Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Treating 20-40 mm Renal Stones.

PURPOSE: To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones between 20 and 40 mm in diameter. MATERIALS AND METHODS: 146 patients, who were treated with RIRS and 146 patients, who were treated with PCNL for renal stones between 20 and 40 mm in diameter were compared retrospectively using a matched-pair analysis. The operative and post-operative outcomes of both groups were analyzed retrospectively. RESULTS: The mean age, gender, body mass index and stone laterality were similar between the groups. The mean stone size was 28.39 ± 4.67 mm for the PCNL group and 25.08 ± 6.07 mm for the RIRS group (P =.21). The mean operative times were statistically longer in the RIRS group, whereas the fluoroscopy times, hospitalization times and post-operative visual analogue scores were statistically higher in the PCNL group. The stone- free rates (SFR) after a single procedure were 91.7% in the PCNL group and 74% in the RIRS group (P = .04). After auxiliary procedures, the overall SFRs reached 94.4% for the PCNL group and 92.3% for the RIRS group (P = .52). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 6.8% and 3.4% for the PCNL and RIRS group, respectively (P =.18). CONCLUSION: RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times and less post-operative pain in treating renal stones between 20 and 40 mm in diameter. However, PCNL has a higher SFR with only a single session.

Treatment of renal stones with flexible ureteroscopy in preschool age children.

The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age (<7 years) children. From September 2005 to May 2013, a total of 65 children (31 boys and 34 girls) with 72 renal stones were treated using RIRS. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. In the presence of residual calculi >4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 ± 1.99 years (6 months-7 years) were included in the present study. The mean stone size was 14.66 ± 6.12 mm (7-30 mm). The mean operative time was 46.47 ± 18.27 min. In 5 (7.69%) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3% after the first and second procedures, respectively. Complications were observed in 18 (27.7%) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2%) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4%) patients, and ureteral wall injury (Clavien III) was noted in 2 (3%) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children.

Impact of PSA and DRE on histologic findings at prostate biopsy in Turkish men over 75 years of age.

Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.

The impact of body mass index on the outcomes of retrograde intrarenal stone surgery.

OBJECTIVE: To compare the outcomes of using retrograde intrarenal surgery (RIRS) for treating renal stones among normal weight, overweight, and obese patients. MATERIALS AND METHODS: From December 2008 to March 2012, 207 patients who underwent RIRS were included in the study. Patients were categorized into 3 groups according to their body mass index (BMI): normal weight <25 kg/m(2) (group 1), overweight 25-29.9 kg/m(2) (group 2), and obese ≥30 kg/m(2) (group 3). We compared the 3 groups with regard to preoperative characteristics, operative parameters, and postoperative outcomes. RESULTS: There were no significant differences in age, gender, or renal stone parameters (size, localization, laterality, multiplicity) among the 3 groups. The mean stone sizes were 18.6 ± 7.1 mm in group 1, 16.9 ± 7.0 mm in group 2, and 18.5 ± 8.4 mm in group 3 (P = .365). The stone-free rates (SFRs) of a single procedure for the groups were 79.0%, 77.9%, and 75.5% for groups 1, 2, and 3, respectively (P = .897). After additional treatments, the final SFR for the groups increased to 85.2%, 84.4%, and 81.6% for groups 1, 2, and 3, respectively (P = .861). We did not find any significant differences among the groups with regard to the operation times, complication rates, and hospital length of stay (LOS). Major complications were not observed either during or after the operations. CONCLUSION: Our study demonstrates that the outcomes of RIRS for treating renal stones are similar in overweight and obese patients when compared with patients who are of normal weight. Therefore, these patients can be treated safely and successfully with RIRS.