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    Does aging affect the outcome of percutaneous nephrolithotomy?
    (Springer, 2015) Buldu, Ibrahim; Tepeler, Abdulkadir; Karatag, Tuna; Bodakci, Mehmet Nuri; Hatipoglu, Namik Kemal; Penbegül, Necmettin; Akman, Tolga
    To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 +/- 15.5 vs. 31.5 +/- 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.
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    Preoperative evaluation of pediatric kidney stone prior to percutaneous nephrolithotomy: is computed tomography really necessary?
    (Springer, 2013) Tepeler, Abdulkadir; Sancaktutar, Ahmet Ali; Taskiran, Mehmet; Silay, Mesrur Selcuk; Bodakci, Mehmet Nuri; Akman, Tolga; Tanriverdi, Orhan
    The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged a parts per thousand currency sign18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 +/- A 1.3 vs. 0.9 +/- A 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children.
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    The Role of Microperc in the Treatment of Symptomatic Lower Pole Renal Calculi
    (Mary Ann Liebert, Inc, 2013) Tepeler, Abdulkadir; Armagan, Abdullah; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk; Penbegül, Necmettin; Akman, Tolga; Hatipoglu, Namik Kemal
    Background and Purpose: The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi. Patients and Methods: We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F all-seeing needle with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 mu m holmium: yttrium-aluminum-garnet laser fiber. Results: A total of 21 patients (mean age 37.3 +/- 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 +/- 6.0 kg/m(2), and the mean stone size was 17.8 +/- 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 +/- 25.2 minutes and 150.5 +/- 92.8 seconds, respectively. The patients were discharged after a mean 37.5 +/- 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 +/- 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe. Conclusion: Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.