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Introduction and objectives Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. Material and methods Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2–L3. Medial location: L4–L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. Results Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4–30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I–II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5–8.1; p = 0.004] in multivariate analysis. Conclusions Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.

Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybr...

Purpose: This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). Materials and Methods: A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. Results: A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51–2.58) (Z = 5.02; p = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52–1.05) (Z = 1.67; p = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05–2.13) (Z = 2.22; p = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. Conclusions: POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.

Objective: Flexible ureterorenoscopy (fURS) is one of the standard treatments for renal calculi up to 20 mm. This study aims to identify factors associated with stone-free status. Materials and Methods: We included patients undergoing fURS for treatment of small to medium-size renal stone (no single stone larger than 20 mm) from April 2017 to September 2019 at King Chulalongkorn Memorial Hospital. All patients had a preoperative CT scan and postoperative imaging for comparison. We collected patient characteristics (sex, age, previous ipsilateral urinary tract surgery, preoperative ureteral stent placement), stone factors (total stone burden, stone number, stone density) and renal factors (anatomical abnormalities, stone location in a lower pole, number of caliceal involvement) and correlated the data against postoperative stone-free status (defined as residual fragment ≤ 2 mm). Results: The overall stone-free rate was 53.3%. From the univariate analysis, previous surgery, total stone burden, stone number, stone location in the lower pole, and the number of caliceal involvement were associated with stone-free status. However, only the total stone burden remained statistically significant in the multivariate analysis (p-value < 0.05). The stone-free rates were 75.9%, 57.1%, and 11.1% in the total stone burden ≤ 10 mm, 11-20 mm, > 20 mm, respectively. Conclusion: Following treatment of renal stones ≤ 20 mm with fURS, the stone-free rate was 53.3% and was significantly associated with the preoperative total stone burden.

OBJECTIVE To comparatively investigate the efficacy, safety and complications of flexible ureterorenoscopy (f-URS) in the treatment of patients of different age groups (

Introduction: Elevated intrarenal pressure (IRP) during flexible ureterorenoscopy (FURS) is a predictor of postoperative complications. The aim of this study is to evaluate IRP during FURS in a por...

Objective:The elderly population has been increasing due to extension in lifespan. Chronic comorbid disorders and medications render a recheck of the treatment modalities of urinary stones for this population. This study aimed to analyse the results of mini-percutaneous nephrolithotomy (PNL) and flexible ureterorenoscopy (F-URS), which are minimally invasive techniques for the treatment of kidney stones in elderly patients.Materials and Methods:Data of patients who are older than 65 years with 10-25-mm kidney stones and who underwent F-URS (n=51) and mini-PNL (n=33) between 2015 and 2019 were retrospectively studied. Demographic data, operative data and postoperative data were evaluated.Results:The mean age of group 1 (F-URS) was 71.5±6.4 and of group 2 (mini-PNL) 70.2±5.6 and the mean stone size was 16.1±3.8 mm for group 1 and 19.7±3.5 mm for group 2. The complete stone-free rate was similar in groups 1 and 2 at 1 month postoperatively (78.4% and 72.7%, respectively; p=0.549). Haemoglobin decrease and operation and hospitalisation time were found to be higher in group 2 (p=0.000, 0.0001, 0.002). Complication rates (transfusion-required haemorrhage, fever and colon perforation) were not statistically different between the two groups (p=0.8).Conclusion:In this study, although the stone-free rate in the F-URS and mini-PNL groups was similar, we believe that F-URS is a safer treatment method in elderly patients with 10-25-mm kidney stones than mini-PNL because of its shorter operation time and lower haemoglobin decrease.

Background Primary flexible ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (SWL) are treatment options in patients with renal calculi of 5–15 mm. Objective To compare effectiveness, complication rates, and pain scores between primary URS and SWL. Design, setting, and participants Between 2011 and 2016, patients with renal calculi between 5 and 15 mm were randomized to undergo either primary URS or SWL. Outcome measurements and statistical analysis Stone-free rate and size of residual fragments assessed by computed tomography after 3 mo, complications, and pain scores were evaluated. Results and limitations The study was prematurely closed after randomizing 44 patients due to poor accrual. The 3-mo stone-free rate and mean residual stone size were, respectively, 61% and 1.8 mm after URS and 48% and 2.4 mm after SWL. Early post-treatment pain scores were significantly higher after URS than after SWL on day 1 (3.3 vs 1.6, p = 0.02) and day 7 (5.2 vs 3.4, p = 0.04), but were no longer detectable after 3 wk and 3 mo, respectively. One Clavien-Dindo grade II complication was observed after URS (5%) and SWL (4%), while one (4%) grade IIIb complication was observed after SWL. Conclusions URS appears to be associated with higher early post-treatment discomfort, which could be associated with routine postoperative stenting. Owing to premature closure of this trial, the power was insufficient to formally compare URS and SWL; however, the present data might be informative to counsel patients about treatment outcomes and allow future meta-analyses. Patient summary This study was ended prematurely, but it contributes data about efficacy and side effects of different treatment options in patients with renal calculi., Take Home Message Primary flexible ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (SWL) are both safe and effective treatment options in patients with renal calculi of 5–15 mm. Although this trial was closed prematurely and the power was insufficient to formally compare URS and SWL, the present data might be informative to counsel patients about treatment outcomes and allow future meta-analyses.

Background To analyze the impact of metabolic syndrome on the safety and efficacy of flexible ureterorenoscopy (fURS) in managing kidney calculi. Methods We retrospectively analyzed the records of 151 patients who received fURS for the renal stones in our center between January 2014 and December 2016. The patients were divided into two groups based on whether they were diagnosed with metabolic syndrome. Information related to the patients, stones and surgeries were analyzed, and the stone-free rates (SFRs) and complications after fURS were reviewed. Results Group 1 consisted of patients with metabolic syndrome, and group 2 contained patients without metabolic syndrome. The mean stone size was 71.9±58.3 mm2 in group 1 and 64.9±43.7 mm2 in group 2 (P=0.399). The mean hospitalization and surgical durations were similar between both groups (P>0.05). The overall complication rates were 8.3% vs. 12.1% (P=0.514). The SFR at 3 months postoperative in group 1 was significantly lower than that in group 2 (80% vs. 92.3%, P Conclusions Our study results revealed that patients with metabolic syndrome can be treated safely with fURS. however, metabolic syndrome has a negative impact on the efficacy of fURS in the treatment of patients with kidney stone.

The effect of preoperative Double-J (DJ) ureteral stenting before flexible ureterorenoscopy (FURS) in the treatment for urinary stones was evaluated. We retrospectively enrolled 306 consecutive patients who underwent FURS from Jan. 2014 to Dec. 2017. All the patients were classified into two groups according to whether they had DJ ureteral stenting before FURS. Baseline characteristics (age, sex, stone location, stone size, surgical success rate, operation time, stone-free rate of the first day after surgery, stone-free rate of the first month after surgery, total complication rate) were compared using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables. In total, 306 patients were included in this study. The group of DJ stenting before FURS included 203 (66.3%) patients, and non-DJ stenting before FURS was observed in 103 (33.7%) patients. The group of DJ stenting before FURS was significantly associated with a shorter operation time (53.8 vs. 59.3 min, P

Background In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. Methods Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n = 145) or spinal anaesthesia (SA group; n = 131) or epidural anaesthesia (EA group; n = 116) were reviewed retrospectively. Results The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p

Purpose To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. Material and Methods The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.

Purpose To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety. Methods A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark. Results and conclusions Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.

Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia. Level of evidence

Purpose: The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the lower pole stones with a maximal dimension of 2 cm or less. Materials and Methods: A systematic review was conducted on PubMed (R), SCOPUS (R), Cochrane and EMBASE (R). The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery, shock wave lithotripsy and percutaneous nephrolithotomy were considered for comparison. The primary end point was the stone-free rate. Results: A total of 15 randomized controlled trials were eligible. Percutaneous nephrolithotripsy and retrograde intrarenal surgery have higher stone-free rates in comparison to shock wave lithotripsy and require fewer re-treatment sessions. Operative time and complications seem to favor shock wave lithotripsy in comparison to percutaneous nephrolithotripsy, but this takes place at the expense of multiple shock wave lithotripsy sessions. Retrograde intrarenal surgery seems to be the most efficient approach for the management of stones up to 1 cm in the lower pole. Conclusions: The pooled analysis of the eligible studies showed that the management of lower pole stones should probably be percutaneous nephrolithotripsy or retrograde intrarenal surgery to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10 mm, retrograde intrarenal surgery is more efficient in comparison to shock wave lithotripsy. The decision between the 2 approaches (percutaneous nephrolithotripsy or retrograde intrarenal surgery) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient.

To evaluate the efficacy and safety of mini percutaneous nephro-lithotripsy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones larger than 20mm in its longest diameter. Patients & Methods: In a prospective randomized study including 40 patients divided into two groups each 20 patient. Gathering An included 12 guys and 8 females with age went from 15 to 62 years had smaller than expected PCNL for renal pelvic and calyceal stones. Gathering B included 8 guys and 12 females with age extended from 18 to 65 years of age had RIRS. Adaptable ureteroscopy was utilized for pelvic and calyceal stones utilizing holmium:YAG laser (tidying approach). In the two gatherings the strategy result regarding Operative time, Blood misfortune, clinic remain, entanglements utilizing changed Clavien reviewing framework , the need of assistant systems , stone free rates following 3 weeks by utilizing CTUT, were assessed measurably. Measurable investigation of the information indicated that there was immaterial contrast between the {mean ± SD} of the BMI in patients of gathering A which was {27.850±3.183} kg/m2; while in patients of gathering B was {29.700±7.927} kg/m2 . With respect to measure, there was immaterial contrast between the {mean ± SD} of gathering A which was 2.57±0.22mm, while in bunch B was 2.6±0.24mm. With respect to usable time the {mean ± SD} of gathering A was 104.43±14.79 minutes which was altogether (P

Background Over the last few years the number of flexible ureterorenoscopies, used for renal stone treatment, has risen steadily. This was associated with an increase in costs for maintenance and repair of the fragile ureterorenoscopes used. To overcome this problem single-use devices have been introduced to the market. The aim of this study was to assess surgical outcome and workability for LithoVue™, a single-use flexible ureterorenoscope. Methods We retrospectively analyzed all flexible ureterorenoscopies performed at our department between January and October 2017. We included a total of 108 interventions for renal stone therapy, all performed using the single-use device LithoVue™. We assessed patients’ characteristics including stone size, count and location. We evaluated the surgical outcome, analyzing stone-free rates, reintervention rates, complication rates, as well as surgery time. Learning curve for single-use ureterorenoscopes was evaluated by comparing the surgical outcome between residents and consultants. Results The average time needed per intervention was 52,31 min ± 28,11. In 77 out of 108 (71,30%) patients we were able to remove all stones by a single intervention. In 8 patients (7,41%) intra- or postoperative complications occurred, none of which was graded higher than Clavien-Dindo III B. We did not find any statistical differences comparing the surgical outcome between residents and consultants. No technical difficulties occurred during surgery. Conclusion Single-use flexible ureterorenoscopes provide decent working properties resulting in good surgical outcome. Furthermore, they are proven to be easy to handle even for unexperienced surgeons, making them a feasible choice for high volume academic centers.

Objective: To objectively assess the performance of graduating urology residents performing flexible ureterorenoscopy (fURS) using a simulation-based model and to set an entrustability standard or benchmark for use across the educational spectrum. Methods: Chief urology residents and attending endourologists performed a standardized fURS task (ureterorenoscopy and repositioning of stones) using a Boston Scientific© Lithovue ureteroscope on a Cook Medical© URS model. All performances were video-recorded and blindly scored by both endourology experts and crowd-workers (C-SATS) using the Ureteroscopic Global Rating Scale, plus an overall entrustability score. Validity evidence supporting the scores was collected and categorized. The Borderline Group (BG) method was used to set absolute performance standards for the expert and crowdsourced ratings. Results: A total of 44 participants (40 chief residents, 4 faculties) completed testing. Eighty-three percent of participants had performed >50 fURS cases at the time of the study. Only 47.7% (mean score 12.6/20) and 61.4% (mean score 12.4/20) of participants were deemed "entrustable" by experts and crowd-workers, respectively. The BG method produced entrustability benchmarks of 11.8/20 for experts and 11.4/20 for crowd-worker ratings, resulting in pass rates of 56.9% and 61.4%. Conclusion: Using absolute standard setting methods, benchmark scores were set to identify trainees who could safely carry out fURS in the simulated setting. Only 60% of residents in our cohort were rated as entrustable. These findings support the use of benchmarks to earlier identify trainees requiring remediation.

OBJECTIVE To describe a novel syphoning ureteric access sheath (UAS) intended for use during flexible ureterorenoscopy (URS). We aimed to assess if in vitro it could reduce intrarenal pressure (IRP) and increase irrigant flow compared to traditional UASs. MATERIALS AND METHODS A validated phantom kidney with fibre optic pressure sensing capabilities was used to assess the IRP. Standardised 80 cmH2 O irrigation via a ureterorenoscope was instilled through traditional UASs (11/13 and 12/14 F) and compared to the novel 11/13-F syphoning UAS. The measured minute volume, calculated hourly flow volume, and steady state IRP were compared. RESULTS The traditional 11/13 and 12/14-F UASs had statistically poorer irrigant flow than the novel syphoning UAS, at 19.3 vs 29.3 mL/min (P

espanolOBJETIVOS: El objetivo es determinar si la ureterolitectomia laparoscopica (UL) es una buena alternativa a la ureterorenoscopia flexible con litotricia (URSF) a traves de la comparacion de ambas tecnicas en lo que a coste y efectividad radica. METODOS: Analizamos 79 pacientes con litiasis ureterales proximales de mas de 1,5 cm que recibieron URSF o UL en relacion a coste-efectividad. Los datos recogidos incluyeron edad, IMC, tamano de la litiasis, tiempo de la cirugia, tiempo de hospitalizacion, complicaciones y tasa libres de litiasis a los 15 dias y 3 meses de la cirugia. Auditamos los costes de las URSF y UL y se compararon en relacion a coste-efectividad. RESULTADOS: No hubo diferencias estadisticamente significativas entre los grupos en relacion a la edad, IMC, tamano de la litiasis, tasa libre de litiasis a los 3 meses y complicaciones (p>0,05). Los tiempos quirurgicos fueron estadisticamente menores en URSF en comparacion a UL (61,5±24,3 min y 140,9±49,1 min, respectivamente, (pz0,05). La tasa libre de litiasis a los 15 dias fue mas baja en el grupo de URSF que UL (31 (81,6%) y 41 (100%), respectivamente, p Aunque la diferencia estadistica desaparece a los 3 meses (p>0,05). El coste medio de URSF y UL fue de $194,2 ± 12,4 y $ 179,2 ± 58,5, respectivamente (p CONCLUSION: URSF es igualmente efectiva que UL en terminos de tasa libre de litiasis. Los costes de URSF es mas alto que UL. URSF es la primera opcion en el tratamiento de litiasis de mas de 1 cm en ureter proximal. En caso de experiencia laparoscopica de alto nivel, UL puede sustituir a URSF, especialmente en casos dificiles. EnglishOBJECTIVES: We aimed to understand whether laparoscopic ureterolithotomy (LU) is a good alternative to flexible ureterorenoscopic lithotripsy (FURS) by comparing these techniques concerning cost-effectiveness. METHODS: We analysed 79 patients with upper ureteral stones larger than 1.5 cm underwent FURS or LU concerning cost-effectiveness analysis. The data including age, body mass index (BMI), stone size, operation time, hospitalisation time, complications and stone-free rates of 15th day and 3rd months. We audited the costs of FURS and LU and compared them concerning cost-effectiveness. Arch. Esp. Urol. 2021; 74 (6): 592-598 https://doi.org/10.37554/en-20201213-3423-7 ORIGINAL ARTICLE Keywords: Flexible ureterorenoscopy. Laparoscopic ureterolitotomy. Cost-effectiveness. Lithotripsy. RESULTS: There was not any statistically significant difference between the two groups with regard to age, BMI, stone size, stone-free rates at the 3rd month, and complication rates, (p>0.05). The operation times were statistically lower in the FURS than in the LU (61.5±24.3 min and 140.9±49.1 min, respectively, p However, this statistical difference disappears at 3 months (p>0.05). The mean costs of FURS and LU were $194.2±12.4 and $179.2±58.5, respectively (p CONCLUSION: FURS is equally effective to LU in terms of stone-free rates. The cost of FURS is higher statistically than LU. FURS is shown as the first choice for the upper ureteral stones larger than 10 mm in size, if the laparoscopic experience is in high-level situations in that clinic, LU may be a suitable alternative to FURS, especially for challenging cases

Aims: Today, we have technology to break up a ureter stone in ureter as well as in renal pelvis during ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices in order not to let the stone migrate through renal pelvis. However, we still do not know whether it is advantageous to dust a stone in ureter where it is impacted or in a wider area such as renal pelvis. This study was carried out to clarify whether it is advantageous to breaking an upper ureter stone up where it is enclaved or in a wider area such as renal pelvis. Study Design: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included in our study and analyzed retrospectively. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: non-push-up group, Group 2: push-up group). Results: Laboratory findings were changed significantly in both groups before and after surgery. However, this change was not significant between the groups. Operation times were statistically similar in both groups in contrast with the literature. Stone-free rates were significantly higher in srURS than in flexible ureterorenoscopy (fURS) (p

Objectives: To report our single center experience in comparing mini-percutaneous nephrolithotomy versus flexible ureterorenoscopy for management of renal stones up to 2 cm in anomalous kidneys. Materials and methods: Records of the last 30 patients with stones less than 2 cm in anomalous kidney treated by mini-percutaneous nephrolithotomy were reviewed and compared to last 30 patients treated by flexible ureterorenoscopy. Results: Mean stone size was significantly higher in the minipercutaneous nephrolithotomy group (17.90 mm) than in flexible ureterorenoscopy group (14.97mm) (p < 0.001). Mean operative time (80.33 min vs 56.43 min) and fluoroscopy exposure time (4.49 min vs 0.84 min) were significantly higher in the mini-percutaneous nephrolithotomy group than in the flexible ureterorenoscopy group (p < 0.001). The mean post-operative drop in hemoglobin concentration was significantly higher in the mini-percutaneous nephrolithotomy group (0.47 gm versus 0.2 gm) (p < 0.001). Stone free rate after 12 weeks follow up was not statistically significant between the 2 groups (90% in minipercutaneous nephrolithotomy vs 80% in flexible ureterorenoscopy) (FEp = 0.472).Conclusions: Both modalities were found to be safe and effective for treatment of stones less than 2 cm in anomalous kidneys.

BACKGROUND Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. MATERIAL AND METHODS A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. RESULTS A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6-12 months). There were no medium-term complications reported. CONCLUSIONS SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.

Amac: Bu calismada ust kaliks tasi tedavisinde fleksible ureterorenoskopi uyguladigimiz obez hastalarin sonuclari analiz edilmistir. Gerec ve Yontem: Ocak 2015-Aralik 2018 tarihleri arasinda ust kaliks taslarina yonelik fleksible ureterorenoskopi uygulanan obez hastalarin verileri geri donuk olarak analiz edildi. Hastalarin demografik verileri, tas boyutlari, ameliyat sonrasi stent kullanimi, ameliyat sureleri, hastanede kalis zamani, komplikasyon ve tassizlik orani degerlendirildi. Bulgular: Calismaya 18'si erkek, 12'u kadin olmak uzere 30 obez hasta alindi. Hastalarin yas ortalamasi 52.6±12.06 yil idi. Ortalama tas boyutu 19.46±6.6 idi. Ortalama operasyon suresi 72.1±16.8 dakika ve ortalama hastanede kalis suresi 1.5±1.1 gun olarak hesaplandi. Basari orani %73.3 olarak belirlendi. Islem sonrasi hastalarin %76.6'sinda d-j stent uygulandi. Postoperatif takiplerinde 3 hastada siddetli kolik agri, 5 hastada kan transfuzyonu gerektirmeyen 24 saatten kisa suren hematuri ve 2 hastada uriner sistem enfeksiyonu goruldu. Hicbir hastada morbite veya mortaliteye neden olacak major komplikasyon izlenmedi. Sonuc: Obez hastalarda ust kaliks taslarinin tedavisinde yuksek tassizlik ve dusuk komplikasyon oranlariyla fleksible ureterorenoskopi etkin bir tedavi yontemidir.

Objectives: To evaluate the safety and effectiveness of flexible ureterorenoscopy (fURS) with holmium laser lithotripsy for treating kidney stones without fluoroscopy as method of best practice for patients and endourologists. Patients and Methods: All patients treated for kidney stones by fURS with holmium laser lithotripsy from February 2016 to February 2017 were retrospectively evaluated. The patients’ demographic characteristics, stone features (size, number, and location), surgical variables (use of fluoroscopy, operative and fluoroscopy time), complications, and success rate (employing stone-free rate [SFR]), were included in the analysis. Results: In all, 100 patients met the inclusion criteria: 33 fURS were performed under fluoroscopy (Group 1) and 67 without it (Group 2). The mean operating time was 94.33 vs 98.29 min (P = 0.888), respectively. The mean stone volume was 78.5 vs 82.4 mL (P = 0.885), respectively. The SFR was 63.6% and 64.2% (P = 0.771), the perioperative complications rate was 18.2% vs 11.9% (P = 0.285), and the postoperative complications rate was 24.2% and 10.4%, in groups 1 and 2 respectively (P = 0.174). Conclusions: fURS with holmium laser lithotripsy without fluoroscopy was a feasible and safe treatment for kidney stones. There was no difference between the use of fluoroscopy or not regarding complications or SFR. Thus, we can reduce the risks of radiation exposure to patients and medical staff whilst maintaining surgical success. However, multicentre randomised controlled studies are necessary to evaluate fluoroless URS further and to confirm our present results. Abbreviations: PTFE: polytetrafluoroethylene; SFR: stone-free rate; (f)URS: (flexible) ureterorenoscopy/ureterorenoscopies; US: ultrasonography

Context and objectives The first-line treatment for >2 cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2–3 cm stones. Material and methods Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with 3 cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective. Results Stone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8–29.0% in the FURS and 11.9–27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. Conclusions The stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.

Background: Preoperative bladder urine culture (PBUC) analysis has become a standard application before any stone surgery. When growth is detected in PBUC, it is contraindicated to perform flexible ureterorenoscopy (f-URS). The results of the PBUC susceptibility test do not correlate well with those of the renal pelvic urine culture (RPUC) analysis. Previous studies have demonstrated the positivity of RPUC as an important marker for the development of infections after endoscopic operations. In the current study, we aimed to evaluate the consistency between PBUC and RPUC and to identify preoperative markers associated with a positive RPUC. Methods: Data from 129 patients who underwent f-URS on renal and proximal ureteral stones in two centers between 2015 and 2020 were prospectively recorded in a database and retrospectively analyzed. PBUC was obtained from all the patients preoperatively, and RPUC was taken at the beginning of the f-URS operation. The results of the two cultures were compared. Results: There was growth in PBUC in 25 (19.4%) patients and RPUC in 35 (27.1%) patients. Possible predictive markers in predicting a positive RPUC were evaluated using multivariate logistic regression analysis. Preoperative urine density at the renal pelvis [odds ratio (OR): 0.848, p

Aim: Percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) are common surgical methods in the treatment of kidney stones. Possible effects on kidneys are an important factor in determining the surgical procedure and the surgical method. In our study, kidney injury molecule-1 (KIM-1) and myo-inositol oxygenase (MIOX) were used to compare acute kidney injury in patients that underwent PNL and RIRS. Material and Method:Eighty patients aged 20 to 75, who underwent PNL or RIRS in our urology clinic between November 2018 and February 2020 were included in the study. In this prospective study, the demographic characteristics, stone size, operation time, preoperative and postoperative hemoglobin and biochemistry values of the patients were recorded. 5 cc blood samples taken from the patients before the operation and at the fourth hour after the operation were centrifuged and kept at -80 °C, and the KIM-1 and MIOX levels were measured in the biochemistry department. Results: There was no difference between the groups in terms of demographic data; however,the operation time and length of hospital stay were significantly longer in the PNL group. The mean increase in MIOX was 10.583±9.73 ng/ml and 7.501±16.46 ng/ml in the PNL and RIRS groups, respectively. Although there was a statistically significant increase in both groups, this increase was greater in the PNL group. A significant increase was observed only in the PNL group in the postoperative period (p=0.003). Discussion and Conclusion:The findings of the study suggest that the PNL procedure causes more damage to the kidneys than RIRS.

OBJECTIVES To externally validate and compare Resorlu-Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito's nomogram, and Retrograde Intra-Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. MATERIALS AND METHODS We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. RESULTS Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2-84 years). Mean stone burden was 102.6 ± 42.2 (48-270 mm2 ). All nomograms predicted stone-free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito's nomogram was able to predict Clavien ≥2 complications. CONCLUSION All four scoring systems (RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S.) could predict stone-free status after f-URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.

Introduction: The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. Methods: We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, n: 55) and adult (group 2, n: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. Results: A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (p = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (p = 0.002; p = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (p < 0.001). Total CR was 13.8% and mostly Clavien I–II, and no difference was observed between the 2 groups (p = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; p = 0.554). On multivariate analysis, stone size (p < 0.001) and lower calyx stone (p < 0.001) were the negative predictive factors for SFR. Conclusion: There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.

Introduction Residual stone fragments remain a challenging topic for urologists following retrograde intrarenal surgery (RIRS). This study investigates the effectiveness of second-look flexible ureterorenoscopy (URS) to achieve a true stone-free status and decrease stone-related events. Material and Method A total of 176 consecutive patients treated with RIRS for kidney stones were included in the study. Patients were divided into two groups, group 1 receiving the standard of care (n=51) and group 2 receiving second-look flexible URS (n=125). In all cases, one or more calyceal stones of 1 to 4 mm were extracted with a basket at the time of stent removal. Unless earlier intervention was necessary, patients were followed up every six months to determine if they had experienced SREs. Results The mean follow-up time for the whole group was 21±11.1 months. The mean number of stones in group 1 and group 2 was 1.25±0.11 and 1.56±0.19, respectively. Postoperative stone-free rate after RIRS for group 1 and group 2 were 37.25% (n=19/51) and 40.8% (n=51/125), respectively. The SFR improved to 93.6% (n=117/125) in group 2. Multivariable analysis showed that type of intervention, stone size, and body mass index were independent prognostic factors for SREs. When group 2 was taken as a reference, the odds ratio for SREs was 8.48 (95% CI: 2.95–24.42) in group 1. Conclusion This study found that second-look flexible URS increased the SFRs and diminished the number of SREs. We propose performing second-look flexible URS following RIRS in the presence or suspicion of RSFs to provide better treatment results, less radiation exposure, and greater patient satisfaction. Key Words Retrograde Intrarenal Surgery, Flexible Ureteroscopy, Stone-free Rate, Residual stone Fragments, Stone-Related Event, Second-look Flexible Ureteroscopy.

Introduction: Although spinal anesthesia (SA) may reduce postoperative morbidity, most urologists perform flexible ureterorenoscopy (fURS) under general anesthesia (GA). The objective of our study is to provide technical details, results, complications, and patients’ satisfaction with fURS performed under exclusive SA. Methods: We analyzed all consecutive fURS performed under SA to treat renal stones from March 2011 to February 2017. Details of technique, operative time, outcomes, need for further treatments, complications, and patients’ satisfaction were evaluated. Results: Two hundred thirty-four fURS under SA were considered. SA was performed through L2-L3 vertebral interspace in 64.1%. Patients were discharged the same day of surgery. Mean stone burden was 13.5 ± 6.6 mm and mean operative time 76.9 ± 34.6 min. Single-procedure SFR was 69.7%. Further treatments were performed in 22.8%. 96.6% had no anesthesia-related complications. No Clavien-Dindo grade ≥ IIIb complications were noticed. 99.6% of patients were satisfied with SA. No cases of conversion from SA to GA occurred. Conclusion: fURS can be performed safely and efficiently under SA, taking into account a few details of the technique. Patients’ satisfaction with SA is very high, and complications are rare. Although SA is usually adopted in unfit patients for GA, it may be considered as a viable alternative in fit patients.

Purpose: Recently developed robotic devices may significantly compensate for ergonomic deficiencies of flexible ureterorenoscopy (FURS) respectively retrograde intra-renal surgery (RIRS). We want to update on current developments.

Aim: In this study, we aimed to demonstrate the effect of mirabegron on ureteral access sheath (UAS) placement during flexible ureterorenoscopy (f-URS).

Background The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS. Methods Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers. Results Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h. Conclusions Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS.

Introduction Renal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments. Stones most commonly develop in the lower pole of the kidney (in ~35% of cases) and here are least likely to pass without intervention. Currently there are three technologies available within the UK National Health Service to remove lower pole kidney stones: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) with laser lithotripsy. Current evidence indicates there is uncertainty regarding the management of lower pole stones, and each treatment has advantages and disadvantages. The aim of this trial is to determine the clinical and cost effectiveness of FURS compared with ESWL or PCNL in the treatment of lower pole kidney stones. Methods The PUrE (PCNL, FURS and ESWL for lower pole kidney stones) trial is a multi-centre, randomised controlled trial (RCT) evaluating FURS versus ESWL or PCNL for lower pole kidney stones. Patients aged ≥16 years with a stone(s) in the lower pole of either kidney confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) and requiring treatment for a stone ≤10 mm will be randomised to receive FURS or ESWL (RCT1), and those requiring treatment for a stone >10 mm to ≤25 mm will be randomised to receive FURS or PCNL (RCT2). Participants will undergo follow-up by questionnaires every week up to 12 weeks post-intervention and at 12 months post-randomisation. The primary clinical outcome is health status measured by the area under the curve calculated from multiple measurements of the EuroQol five dimensions five-level version (EQ-5D-5L) questionnaire up to 12 weeks post-intervention. The primary economic outcome is the incremental cost per quality-adjusted life year gained at 12 months post-randomisation. Discussion The PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options. Trial registration ISRCTN: ISRCTN98970319. Registered on 11 November 2015.

INTRODUCTION AND OBJECTIVE:Pressured irrigation is routinely utilised in treatment of urinary calculi by uretero-renoscopic surgery. Although this can be in multiple forms, standardised pneumatic p...

Purpose of review The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL). Recent findings In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models. Summary The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.

Background: Urolithiasis affects 5-15% of the world population, with high recurrence, (2) which at 5 years can be up to 50%, with high frequency in the labor force population, which produces a high individual and hospital cost, so it constitutes a health problem of high socio-sanitary interes. Objective: To compare the treatment outcomes of Flexible ureterorenoscopy and extracorporeal shock wave lithotripsy for patients with lower pole stones. Patients and method: Data base review for the patients in the period from first of Jan 2018 to the end of June 2019, in which 131 patients underwent interventions for the management of small lower pole stone. Sixty-seven patients were treated by ESWL and the rest (64) treated by F-URS. The most common complication was UTI 9/19 Results: 86/131 were male and 45/131 were female with mean age for F-URS group (52±9.7 years) and (49.6±12.3 years) for ESWL group, with highly significant differences regarding the stone size between the studied groups. The treatment rate, operative time and procedure per patient were highly significantly decrease in F-URS group than in ESWL (p

The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.

Objective: Urinary system stone disease is a very common health problem that affects 2 to 3% of people and causes serious complications when it is not treated. The prevalence of renal stones has been increasing worldwide and surgical methods have changed over time. However, there is no comprehensive bibliometric analysis of the retrograde intrarenal surgery (RIRS) method in the literature. This study aimed to conduct a bibliometric analysis of all articles regarding RIRS published between 1980 and 2019. Materials and Methods: The literature search was performed using only the following keywords: “RIRS” and “flexible ureterorenoscopy/flexible ureteroscopy”, in the “title” part of the search. Using this search method, all the articles published between 1980 and 2019 on this topic were accessed and downloaded from the Web of Science database, and the articles were analyzed using bibliometric methods. Results: Totally, 1378 publications were found as a result of the literature search, of which 619 were articles. We noted that there has been a rapid increase in the number of publications, especially from the year 2011. Turkiye was found to be the most productive country with regard to RIRS. The journals that contributed most to the literature were: Journal of Endourology, Urology, Journal of Urology, Urolithiasis, and World Journal of Urology. Conclusion: One of the notable findings of this study is that Turkiye is among the world countries that produced the highest number of publications with regard to this topic and that the hospitals where this technique is used the most are located in Turkiye. Amaç: Üriner sistem taş hastalığı, insanların %2 ila 3’ünü etkileyen ve tedavi edilmediğinde ciddi sorunlara neden olan çok yaygın bir sağlık sorunudur. Renal taşların prevalansı dünya çapında artmaktadır ve cerrahi yöntemler zaman içinde değişmiştir. Bununla birlikte, literatürde retrograd intrarenal cerrahi (RIRC) yönteminin kapsamlı bir bibliyometrik analizi yer almamaktadır. Bu çalışma 1980 ve 2019 yılları arasında yayınlanan RIRC ile ilgili tüm makalelerin bibliyometrik analizini yapmayı amaçlamaktadır. Gereç ve Yöntem: Literatür taraması sadece aramanın “başlık” kısmında “RIRC” ve “esnek üreterorenoskopi/esnek üreteroskopi” anahtar kelimeleri kullanılarak yapıldı. Bu arama yöntemi kullanılarak 1980-2019 yılları arasında bu konu hakkında yayınlanan tüm makalelere erişildi ve Web of Science veritabanından indirildi. Makaleler bibliometrik yöntemler kullanılarak analiz edildi. Bulgular: Literatür taraması sonucunda toplam 1378 yayın bulundu. Bu yayınlardan 619’u makaleydi. Özellikle 2011 yılından bu yana yayın sayısında hızlı bir artış olmuştur. Türkiye’nin RIRS konusunda en verimli ülke olduğu tespit edildi. Literatüre en fazla katkıda bulunan dergiler Journal of Endourology, Urology, Journal of Urology, Urolithiasis, and World Journal of Urology olarak bulundu. Sonuç: Bu çalışmanın dikkate değer bulgularından biri de Türkiye’nin bu konuda en fazla sayıda yayın yapan dünya ülkeleri arasında olması ve bu tekniğin en çok kullanıldığı hastanelerin Türkiye’de bulunmasıdır. WOS:000561681300005

Objectives: To investigate the operation time (OT) and ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT. Methods: We retrospectively analysed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analysed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. Results: A total of 575 patients were enrolled in the study. The rates of the usage of UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection (94.1 ± 14.2 and 68.01 ± 23.1, for groups 1 and 2, respectively, P

Introduction Saline solution is the standard irrigant used during ureteroscopy. However, there is an opinion that water has better visual clarity. We aimed to compare the visual clarities of saline, water, and 5% mannitol as an irrigant during ureteroscopy. Material and methods An in vitro model consisting of an irrigant-filled container and a fiberoptic flexible ureteroscope was designed. A 1951 USAF Resolution Test Target and color checker within irrigants were used to evaluate the clarity of vision. The visual clarity was compared for 0.9% saline, distilled water and 5% mannitol solution with screen resolution and color contrast. The tests were repeated after adding human blood (2/400 ml) and contrast (20/400 ml) to the irrigants. Results There was no significant difference in resolution values of three plain irrigants at a distance of 10 mm. However, when blood was added to the irrigants, a better resolution of 29.3% for water and 20.6% for mannitol was achieved compared to saline. At 20 mm of distance, it was observed that the difference was more pronounced in irrigants with blood. Water and mannitol had 55.6% and 37.1% better resolution than saline, respectively. In the color reproduction test, there was no significant difference in the three plain irrigants, however, water had better color contrast compared to the others. Conclusions Water and 5% mannitol did not provide a significant image clarity advantage compared to saline. However, when blood was added to the irrigants, water provided significantly better visual clarity compared to saline. The use of water during various clinical scenarios in flexible ureteroscopy should be further investigated.

In the present study, we aimed to clarify predictive factors that may cause postoperative infectious complications after flexible ureterorenoscopy (f-URS). In a 4-year prospective study, charts of patients who underwent f-URS between January 2014 and January 2018 for renal stone(s) in a tertiary academic center were reviewed. A standardized f-URS procedure was performed for all patients. Post-operative infectious complications including fever, sepsis and septic shock were categorized into same group. Patients with and without infectious complications were compared in the terms of preoperative, operative and post operative characteristics. In total, 463 patients who did not face infectious complications and 31 patients who faced infectious complications were enrolled into the study. The mean age was significantly lower in patients who did face infectious complications (34.8 vs 44.7 years old, p

Development of surgical expertise and technology has affected the way renal tract stones are treated. Our hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results. Our outcomes were reviewed. A retrospective case note review was performed for children with upper tract calculi who were treated by FURS. There were 56 stone episodes in 36 patients. Median age was 10.6 years. Stones were 3-23 mm (median 8 mm); 64.3% had multiple calculi. Median follow-up was for 17.1 months. After the first FURS there was stone clearance in 42/56 (75%). Although there were no immediate complications, two required re-admission; one with stent symptoms, the other with urinary infection. A second FURS was performed in 11, bringing the cumulative clearance to 89%, although this was often done as "another look" before stent removal. There was no statistically significant difference in stone clearance after first FURS for those with single stones (81.0%) compared to those with multiple stones (72.2%). Clearance rates of more than 70% after first FURS were achieved with stones of up to 17 mm. Unexpected disease was found and treated during FURS in 9 (16.1%) children. FURS is safe in children and good clearance rates are achieved. Multiple stones at different sites may be treated during the same treatment. In addition, FURS allows diagnosis and treatment of unexpected problems.

Aim: Although the advantage of ureteral double j(D/J) stenting has been shown in reducing post- operative pain afterureteroscopic surgery, its contribution to stone clearance for additionaltreatment has not been fully assessed. In this study we aimed to evaluate theeffect of stenting on stone free rates at the end of the additional treatment. Methods: We reviewed the medical records of allpatients who underwent flexible ureterorenoscopy (FURS) for kidney stonesbetween October 2009 and January 2015. Patients with malignant ureteralstricture, severe skeletal malformation, renal unit malformation, non-opaquerenal stone or lost to follow-up were excluded. 47 of 289 patients (stenting 24patients, non-stenting 23 patients) assessed. The perioperative andpostoperative parameters and stone-free rates were compared in patients whetherthey had intraoperative D/J stent (group 1) or not (group 2). Results: No differences were found between groups according to age, gender, body mass index, operation history, preoperative stenting history, shockwave lithotripsy history, ureteral stricture, stone size, access sheath rate, retreatment, or additional treatment number and stone location. Operation time was significantly higher in group 1. Those who refused additional treatment were insignificantly lower in group 1. Although the stone-free rates were similar for the two groups at the end of the first month, the stone-free rates after the additional treatments were significantly higher in group 1.Conclusion: Stenting during FURS, improved the stone-freerate on final follow-up, if residual stones remain., Amaç: Her ne kadar üreteroskopikcerrahi sonrası üreteral çift J uçlu (Double J-D/J) stent yerleştirilmesininpostoperatif ağrıyı azaltmaktaki avantajı gösterilmiş olsa da taşlarıntemizlenmesi ve ek işlem için hasta uyumuna etkisi tamolarak değerlendirilmemiştir. Biz bu çalışmada stent takılmasının ek tedavilersonunda taşsızlık oranlarına olan etkisini araştırdık.Yöntem: Kasım 2009 veOcak 2015 tarihleri arasında fleksibl üreterorenoskopi (FURS) uygulananhastaların tıbbi kayıtları gözden geçirildi. Maling üreteral darlık, ileriderecede iskelet malformasyonu, böbrek malformasyonu olan hastalar ve takiptençıkan hastalar çalışmadan çıkarıldı. 289 hastanın 47’si (24 stent takılan, 23stent takılmayan) değerlendirilmeye alındı. Operasyon sırasında D/J stenttakılan (grup 1) ve takılmayan (grup 2) hastaların perioperatif ve postoperatifparametreleri ve taşsızlık oranları karşılaştırıldı.Bulgular: Gruplararasında yaş, cinsiyet, vücut kitle indeksi, operasyon öyküsü, operasyon öncesistent yerleştirilmesi, şok dalga litotripsi hikayesi, üreteral darlık, taşboyutu, akses kılıfı kullanım oranı, tekrar tedavi, ek tedavi taş sayısı velokalizasyonu açısından fark yoktu. Stent uygulanan grupta anlamlı olarakoperasyon süresi uzun izlendi. Ek tedavileri red etme oranı grup 1’de dahadüşük izlendi. İlk ay sonunda taşsızlık oranları iki grup için benzer olmasınarağmen, ek tedavilerden sonra taşsızlık oranları grup 1’de anlamlı olarakyüksek izlendi. Sonuç: FURS sırasında stent yerleştirilmesi,rezidüel taşların kalması durumunda son takipte taşsızlık oranınıarttırmaktadır.