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Öğe Determining the Stone Free Rate of Retrograde Intrarenal Surgery. Which Radiological Technique? RIRSearch Study Group(Elsevier Science Inc, 2024) Yazıcı, Cenk Murat; Gönen Korcan, Aysun; Ozman, Oktay; Çakır, Hakan; Başataç, Cem; Akgül, Hacı Murat; Çınar, Önder; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakOBJECTIVE To evaluate the sensitivity and specificity of ultrasonography (USG) and kidney ureter bladder radiography (KUB) for the determination of stone-free status of retrograde intrarenal surgery (RIRS) according to different stone-free status definitions. MATERIALS AND METHODS The patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system USG and noncontrast abdominal tomography at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of USG and KUB on evaluating the stone-free rate were analyzed according to different stone-free status definitions. RESULTS A total of 178 patients were included in the study. The stone-free rates according to stone-free definitions as; residual stone < 4 mm, < 2 mm and no residual stone were 79.2%, 64.0%, and 56.7%, respectively. According to its definition as a residual stone < 4 mm, the sensitivity and specificity of USG were 64.9% and 84.3%, respectively. The sensitivity of USG was 57.1% and 52.5% as the definitions were residual stone < 2 mm and no residual stone, respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity. CONCLUSION USG had high specificity but low sensitivity for evaluating stone-free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone-free status and noncontrast abdominal tomography must be used during the clinical trials to document the exact stone-free rates of RIRS. (c) 2024 Elsevier Inc. All rights reserved.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 Factors affecting Urethral Catheter Placement Following Flexible Ureterorenoscopy: RIRSearch Study Group(2024) Cakir, Hakan; Çinar, Önder; Akgül, Murat; Özman, Oktay; Başataç, Cem; Şimşekoğlu, Muhammed Fatih; Teke, KeremBackground/Purpose: To investigate the factors affecting UC placement following flexible ureterorenoscopy (fURS) and the effect of urethral catheter (UC) placement on patient quality of life. Methods: The present study was performed in prospective manner from 1st January 2015 to 30th December 2023, and patients with renal stones smaller than two centimeters who underwent fURS were analyzed for study inclusion. Patients’ demographic characteristics, operative parameters, success of procedure, complications, and VAS score were recorded. Patients were categorized into two groups according to UC placement or not. These groups were compared according to preoperative parameters, intraoperative data, complications, success and VAS at postoperative 6th hour. Results: In total, 324 patients were enrolled into the study. UC was inserted in 170 patients following fURS and was not inserted to 154 patients. In the patient group with UC placement, ratio of male patients (p= 0.002), ratio of anticoagulant use (p= 0.002), preoperative creatinine level (p=0.001), stone size (p= 0.001), stone burden (p= 0.001), and ratio of multiple stones (p= 0.001) were significantly higher. Operation time was significantly longer (p= 0.003) and intraoperative complications (p= 0.045) were significantly higher in patients with UC insertion. Need for additional analgesia and VAS score was significantly lower in patients without UC placement (p= 0.004 vs. p= 0.001). Multivariate analysis revealed that male gender, higher preoperative creatinine level, higher stone size and stone burden, and longer operation time were predictive factors for UC placement following fURS (p= 0.008, p= 0.001, p= 0.001, p= 0.010, and p= 0.001, respectively). Conclusion: The present study demonstrated that UC placement following fURS was associated with increased analgesia requirements and more pain. Moreover, our study demonstrated that male gender, higher preoperative creatinine level, higher stone size and stone volume, and longer operation time resulted in UC insertion after fURS.Öğe 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 The effect of optical dilatation before retrograde intrarenal surgery on success and complications: Results of the RIRSearch group study(Wiley, 2021) Sancak, Eyüp Burak; Başataç, Cem; Akgül, Hacı Murat; Çınar, Önder; Özman, Oktay; Yazıcı, Cenk Murat; Akpınar, HalukAim The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are currently no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS). The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the RIRS procedure on the success and complications of RIRS. Methods A total of 422 patients were included in the retrospective multicentre study. The patients were divided into two groups according to whether sURS was to be performed. Patients' demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. Results Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Stone characteristics and patients' demographics were similar between the groups. Operation time in the sURS group was significantly longer (compared with the non-sURS group, P < .0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (P = .03). Compared with the non-sURS group, the intraoperative complication rate was lower in the sURS group (14 [4.8%] vs 1 [0.8%], P = .04). The surgical success rate was higher in the sURS group (P = .002). Nevertheless, sURS had no independent effect on surgical success. We found two independent predictors for surgical success rate: stone number (P < .0001, OR:2.28) and failed UAS placement (P = .035, OR:3.49). Conclusions Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied to patients who have not been passively dilated with a JJ stent.
