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    Can we predict postoperative fever and urinary tract ınfection after retrograde ıntrarenal surgery? Results of a case control matching multicentric RIRSearch study group
    (Springer, 2025) Akgül, Murat; Ozman, Oktay; Başataç, Cem; Çakır, Hakan; Çınar, Önder; Şahin, Mehmet Fatih; Şimşekoğlu, Fatih; Sıddıkoğlu, Duygu
    PurposePostoperative fever (POF)/urinary tract infection (UTI) is one of the most unpleasant and undesirable conditions for surgeons after retrograde intrarenal surgery (RIRS). RIRS is not recommended for any patient with a positive urine culture to avoid POF and UTI, but some patients may develop postoperative UTI even if the urine culture is sterile. This study investigated the predictive factors of fever and UTIs after RIRS.MethodsIn total, 1240 patients who underwent RIRS for proximal ureteral stones and/or kidney stones were analyzed. After case-control matching, 168 patients were included in the study. Demographic data, preoperative/peroperative/postoperative data, and hematological parameters were compared. Patients with sterile urine cultures were included in the study. Postoperative fever was defined as fever >= 38 degrees C within 72 h after RIRS. Patients were divided into two groups: those with and without POF/UTI. Demographic data, preoperative and postoperative findings, and inflammatory parameters of the patients were compared retrospectively.ResultsPOF/UTI was observed in 61 (36.3%) of 168 patients who underwent RIRS. After case-control matching, increased body mass index (BMI) and longer operation time were found to be significant predictors of POF/UTI (p = 0.001 and 0.016 respectively). Preoperative systemic immune-inflammation index (SII) (PxN/L), high Platelet/Lymphocyte Ratio (PLR), and urine leukocyte positivity were found to be significant predictors of POF/UTI (p = 0.037, 0.025 and 0.038 respectively).ConclusionHematological parameters are simple and feasible to use to evaluate POF/UTI in patients undergoing RIRS. High SII and PLR may predict POF and early infection after RIRS. In addition, according to demographic data and per-operative status, high BMI and prolonged operation time are risk factors for infection.
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    Predictive Modeling Is a Reliable Indicator in Determining Excessive Renal Mobility Single-Center Randomized Study
    (Mary Ann Liebert, Inc, 2025) Doğan, Çağrı; Özgur, Cihan; Şahin, Mehmet Fatih; Sıddıkoğlu, Duygu; Topkaç, Erdem Can; Yazıcı, Cenk Murat
    Purpose: Excessive kidney mobility is an underestimating challenge for surgeons during retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESL). There is no technique approved as a gold standard procedure for reducing excessive kidney mobility. The study aimed to uncover predictive factors for determining excessive renal mobility by utilizing clinicodemographic characteristics and noncontrast computed tomography (NCCT) data. Materials and Methods: The patients were categorized into two groups based on the presence of excessive renal mobility. Patients were scanned with a 16-channel, multislice NCCT, and images were captured utilizing a 16 x 1.25 mm collimation, 5 mm slice thickness. Many parameters including the origin angle of the renal artery, renal artery, vein length, diameter, the area and length of the psoas muscle, and perirenal and pararenal fatty tissue were measured on the images and analyzed. The data were analyzed using multivariate logistic regression, and the receiver operating characteristic curve model and we used predictive modeling based on three significant parameters. Results: Between May 2023 and May 2024, a total of 140 patients with and without excessive renal mobility enrolled into study. After multivariate analysis, increasing renal vein length and renal artery origin angle results in higher renal motility (odds ratio [OR]: 0.982; 95% confidence interval [CI]: 0.966-0.998; p = 0.030 and OR: 0.973; 95% CI: 0.948-0.999; p = 0.044; respectively). It also observed that an increase in tidal volume led to a reduction in renal mobility (OR: 1.015; 95% CI: 1.007-1.024; p = 0.001). Predictive modeling was designed based on these outcomes. This predictive modeling accurately estimates the presence of excessive renal mobility with improved 59% specificity and 65% sensitivity (p < 0.001, area under the curve 0.757; CI: 0.671-0.843). Conclusion: Physicians may predict the presence of excessive renal mobility via the predictive modeling mentioned in the current article. They may perform manipulations to reduce kidney mobility prior to ESL and RIRS.
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    Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study
    (Karger, 2023) Şahin, Mehmet Fatih; Ozman, Oktay; Çakır, Hakan; Çınar, Önder; Akgül, Murat; Başatac, Cem; Şimşekoğlu, Muhammed Fatih; Sancak, Eyüp Burak
    Introduction: Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. Materials and Methods: The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. Results: The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). Conclusions: This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.
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    The comparison of efficacy and safety of reusable and disposable-flexible ureteroscopes: case-control matching results of multicentric RIRSearch study group
    (Springer Science and Business Media B.V., 2025) Şahin, Mehmet Fatih; Dayısoylu, Hulusi Sıtkı; Yazıcı, Cenk Murat; Sıddıkoğlu, Duygu; Çınar, Önder; Akgül, Murat; Çakır, Hakan
    Purpose: Today, disposable flexible ureteroscopes are increasingly used in retrograde intrarenal surgery (RIRS) as an alternative to reusable flexible ureteroscopes. The comparison of the safety and effectiveness of these two devices is still a matter of debate. This study evaluates the efficacy and safety of disposable-flexible ureteroscopes vs reusable flexible ureteroscopes in RIRS. Materials and methods: The study included 1165 RIRS cases, and the patients were divided into two groups. Group 1 consisted of cases with reusable RIRS, 838 in total, while Group 2 consisted of disposable RIRS cases, 327 in total. Due to significant differences, case–control matching was performed, and subsequently, there were 229 patients in both groups. The demographic and clinical data of patients, stone characteristics, surgical data, perioperative and postoperative complications, postoperative urinary tract infection rate, duration of hospitalization, and stone-free rates (SFR) were analyzed and compared. Results: No demographic differences were observed between the two groups after case–control matching. While operative time, SFR, and postoperative infection rates were similar between the groups (p > 0.05), fluoroscopy (p = 0.001) and hospitalization (p = 0.029) times were statistically significantly lower in the disposable ureteroscopy group. Perioperative and postoperative complications were also lower in this group (p = 0.018 and p = 0.001 respectively). Conclusion: Our research indicates that single-use ureteroscopes are a strong alternative to reusable ureteroscopes, demonstrating similar efficacy and reduced complication rates in the treatment of upper urinary tract stones. © The Author(s), under exclusive licence to Springer Nature B.V. 2025.
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    The impact of preoperative ureteral stent duration on retrograde intrarenal surgery results: a RIRSearch group study
    (Springer, 2024) Şahin, Mehmet Fatih; Akgül, Murat; Çakır, Hakan; Ozman, Oktay; Başataç, Cem; Çınar, Önder; Sıddıkoğlu, Duygu; Sancak, Eyüp Burak
    A JJ stent placed before retrograde intrarenal surgery (RIRS) may ease the procedure. However, it is important to note that a prolonged duration of double J stent (DJS) placement before RIRS may increase the risk of postoperative urinary tract infection (UTI). Various publications have established this association, although the duration of the DJS before surgery is scarce. Our study investigates the relationship between the pre-stenting period and postoperative UTI and establishes a cut-off period to minimize this risk. We included a total of 500 cases with preoperative DJS prior to RIRS. The patients were divided into five groups according to their preoperative stenting duration (Group 1: 0-15 days; Group 2: 16-30 days; Group 3: 31-45 days; Group 4: 46-60 days; Group 5: >60 days). Demographic and clinical data of the patients, stone properties, operation data, perioperative and postoperative complications (including fever and UTI), hospitalization time, and stone-free rates (SFR) were compared. The groups contained 53, 124, 102, 63, and 158 patients. The demographics of the patients in each group were similar. There was no statistically significant difference between DJS duration, perioperative/postoperative complications, and SFR, except for the ureteral access sheath (UAS) insertion rate. (p = 0.001). The postoperative fever/UTI rate was the lowest in Group 1 (p = 0.046) compared to other durations. Stent duration does not impact SFR. Longer stents enhance UAS insertion success but increase postoperative infection risk. Our results suggest that RIRS should be performed within two weeks, ideally 20 days following stent insertion, to minimize postoperative infection risk.