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Öğe 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, DuyguPurposePostoperative 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.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 Does the 5-Item Modified Frailty Index Predict Adverse Outcomes after Retrograde Intrarenal Surgery? A Case-Control Study by the RIRSearch Group(Mary Ann Liebert, Inc, 2025) Başataç, Cem; Şimşekoğlu, Muhammed Fatih; Teke, Kerem; Tuna, Mustafa Bilal; Çınar, Önder; Akgül, Hacı Murat; Özman, Oktay; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakObjectives: We aim to assess whether severely frail patients have an increased risk of complications and worse surgical outcomes after retrograde intrarenal surgery. Methods: The data of 340 consecutive patients undergoing retrograde intrarenal surgery to treat upper tract urinary stones were analyzed retrospectively. The 5-item modified frailty index (mFI-5) was used to assess the frailty status. Using a cutoff value of score 2 in the mFI-5 score, patients were divided into two groups: patients with an mFI-5 score <2 were assigned to a non-frail (Group 1) group, and patients with an mFI-5 score >= 2 were assigned to a frail (Group 2) group. The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the surgical outcomes were much better in non-frail patients. Results: After matching confounding factors, Group 1 comprised 255 patients, and Group 2 comprised 85 patients. The baseline characteristics were similar between the groups. There were no statistically significant differences in terms of the median operation time and length of hospital stay among groups. There were no significant differences between groups for intraoperative complication rates (7.6% and 9.4%, respectively; P = .47) and postoperative complication rates (13.8% and 11.8%, respectively; P = .71), and stone-free rates (70.9% versus 72.9%, respectively; P = .73). Conclusions: Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severely frail patients.Öğe Factors affecting Urethral Catheter Placement Following Flexible Ureterorenoscopy: RIRSearch Study Group(Acıbadem Üniversitesi, 2024) Çakır, Hakan; Çınar, Önder; Akgül, Murat; Özman, Oktay; Başataç, Cem; Şimşekoğlu, Muhammed Fatih; Teke, Kerem; Sancak, Eyüp BurakBackground/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 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; Çakır, Hakan; Sıddıkoğlu, Duygu; Ozman, Oktay; Başataç, Cem; Akgül, Hacı Murat; Çınar, ÖnderObjective: 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.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 Prediction of Possible Factors that Affect Stone Free Rate of Retrograde Intrarenal Surgery; A Multicenter Study(Tekirdağ Namık Kemal Üniversitesi, 2020) Özman, Oktay; Başataç, Cem; Akgül, Murat; Çınar, Önder; Sancak, Eyüp Burak; Yazıcı, Cenk Murat; Onal, BulentObjective: The aim of the study was to evaluate possible factors predicting stone-free status at retrograde intrarenal surgery for renal stones. Material and Method: A retrospective multicenter study was performed using data from 513 patients treated between February 2016 and January 2020 at four referral centers in Turkey. The patients were divided into two groups whether they had no residual stone over 3 mm (Group 1) or not (Group 2). Pre and peroperative parameters were compared in both groups (Table 1). Univariate and multivariate analyzes were performed to identify any factors affecting the stone-free rate (Table 2). Results: Overall stone-free rate was 88.5% (454/513). Lower calyx stones and multipl stones were significantly higher in Group 2 (p=0.006, p=0.02, respectively). Also access sheathless procedure rate was significantly higher and the basket catheter useage rate was significantly lower in Group 2 (p=0.04, p [TR] Amaç: Bu çalışmanın amacı Retrograd İntrarenal Cerrahi’de taşsızlığı öngören olası faktörleri araştırmaktır. Materyal ve Metod: Şubat 2016-Ocak 2020 tarihleri arasında Türkiye'deki dört ayrı merkezde tedavi edilen 513 hastanın verileri kullanılarak retrospektif çok merkezli bir çalışma gerçekleştirildi. Hastalar 3 mm'nin üzerinde rezidü taş saptananlar (Grup 1) ve rezidü taş saptanmayanlar (Grup 2) olmak üzere iki gruba ayırıldı. Pre ve peroperatif parametreler her iki grupta karşılaştırıldı (Tablo 1). Taşsızlık oranını etkileyen faktörleri araştırmak için univariate ve multivariate analizler yapıldı (Tablo 2). Bulgular: Toplam taşsızlık oranı % 88.5 idi (454/513). Alt kaliks taşları ve multipl taşlar Grup 2'de anlamlı olarak daha yüksekti (sırasıyla p = 0.006, p = 0.02). Ayrıca erişim kılıfsız prosedür oranı Grup 2'de anlamlı olarak yüksek ve basket kateter kullanım oranı anlamlı olarak düşüktü (sırasıyla p = 0.04, pÖğe Safety and Efficacy of Retrograde Intrarenal Surgery in the Solitary Kidney: A Propensity Score-Matched Analysis of the RIRSearch Study Groups' Results(Mary Ann Liebert, Inc, 2024) Çınar, Önder; Çakır, Hakan; Ozman, Oktay; Akgül, Murat; Başataç, Cem; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakBackground: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case-control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score-matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4-7565.9) versus 991.1 mm3 (range: 201.2-4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS.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.Öğe The Effect of Reusable Flexible Ureteroscope Aging on the Efficacy and Safety of Retrograde Intrarenal Surgery(Mary Ann Liebert, Inc, 2024) Yazıcı, Cenk Murat; Çakır, Hakan; Ozman, Oktay; Başataç, Cem; Akgül, Hacı Murat; Çınar, Önder; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakPurpose: 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.Öğe The Efficacy and Safety of Retrograde Intrarenal Surgery: A Multi-Center Experience of the RIRSearch Group Study(Society of Urological Surgery, 2023) Akgül, Murat; Çakır, Hakan; Ozman, Oktay; Çınar, Önder; Başataç, Cem; Sıddıkoğlu, Duygu; Doğan, Çağrı; Sancak, EyüpObjective: We reported the results of retrograde intrarenal surgeries (RIRS) according to multi-center experience and to assess the efficacy and safety of this procedure. Materials and Methods: A total of 1067 patients to whom RIRS operations were performed between 2016 and 2021 were included in the study. The demographic and clinical features of patients, stone properties, per-operative, and post-operative results were analyzed retrospectively. Additionally, the success and complication rates of RIRS according to the clinical and demographic properties of the patients were analyzed. Results: The mean age, stone volume, operation time, and hospitalization time were 46.8±15.4, 1011 mm3 (min 19 mm3- max 12.483 mm3), 67.4±30.8 min, and 1.83±2.3 days, respectively. The stone-free (success) rate after RIRS was 74.5%. In multivariate analysis, pre-op pyuria, number of stones, and stone volume had a significant effect on success. There were 251 (23.5%) patients with post-operative complications. The most common complications were hematuria, fever, and urinary tract infections; they comprised 86.8% of all complications. The number of stones, pre-op ESL, and absence of pre-operative DJ stent had a significant effect on complications in multivariate analysis. Conclusion: Retrograde intrarenal surgery is an efficient minimal invasive procedure for treating urinary system stone disease with low morbidity and high success rates. Although the complication rates are mostly insignificant, there may also be severe vital complications.Öğe 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 BurakA 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.Öğe Virgin ureter vs. non-virgin ureter? A comparative analysis on complications and failure of retrograde intrarenal surgery: a multicentre case-control study from RIRSearch Group(Springer, 2025) Teke, Kerem; Çınar, Naci Burak; Çınar, Önder; Akgül, Murat; Başataç, Cem; Şimşekoğlu, Muhammet Fatih; Çakır, Hakan; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakIt is unclear whether ureteral virginity has an effect on retrograde intrarenal surgery (RIRS). We aimed to evaluate the impact of ureteral virginity on RIRS outcomes in a multicenter study. Data from the RIRSearch study group database were retrospectively reviewed. Patients with a history of endoluminal interventions or extrinsic ureteral surgery were categorized as having a non-virgin ureter, while those without such histories were classified as virgin ureters. Case-control matching was performed based on age, gender, uretral access sheath size, and stone characteristics. Demographic, clinical, surgical and complication data were compared after-matching. A total of 894 procedures were included, with 119 (13.3%) involving non-virgin ureters. Pre-matching, the non-virgin ureter group had higher mean age (50.6 +/- 13.2 vs. 46.6 +/- 13.6 years) and Charlson comorbidity index >= 2 (51.3% vs. 40.4%). In addition, number of stones, total-stone volume and rate of multiple stone localization were significantly higher in non-virgin ureter group. Operation time, hospital stay, surgical failure, need for auxiliary treatment, and perioperative complications were significantly higher in non-virgin ureter group (p < 0.05). After case-matching, perioperative complications (18.7% vs. 5.3%), hospital stay (1.54 +/- 1.30 vs. 1.18 +/- 0.98 days), and auxiliary treatment requirements (20% vs. 8.4%) remained significantly higher in non-virgin ureter group (p < 0.05). There was no significant difference in postoperative complication rates (17.3% vs. 19.8%) or surgical failure rates (36% vs. 26%). Non-virgin ureters were associated with higher perioperative complication rate, longer hospital stays and increased need for auxiliary treatments during RIRS. Patients with non-virgin ureters may be informed about these potential risks before surgery.Öğe 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) Yazıcı, Cenk Murat; Sıddıkoğlu, Duygu; Özman, Oktay; Çınar, Önder; Akgül, Hacı Murat; Çakır, Hakan; Başataç, Cem; Sancak, Eyüp BurakObjective: 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.
