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    Avoiding radiation exposure during retrograde intrarenal surgery; a RIRSearch score for predicting longer fluoroscopy times
    (Springer, 2025) Ozman, Oktay; Simsekoglu, Fatih; Sahin, Mehmet Fatih; Basatac, Cem; Akgul, Murat; Cakir, Hakan; Cinar, Onder
    The aim of this study was to identify preoperative and perioperative predictors of radiation exposure during retrograde intrarenal surgery and to develop a scoring system to estimate intraoperative fluoroscopy time. Data from 753 patients who underwent retrograde intrarenal surgery for renal stones were obtained from a multicenter database. All procedures were performed under general anesthesia using fluoroscopy. Fluoroscopy time, recorded in seconds, was the primary outcome. Ordinal regression analysis was applied to evaluate the association between clinical variables and fluoroscopy duration. A predictive score was developed based on statistically significant factors. The performance of the score was tested using receiver operating characteristic curve analysis and a calibration plot.The mean fluoroscopy time was 58 seconds, while the median was 5 seconds. In 140 procedures, fluoroscopy time exceeded 120 seconds. Six parameters were independently associated with longer fluoroscopy use: absence of preoperative ureteral stenting, low stone density (<1000 Hounsfield units), small stone burden (<250 cubic millimeters), multiple stone localizations, failure of ureteral access sheath insertion, and use of large-caliber sheaths (>= 10-12 French). Each parameter was assigned a weighted value, generating a score ranging from 0 to 15. The scoring system demonstrated excellent discriminatory ability (area under the curve: 0.901). A score of 10 or more predicted fluoroscopy duration above 120 seconds with 87.5% sensitivity and 86.2% specificity.The RIRSearch Score is a practical tool for anticipating prolonged radiation exposure before retrograde intrarenal surgery. Surgeons may use this model to minimize unnecessary fluoroscopy and enhance occupational safety.
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    Outcomes of retrograde intrarenal surgery in patients on anticoagulant or antiplatelet therapy: a multicenter matched case-control study by the RIRSearch Study Group
    (Springer, 2025) Simsekoglu, Muhammed Fatih; Ozman, Oktay; Sahin, Mehmet Fatih; Cakir, Hakan; Teke, Kerem; Cinar, Onder; Akgul, Murat
    Purpose This study aimed to assess the outcomes of various perioperative management strategies employed during retro-grade intrarenal surgery (RIRS) in patients receiving anticoagulant (AC) or antiplatelet (AP) therapy. Methods In this multicenter retrospective matched case-control study, we included patients with nephrolithiasis who received AC or AP therapy and underwent RIRS. The control group consisted of patients not receiving AC/AP therapy. Group 1 included patients who discontinued AC/AP treatment prior to RIRS, whereas Group 2 comprised patients who also discontinued AC/AP therapy but received bridging anticoagulation. The primary endpoints were surgical success and RIRS-related complications. These outcomes were assessed using non-contrast abdominopelvic computed tomography (CT) scans obtained during the first postoperative month. Results In the final analysis, Group 1 and Group 2 each comprised 50 patients, while the control group consisted of 56 patients. The mean age was 59.36 +/- 8.86 years in Group 1, 59.96 +/- 9.70 years in Group 2, and 56.59 +/- 11.56 years in the control group (p = 0.452). Surgical success was significantly lower in Group 2 (p = 0.026), and the need for auxiliary proce-dures was significantly higher in this group (p = 0.009). Although perioperative complications tended to be higher in Group 2 (p = 0.053), no statistically significant differences were observed in postoperative or overall complication rates. Conclusions Patients undergoing RIRS with bridging anticoagulation demonstrated lower surgical success rates and a higher need for auxiliary procedures. These findings underscore the importance of close monitoring and individualized periopera-tive management in this high-risk patient population.
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    The Impact of Preoperative JJ Stent Diameter on Retrograde Intrarenal Surgery: A RIRSearch Group Study
    (Mary Ann Liebert, Inc, 2025) Sahin, Mehmet Fatih; Ozman, Oktay; Teke, Kerem; Simsekoglu, Muhammet Fatih; Akgul, Murat; Basatac, Cem; Cinar, Onder
    Introduction: A JJ stent placed before retrograde intrarenal surgery (RIRS) may passively dilate the ureter and facilitate ureteral access sheath (UAS) implantation. No studies have examined the significance of preoperative JJ stent diameter, even though numerous studies have shown that UAS insertion is simpler in patients with them. Our study examines the relationship between preoperative ureteral stent caliber and UAS placement and RIRS results. Materials and Methods: A total of 655 patients with known preoperative double-J stent size before RIRS were analyzed. The patients were categorized into two groups based on their preoperative stent diameter (Group 1: 4.8 Fr and Group 2: 6 Fr). Demographic and clinical data of the patients, stone characteristics, surgical data, perioperative and postoperative complications, duration of hospitalization, and stone-free rates (SFRs) were analyzed for comparison. Results: The groups contained 323 and 332 patients. The demographic data of the two groups were similar. There was no statistically significant difference between SFR, UAS insertion rate, hospitalization time, and complications. The success rate of placing a UAS with a higher caliber was statistically significantly higher in those with a 6 Fr JJ stent than in those with a 4.8 Fr stent (P = .001). The operation time was also shorter in the group with a thicker stent (P = .003). Conclusions: Our data suggest that while the preoperative JJ stent diameter does not significantly affect overall UAS insertion success, complication rates, or postoperative stone-free status, using a 6 Fr stent facilitates the placement of larger UAS calibers and may decrease operation time. Consequently, although both stent diameters are efficacious, selecting a 6 Fr stent may provide procedural benefits without jeopardizing safety or results.