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Öğe Comparative analysis of combined spinal-epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction(Springer, 2024) Burlukkara, Salih; Kabalak, Afife Ayla; Ates, Alpay; Baran, Ozer; Aykac, Aykut; Ozok, Hakki UgurObjective We aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively. Materials and methods The study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal-epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded. Results During the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team's satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05). Conclusion PCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.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 Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Used in the Treatment of 2-4 cm Kidney Stones in Terms of Pain and Need for Additional Analgesics: A Prospective Randomized Study(Mary Ann Liebert, Inc, 2020) Cakici, Mehmet Caglar; Karakoyunlu, Nihat; Sari, Sercan; Ozok, Hakki Ugur; Selmi, Volkan; Kartal, Ibrahim Guven; Nalbant, IsmailPurpose: To compare the effects of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) on postoperative pain and their differences in terms of the postoperative need for analgesics in the treatment of 2-4 cm kidney stones. Methods: A total of 132 patients who suffered from renal stones 2-4 cm in size and had surgery at our urology clinic between April 2015 and April 2017 were enrolled in this prospective study (NCT02430168). Patients were randomized into either the RIRS group (Group 1) or PNL group (Group 2) in a ratio of 1:1. Postoperative visual analog scale (VAS) values at 8 and 24 hours postoperatively and analgesic treatments of patients were recorded. Results: Patients from both groups had similar demographic characteristics. Stone-free states were achieved in 37 (74%) patients in the RIRS group and 45 (90%) patients in the PNL group. Postoperative complication rates were similar in two groups. Moreover, there was no statistically significant difference between the groups in terms of the postoperative need for analgesics (P = .309). However, the PNL group had higher VAS values (P < .001). Conclusion: Although the early postoperative pain scales were high in the PNL group, there was no significant difference between the groups in terms of the standard analgesic treatments for achieving patient's comfort. PNL, which has similar complications, but with higher success rates, compared with RIRS, did not require additional analgesic treatment during postoperative pain management. Thus, in our opinion, PNL should still remain as a first choice in treatment of 2-4 cm renal 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 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.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 Wunderlich Syndrome, Tuberous Sclerosis-Related Giant Renal Angiomyolipoma Rupture: Case Report(Galenos Yayincilik, 2018) Baran, Ozer; Aykac, Aykut; Oner, Serkan; Aktumen, Alpay; Burlukkara, Salih; Sunay, Mehmet Melih; Ozok, Hakki UgurAngiomyolipoma (AML) is a mesenchymal tumor of the kidney that is composed of morphologically abnormal smooth muscle cells, blood vessels, and adipose-like foci. Renal AML is usually clinically asymptomatic and detected incidentally during imaging. Rarely, renal AML can cause life-threatening spontaneous massive retroperitoneal hemorrhage, known as Wunderlich syndrome. A 39-year-old man with tuberous sclerosis was admitted to the emergency room with left flank pain, hematuria, and nausea. On physical examination, there was a hard sensitive mass extending from the upper left half of the abdomen to the midline. Left renal AML and extensive retroperitoneal hematoma measuring about 360x220x195 mm were detected on abdominal computed tomography. The patient exhibited signs of hypovolemic shock and emergency total nephrectomy was performed. He was discharged from the intensive care unit on postoperative day 1 and from the hospital on day 5.
