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Öğe Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery(Edizioni Minerva Medica, 2019) Cakici, Mehmet C.; Ozok, Hakki U.; Erol, Demet; Catalca, Sibel; Sari, Sercan; Ozdemir, Harun; Selmi, VolkanBACKGROUND: To investigate the applicability of the combined spinal-epidural anesthesia (CSEA) method in RIRS for the treatment of kidney stone disease and also to compare with general anesthesia (GA) in terms of their effects on early postoperative pain levels and their cost. METHODS: A hundred consecutive patients who were scheduled for RIRS were enrolled in this study and were prospectively evaluated according to the anesthesia methods. Patients were divided into 2 groups randomly: the GA (N. 50) and CSEA (N.=50) groups. Five patients were excluded due to patient incompatibility or inadequate anesthesia. The pain levels of patients in the Group 2 were recorded during the operation using the Visual Analog Scale (VAS) at minutes 1, 5, 10, 15, 30 and 60. Peak pain levels within the first 24 hours following the operation were recorded for both groups. RESULTS: Ninety five patients in the two groups were determined to be similar in terms of demographic characteristics. The mean VAS score at the postoperative 1st day was found as 1.20+0.9 for Group 1 and 0.82 +/- 1.3 for Group 2. No statistically significant differences were identified between the VAS-nram and VAS-ram groups (P=0.450). The total cost of anesthesia medications was similar between the both groups. CONCLUSIONS: Combined spinal-epidural anesthesia, which produces favorable outcomes in the intraoperative and postoperative periods, will become an alternative to general anesthesia. Also, the costs associated with these two anesthesia methods were calculated, it was found that the total cost of anesthesia medications and materials per operation was similar both methods.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 Does Previous Failed Shockwave Lithotripsy Treatment Have an Influence on Retrograde Intrarenal Surgery Outcome?(Mary Ann Liebert, Inc, 2019) Selmi, Volkan; Sari, Sercan; Cakici, Mehmet Caglar; Ozdemir, Harun; Kartal, Ibrahim Guven; Ozok, Hakki Ugur; Imamoglu, Muhammet AbdurrahimBackground: The prevalence of urolithiasis is nearly 20% and patients with urolithiasis constitute an essential part of the patients referred to the urology clinic. Many parameters should be considered for the management of renal stones and authors recommend extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PNL), as treatment options. Among these techniques, SWL does not require general anesthesia, has 89% success rate for renal pelvic stones: 83% for upper caliceal stones, 84% for middle caliceal stones, and 68% for lower caliceal stones. In this study, we aimed to investigate whether the previously failed SWL treatment affects RIRS outcome. Methods: Patients who underwent RIRS for kidney stones between January 2012 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital were reviewed retrospectively. Patients treated with primary RIRS (186 patients) were classified as Group 1. The outcomes of these patients were compared with those of 186 patients who underwent RIRS after failed SWL treatment using matched-pair analysis, and these patients were classified as Group 2. Results: The procedure success was defined as the sum of the stone-free and clinically insignificant residual fragments (CIRFs); final success rates were 90.3% and 91.9%, respectively. If we compare the final success rates, there was no statistically significant difference between both groups (P=.584). Conclusions: As a result, there is no negative effect of the previous unsuccessful SWL treatment on the RIRS success. Patients with CIRF should be followed up more carefully in terms of becoming symptomatic.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.
