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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.