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Öğe Does extracorporeal shock wave lithotripsy before retrograde intrarenal surgery complicates the surgery for upper ureter stone? The results of the RIRSearch group(Wiley, 2021) Yazıcı, Cenk Murat; Sıddıkoğlu, Duygu; Çınar, Önder; Özman, Oktay; Başataç, Cem; Akgül, Murat; Sancak, Eyüp Burak; Önal, Bülent; Akpınar, HalukAims: To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones. Methods: The patients in the study population were divided into two groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalisation time and stone-free rates were compared between the groups. Results: There were 56 patients in Group 1 and 95 patients in Group 2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group 1 (P =.043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status. Conclusion: Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient's last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications. © 2021 John Wiley & Sons LtdÖğe Is It a Good Strategy to Proceed a Retrograde Intrarenal Surgery Session Sheathless After Ureteral Access Sheath Insertion Failure? A RIRSearch Study(Mary Ann Liebert Inc., 2023) Özman, Oktay; Çınar, Önder; Çakır, Hakan; Başataç, Cem; Demirbilek, Muhammet; Önal, BülentObjectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless (n = 110, Group 1) and those who proceeded without UAS after insertion failure (n = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS (p = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) (p = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p = 0.001). Stone burden (odds ratio [OR]: 1.002, p = 0.019) and stone density (OR: 1.002, p = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases.Öğe Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study(Editorial Office of Asian Journal of Urology, 2024) Özman, Oktay; Akgül, Hacı M.; Başataç, Cem; Çınar, Önder; Sancak, Eyüp B.; Yazıcı, Cenk M.; Önal, Bülent; Akpınar, HalukObjective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [−] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5–11.5 Fr, 10–12 Fr, 11–13 Fr, and 13–15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS− patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5–11.5 Fr: 66.7%; 10–12 Fr: 87.0%; 11–13 Fr: 90.6%; 13–15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS− patients (27.6%) (p=0.01). Complications (8.7%) with 9.5–11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314–10.162; OR 4.443, 95% CI 1.350–14.552; OR 4.107, 95% CI 1.366–12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.Öğe Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: Results of propensity score matching study(Elsevier, 2021) Özman, Oktay; Akgül, Hacı Murat; Basatac, Cem; Çınar, Önder; Sancak, Eyüp Burak; Yazıcı, Cenk Murat; Önal, Bülent; Akpınar, HalukThe aim of this study is to evaluate the effect of ureteral access sheath (UAS) use and calibration change on the success and complications of retrograde intrarenal surgery (RIRS)
