The Effect of Ureteral Access Sheath Use/Caliber Change on Outcomes of Retrograde Intrarenal Surgery, Short-Term Kidney Functions, Radiation Exposure, Ureteroscope Lifetime, and Factors Predicting Insertion Failure: A RIRSearch Study.

Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = -0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.

Trifecta Outcomes of Laparoscopic Partial Nephrectomy for T1a and T1b Renal Tumors: A Single-Center Experience in a Tertiary Care Institution.

Objective: To assess the effectiveness and safety of laparoscopic partial nephrectomy (LPN) in T1a and T1b renal tumors using "Trifecta" in partial nephrectomy and determine the predictive factors in respect to the criteria that constitute Trifecta. Materials and Methods: We retrospectively analyzed the data harvested from the patients who underwent LPN for T1a or T1b tumors. Preoperative, perioperative, and postoperative outcomes were evaluated and analyzed. Patients who had grade <2 Clavien complications, negative surgical margins, and minimal renal function deterioration (warm ischemia time [WIT] ≤25 minutes and ≤15% postoperative estimated glomerular filtration rate [eGFR] decrease) were acccepted to fit the strict Trifecta outcomes. Multivariate analysis was done using logistic regression test to determine the predictive factors affecting Trifecta. Results: A total of 128 patients underwent LPN. Of these, 65 (50.8%) patients had cT1a and 63 (49.2%) patients had cT1b renal tumors. The mean age was 55.8 (24-85) years. Mean operative time was 143.6 (100-200) minutes. A total of five (3.9%) patients had positive surgical margins. Mean WIT was 22.1 minutes. Ten patients (7.8%) had a >15% decrease in eGFR after surgery. Complications were observed in 11 (8.6%) patients. A total of 78 (60.9%) patients had strict trifecta outcomes. Tumor size was found to be a predictive factor affecting Trifecta at multivariate analysis. Conclusions: LPN procedure has been shown to demonstrate improved strict Trifecta outcomes in patients with T1a and T1b renal tumors. Only the tumor size was found to be a predictive factor regarding the Trifecta criteria.

The Clinical Effect of Bipolar and Monopolar Transurethral Resection of the Prostate More Than 60 Milliliters.

OBJECTIVE: To compare the effect, safety, and complication rates of monopolar vs bipolar transurethral prostate resection (TURP) in patients with prostate gland larger than 60 mL. PATIENTS AND METHODS: Patients with prostate gland larger than 60 mL who were scheduled for surgery because of benign prostatic hyperplasia were randomized into bipolar or monopolar TURP arms via software program with a 1:1 ratio. Preoperatively and postoperative sixth hour and first day, hemoglobin and serum sodium levels were measured. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL), and International Index of Erectile Function scores were determined, and maximal flow rate and residual urine volume were calculated in the preoperative period and postoperative sixth month. Postoperative clot formation, blood transfusion rates, and other complications were recorded on a database. RESULTS: Of 81 patients included in the study, 45 (55.5%) underwent monopolar and 36 (44.5%) underwent bipolar TURP (M-TURP and B-TURP groups, respectively). The only statistically significant change between the preoperative and the postoperative variables was detected in sodium levels, which were -5.0 mmol/L and -1.2 mmol/L in the M-TURP and B-TURP groups, respectively (P = .001). Although 2 of the patients in the M-TURP group experienced transurethral resection syndrome, none of the patients in the B-TURP group experienced this complication (P = .584). CONCLUSION: Bipolar and monopolar TURP showed similar effect and safety in patients with prostate glands larger than 60 mL. The only significant difference between the 2 groups was the greater decrease in serum sodium levels in the M-TURP group.