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Öğe Are small residual stone fragments really insignificant in children?(W B Saunders Co-Elsevier Inc, 2013) Dincel, Nida; Resorlu, Berkan; Unsal, Ali; Tepeler, Abdulkadir; Silay, Mesrur Selcuk; Armagan, Abdullah; Diri, AkifObjectives: To assess the significance of asymptomatic residual stone fragments of less than 4 mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children. Patients and Methods: Eighty-five children were followed up for 6 to 50 months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage. Results: During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p<0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p<0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p=0.079), stone growth (p=0.528), and symptomatic episodes (p=0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications. Conclusions: Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6 months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term CIRF is not appropriate for postoperative residual fragments in children. (c) 2013 Elsevier Inc. All rights reserved.Öğe Comparison of Scoring Systems in Pediatric Mini-Percutaneous Nephrolithotomy(Elsevier Science Inc, 2016) Utangac, Mehmet Mazhar; Tepeler, Abdulkadir; Daggulli, Mansur; Tosun, Muhammed; Dede, Onur; Armagan, AbdullahOBJECTIVE To apply urolithiasis scoring systems to the pediatric miniperc procedure and to compare their predictive capability for postoperative outcomes. MATERIALS AND METHODS Records from 2 referral centers of patients under 18 years of age who had the miniperc procedure between 2010 and 2015 were retrospectively investigated. All patients included in the study were graded by the same surgeon according to Guy's and Clinical Research Office of the Endourological Society (CROES) scoring systems using preoperative imaging methods. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. RESULTS The mean age of the 97 patients was 7.1 +/- 5.2 (1-17) years. The mean stone burden and number were 388.4 +/- 233.9 mm(2) and 1.5 +/- 1.3, respectively. The mean procedure, fluoroscopy, and hospitalization times were 78.2 +/- 32.8 minutes, 144.8 +/- 84.3 seconds, and 4.1 +/- 2.8 days, respectively. The mean hematocrit drop was calculated as 2.2 +/- 2.2. The mean scores were 1.7 +/- 1.0 and 259.9 +/- 50.6 for Guy's and CROES scoring systems, respectively. In the multivariate analysis, stone-free status was found to be associated with Guy's (r: -0.464, p: .000) and CROES (r: 0.490, : 0.000) scoring systems and stone burden (r: -0.161, p: .041). In the analysis of factors related to complication, Guy's score was identified as an independent predictor of complication (p: .02, odds ratio: 1.9, 95% confidence interval 1.097-3.319). CONCLUSION According to our results, using Guy's and CROES scoring systems, stone-free ratios after percutaneous nephrolithotomy may be predicted preoperatively. In addition, Guy's system is a predictor of postoperative complication rate. (C) 2016 Elsevier Inc.Öğe 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 KemalBackground 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.
