urology. Few studies are present about this issue. Percutaneous nephrolithotomy(PNL), Retrograde Intrarenal Surgery(RIRS) and open surgery are the methods used in stone management. In our study we aimed to compare RIRS and PNL in the management of >= 4 cm sized kidney stones. Materials and methods: Among patients who had undergone RIRS and PNL in Diskapi Yildirim Beyazit Training and Research Hospital, 94 patients who had >= 4 cm sized kidney stones were included our study. The demographic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively. Results: 94 patients (67 PNL, 27 RIRS) were in the study. Stone laterality, urinary anomaly and gender were similar in two groups.(Group PNL(P) and Group RIRS(R)) Stone number were 2.55 +/- 1.44 and 2.78 +/- 1.42 in Group P and R, respectively. Stone size were 47.06 7.02 and 46.41 6.00 mm. in Group P and R, respectively. The differences between two groups were not statistically significant.(P >.05) In Group P scopy time, hospital stay and stone free rate were higher and operation time was lower than Group R. And the difference was statistically significant(P <.05). Conclusions: As a result, PNL is an effective method and operation time is lower than RIRS. Also a second operation for JJ stent taking is lower in PNL. RIRS is a safe method. RIRS has less complications and hospitalization time. They are feasible in treatment of >= 4 cm sized kidney stones.Öğe 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(Pagepress Publ, 2020) Sari, Sercan; Cakici, Mehmet Caglar; Kartal, Ibrahim Guven; Selmi, Volkan; Ozdemir, Harun; Ozok, Hakki Ugur; Karakoyunlu, Ahmet NihatObjectives: 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 Wan 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 I. 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.Öğe Is RIRS Safe and Efficient In Patients With Kidney Stones Who Had Previous Open, Endoscopic, or Percutaneous Kidney Stone Surgery? One Center Retrospective Study(Urol & Nephrol Res Ctr-Unrc, 2020) Baylan, Burhan; Sari, Sercan; Cakici, Mehmet Caglar; Selmi, Volkan; Ozdemir, Harun; Ozok, Hakki Ugur; Karakoyunlu, Ahmet NihatPurpose: 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.Öğe Kidney Stone Treatment in the Anomalous Kidney with Retrograde Intrarenal Surgery: A Matched Pair Analysis(Galenos Yayincilik, 2020) Sari, Sercan; Cakici, Mehmet Caglar; Aykac, Aykut; Baran, Ozer; Kartal, Ibrahim Guven; Ozok, Hakki Ugur; Karakoyunlu, Ahmet NihatObjective: To show our retrograde intrarenal surgery (RIRS) experience in anomalous kidney stones and compare its safety and efficiency with normal kidney stones. Materials and Methods: Between 2012 and 2018, patient data was reviewed retrospectively and 1700 procedures were taken into consideration. Forty-seven anomalous kidney stones were included in the study (group A). In these patients, 18 had calyx diverticulum, 12 had horseshoe kidney, 8 had ureteral duplication, 2 had ectopic kidneys, 1 had malrotation, and 1 had bifid pelvis. After making a matched pair analysis, 47 normal kidney stones with similar demographic and stone characteristics were included in our study (group N). Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency and safety. Results: Average scope time, hospitalization time, and postoperative double J-stent rate were higher in group A. The difference was statistically insignificant (p>0.05). Ureteral access sheath usage was higher in group N, though the difference was statistically insignificant (p=0.63). Stone-free rates and success rates were higher in group N though the difference was not statistically significant (p>0.05). The rate of complications was statistically significantly higher in group A (p=0.02). Conclusion: RIRS can be used in the management of anomalous kidney stones. It is an efficient and safe method. Prospective and larger patient numbered studies are needed.Öğe Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis(K Faisal Spec Hosp Res Centre, 2020) Sari, Sercan; Cakici, Mehmet Caglar; Aykac, Aykut; Baran, Ozer; Selmi, Volkan; Karakoyunlu, Ahmet NihatBACKGROUND: 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. OBJECTIVES: 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.
