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    External validation of Modified Seoul National University Renal Stone Complexity Score to predict outcome and complications of retrograde intrarenal surgery: a RIRSearch Group study
    (Taylor & Francis Ltd, 2022) Ozman, Oktay; Basatac, Cem; Akgul, Haci Murat; Cinar, Onder; Sancak, Eyup Burak; Ozden, Sami Berk; Elmaagac, Burak
    Introduction The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden. Material and methods Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS. Results The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates (p<.001, p<.001, p=.008 and p<.001, respectively). S-ReSC score (p=.02) and stone burden (p<.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618). Conclusions The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.
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    Is Psoas Muscle Mass Associated with Failure of Ureteral Access Sheath Insertion and Complications from Retrograde Intrarenal Surgery? A Case-Control Study from RIRSearch group
    (Mary Ann Liebert, Inc, 2024) Teke, Kerem; Cakir, Hakan; Siddikoglu, Duygu; Ozman, Oktay; Basatac, Cem; Akgul, Haci Murat; Cinar, Onder
    Objective: To investigate the association between psoas muscle mass (PMM) and failure of ureteral access sheath (UAS) insertion and complications from retrograde intrarenal surgery (RIRS). Materials and Methods: A multicenter retrospective case-control study was conducted that included patients who underwent RIRS despite failure of UAS insertion (Cohort 1) and confounder-matched control patients who underwent RIRS after successful UAS insertion (Cohort 2). For morphometric analysis of PMM, ipsilateral psoas muscle areas (iPMAs) were measured using the coreslicer.com webkit. After comparing demographic, clinical, and complication rates and iPMAs between cohorts, gender-specific median iPMAs were also determined to further subdivide patients in each cohort as either low iPMAs or high iPMAs. Thereafter, patients were also compared in terms of RIRS complications. Results: Cohort 1 included 86 patients whereas Cohort 2 consisted of 124 matched cases. The median (interquartile range) iPMAs were similar between the cohorts: Cohort 1, 11.05 (6.82-14.44) cm(2) versus 11.12 (6.97-13.69) cm(2) for Cohort 2 (P .05). There was a significant inverse relationship between iPMAs with age (r = -0.222) and Charlson comorbidity index (r = -0.180) for all patients (P .05). Perioperative and postoperative complication rates were 8.1% and 16.3% for Cohort 1 and 6.5% and 21% for Cohort 2, respectively. The complication rates were not statistically different between patients with high iPMAs and those with low iPMAs, in male or female patients (P > .05). Conclusions: These results show that failure of UAS was not associated with PMM. Furthermore, since the complication rates were similar between patients with high PMM and low PMM, RIRS may be a reliable treatment choice for sarcopenic patients as well as in nonsarcopenic patients.
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    Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis
    (Polish Urological Assoc, 2022) Ozman, Oktay; Akgul, Haci Murat; Basatac, Cem; Sancak, Eyup Burak; Cinar, Onder; Cakir, Hakan; Yazici, Cenk Murat
    Introduction Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery. Materials and methods PubMed and Web of Science databases were searched systematically between April and May 2021. The scoring systems which were validated externally or studied at least by two different researcher groups were selected for further analysis. Of 59 records, 14 studies met the inclusion criteria (n = 4137). Area under curve (AUC) values of selected scoring systems were pooled in random or fixed effects. Thertest was used to quantify heterogeneity. Results Eight, 5, 8, 4 and 3 studies included in meta-analyses for the modified Seoul National University Renal Stone Complexity Score (S-ReSC), R.I.R.S., Resorlu-Unsal Score (RUS), S.T.O.N.E., and Ito's Nomogram, respectively. We found pooled AUC values 0.709 (95% CI 0.670-0.748), 0.704 (95% CI 0.668-0.739), 0.669 (95% CI 0.646 to 0.692), and 0.771 (95% CI 0.724 to 0.818), for first four of them, respectively. Heterogeneity was very high to pool AUC values for Ito's nomogram. Conclusions Although S.T.O.N.E. score showed higer pooled AUC value, this systematic review and meta-analysis has not revealed superiority of any scoring system. High heterogeneity between studies and dependencies between scoring systems make it difficult to design a comparative statistical model to generalize the findings. Also, limitations aside, neither scoring system has demonstrated good predictive/discriminative performance.
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    Retrograde Intrarenal Surgery Is a Safe Procedure in Severe Obese Patients: Is It Reality or Prediction? A Propensity Score-Matching Analysis from RIRSearch Study Group
    (Mary Ann Liebert, Inc, 2022) Basatac, Cem; Ozman, Oktay; Cakir, Hakan; Cinar, Onder; Akgul, Haci Murat; Siddikoglu, Duygu; Sancak, Eyup Burak
    Objective: The aim of the study was to assess whether severely obese patients have an increased risk of complications during and after retrograde intrarenal surgery (RIRS). Materials and Methods: The data of 639 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were analyzed retrospectively. The patients were divided into two groups according to their body mass index numbers (Group 1, <35; Group 2, >= 35). The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the intraoperative and postoperative complication rates were higher in patients with a body mass index of >= 35 kg/m(2). Results: After matching of confounding factors, Group 1 comprised 135 patients, and Group 2 comprised 47 patients. The baseline characteristics were similar between the groups. There were no significant differences between groups for intraoperative complication rates (11.8% and 12.8%, respectively; p = 0.97). There was statistically significant difference in favor of Group 2 for postoperative complication rates (12.6% and 29.7%; respectively, p < 0.01), overall complication rates (22.9% and 38.2%; respectively, p = 0.02), mean operation time (56.15 vs 66.45 minutes; respectively, p = 0.01), and length of stay (1.4 vs 2.1 days; p = 0.03). Stone-free rates (75.5% vs 85.1%; respectively, p = 0.17) did not differ between groups. Conclusions: RIRS is an efficient and feasible treatment option for upper urinary tract stones in severely obese patients. However, higher possibility of postoperative, especially infectious, complication rates should be considered in these patients.
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    Standardizing the Stone Free Definition After Retrograde Intrarenal Surgery
    (Elsevier Science Inc, 2024) Yazici, Cenk Murat; Goenen, Korcan Aysun; Ozman, Oktay; Cakir, Hakan; Basatac, Cem; Akgul, Haci Murat; Cinar, Onder
    [Anstract Not Available]
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    The Effect of Reusable Flexible Ureteroscope Aging on the Efficacy and Safety of Retrograde Intrarenal Surgery
    (Mary Ann Liebert, Inc, 2024) Yazici, Cenk Murat; Cakir, Hakan; Ozman, Oktay; Basatac, Cem; Akgul, Haci Murat; Cinar, Onder; Siddikoglu, Duygu
    Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as aging of the flexible ureteroscope. Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS.Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X2) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups.Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively (p = 0.304). The complication rates were also similar between the groups (p = 0.591).Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.
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    Which is a Better Predictor for the Safety and Efficacy of Retrograde Intrarenal Surgery; Stone Size or Volume? A Study of RIRsearch Study Group
    (Mary Ann Liebert, Inc, 2024) Yazici, Cenk Murat; Siddikoglu, Duygu; Ozman, Oktay; Cinar, Onder; Akgul, Haci Murat; Cakir, Hakan; Basatac, Cem
    Objective: To compare the predictive effects of stone size and volume on the efficacy and safety of retrograde intrarenal surgery (RIRS) and to determine the cutoff values of stone volume for prediction of RIRS efficacy and safety. Methods: Patients who underwent RIRS between 2017 and 2021 in six referral centers were retrospectively included in the study. The database of the RIRsearch group, which was formed prospectively, was used for this retrospective analysis. The surgical results and complications of RIRS were evaluated according to stone size and stone volume and compared between these groups. Results: A total of 1128 patients were included. Operation time, intraoperative complication rate, and postoperative complication rate increased significantly as stone size and stone volume increased (P < .05). Stone size and volume were significant indicators for stone-free rates, but pairwise comparison showed that stone volume was a significantly better predictor of surgical success compared with stone size (P < .001). Stone size was not sufficient to predict postoperative complications, whereas stone volume predicted these complications with low performance. Conclusions: Stone volume was a better predictor for surgical success than stone size, and it was as reliable as stone size in predicting postoperative complications.