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    Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different from Non-elderly Adults?
    (Springernature, 2019) Cakici, Mehmet Caglar; Sari, Sercan; Selmi, Volkan; Sandikci, Fatih; Karakoyunlu, Nihat; Ozok, Ugur
    Background and objectives The population of elderly adults is increasing globally, and due to metabolic changes related to advanced age, many elderly adults experience kidney stones. Flexible ureteroscopy (f-URS) is a minimally invasive procedure to treat kidney stones, but it is not free of complications. The goals of this study were to analyze the efficacy and safety of f-URS in the management of kidney stones in patients aged >= 60 years and compare the outcomes of this surgery with the outcomes of the same surgery in a younger population. Materials and methods We retrospectively reviewed patient data from 1750 patients who met our inclusion criteria and received f-URS at the urology clinic of our hospital from 2012 to 2017. Patients were assigned into two groups: those aged >= 60 years (Group 1, n=291) and those aged 19-59 years (Group 2, n=1459). The perioperative results were evaluated comparatively. We performed multivariable analyses for factors predicting complications. Results When we compared the groups on demographic attributes, we noted statistically significant differences in gender, body mass index (BMI), and American Society of Anesthesiologists scores. Stone size and operation time were higher in the >= 60-year age group (Group 1). Other stone characteristics and operative features were similar. Stone-free rates (SFR) after the first procedure were 88.0% in Group 1 and 89.2% in Group 2. SFR and success rates at three months were similar for both groups. The complication rates were similar, and multivariable regression analysis revealed the most important factor affecting the complications was the presence of residual stones in both groups. The second most important factor affecting the complication was the operation time in Group 1 and the number of stones in Group 2. Conclusion In our study, there were no significant differences in terms of results and complications among elderly and young patients after f-URS except for the duration of the operation. The prolongation of operation time results in worse outcomes in terms of perioperative complications in patients aged >= 60 years. f-URS is a relatively safe and efficient procedure, with a small risk of minor complications even in the elderly population, with increased comorbidity.
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    Simultaneous Measurement of Pressure in the Calyces During RIRS in a Human Cadaver Model
    (Galenos Yayincilik, 2019) Aykac, Aykut; Baran, Ozer; Oner, Zulal; Kaya, Coskun; Ozok, Ugur; Sunay, Melih
    Objective: The aim of this study was to evaluate calyceal pressure caused by irrigation of the upper, mid and lower calyces in a cadaver kidney model and to examine the interactions. Materials and Methods: The kidney was dissected together with the ureter from a human cadaver from a 75-year-old without a history of renal disease. Catheters were placed in the bases of the calyces to perform pressure measurements. After recording baseline pressures while the flexible ureteroscope working channel was empty during irrigation, pressures were then measured by administering fluid with a hand pump, 5 cc and 50 cc syringe. Then, 272 mu and 350 mu laser probes were placed in the flexible ureteroscope and, after recording the baseline calyceal pressures, the measurements were repeated 3 times during hand pump irrigation. Results: Lowest calyceal pressures were measured when a 300 mu laser probe in the working channel of the flexible ureteroscope was placed in the upper calyx during irrigation at 60 cm H2O. Independent of the location of the flexible ureteroscope, the pressure in all the calyces was observed to be >= 50 mmHg during all types of fluid irrigation. All the calyceal pressures were observed to be affected by each other. The pressure within the calyx where the flexible ureteroscope was located was statistically significantly higher than in the other calyces (p<0.001). Conclusion: Application of additional fluid irrigation during flexible ureteroscopy causes a serious increase in intrarenal pressure. If fluid irrigation is to be applied, it should be done using a very small amount of fluid and for a very short duration.