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    Comparison of Monoplanar and Biplanar Access Techniques for Percutaneous Nephrolithotomy
    (Mary Ann Liebert, Inc, 2015) Dede, Onur; Bas, Okan; Sancaktutar, Ahmet Ali; Daggulli, Mansur; Utangac, Mazhar; Penbegül, Necmettin; Hatipoglu, Namik Kemal
    Purpose: The aim of this study was to compare the positive aspects and complications of monoplanar and biplanar access techniques used in percutaneous nephrolithotomy (PCNL) based on the modified Clavien complication grading system. Patients and Methods: The data from patients who underwent PCNL using either monoplanar access (group 1) or biplanar access (group 2) techniques were analyzed retrospectively. For the biplanar technique, puncture is adjusted based on different fluoroscopic projections, including vertical and 30 degree positions. For the monoplanar technique, a C-arm fluoroscope was brought into vertical position, the collecting system was visualized with a contrast agent, and the most appropriate calix was selected to extract the targeted stone. Results: The monoplanar technique was performed for renal access in 310 patients (group 1), and the biplanar technique was used for renal access in 351 patients (group 2). There were no statistically significant differences between the two groups with regard to demographic data. The mean puncture time was significantly lower in group 1 (monoplanar) when compared with that of group 2 (biplanar, P=0.04). The overall success rates of the monoplanar and biplanar groups were 88% and 89% (including clinically insignifican residual fragments in 9% and 7%), respectively (P>0.05), and the complication rates of both groups were similar. Conclusion: The monoplanar access technique, which is safe to use, decreases puncture time, minimizes the surgeon's direct exposure time to radiation, and has similar success rates as the biplanar access technique.
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    Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones
    (Mary Ann Liebert, Inc, 2016) Bas, Okan; Dede, Onur; Aydogmus, Yasin; Utangac, Mazhar; Yikilmaz, Taha Numan; Damar, Erman; Nalbant, Ismail
    Purpose: To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. Materials and Methods: A retrospective analysis was made of pediatric patients aged < 18 years with kidney stones that ranged from 10 to 20mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. Results: In the RIRS group, the mean age of patients was 8.39 -4.72 years and in the micro-perc group, it was 5.62 -4.50 years (p = 0.01). The mean stone size was 12.80 -3.03mm in the RIRS group and 13.97 -3.46mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and microperc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 -0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. Conclusion: The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.
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    Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?
    (Aves Yayincilik, Ibrahim Kara, 2015) Dede, Onur; Sener, Nevzat Can; Bas, Okan; Dede, Gulay; Bagbanci, Muhammet Sahin
    Objective: The aim of the current study was to investigate whether obesity influences the outcome of extracorporeal shockwave lithotripsy (ESWL) treatment for upper ureteral stones. Material and methods: This is a retrospective study of 134 patients who underwent ESWL between June 2011 and May 2014. Patients were divided into 2 groups. Group 1 comprised 94 patients of normal weight, and group 2 comprised 40 morbidly obese patients. Patients in both groups had upper ureteral stones. Results: The mean age of groups 1 and 2 was 45.6 +/- 12.1 and 45.3 +/- 15.5 years, respectively (p=0.98). There was no significant difference in demographic variables between the groups. The mean stone size in Groups 1 and 2 was 81.7 +/- 25.7 mm(2) and 86.3 +/- 22.4 mm(2), respectively (p=0.51), the mean body mass index (BMI) was 27.4 +/- 2.9 and 42.9 +/- 2.1, respectively (p<0.01), the mean number of ESWL sessions was 2.4 +/- 0.6 and 2.4 +/- 0.7, respectively (p=0.97), and the mean follow-up time was 7.1 +/- 3.4 and 6.6 +/- 2.8 weeks, respectively (p=0.67). The overall stone-free rate was 82% in group 1 and 67% in group 2 (p=0.01). Conclusion: It is well-known that morbidly obese patients have higher rates of anesthesia-related problems due to the comorbidities commonly observed in this population. In the current study, we found that ESWL is a safe and acceptable treatment option for morbidly obese patients with upper ureteral stones.
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    Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience
    (Springer, 2017) Bas, Okan; Tuygun, Can; Dede, Onur; Sari, Sercan; Cakici, Mehmet Caglar; Ozturk, Ufuk; Goktug, Goksel
    To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. The mean patient age in the total procedures was 45.68 +/- 14.00 years (range 2-86 years), and the mean stone size was 15.15 +/- 8.32 mm (range 5-75 mm). The overall success rate was 95.6 %. A total of 209 (13.3 %) cases suffered from complications with intraoperative complications rates of 5.9 % and postoperative complication rates of 7.3 %. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value > 0.05). Complication rates were determined to be significantly affected by stone size (p = 0.026), multiplicity (p = 0.028) and the presence of congenital renal abnormality (p < 0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p = 0.02). The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.
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    Micro-percutaneous nephrolithotomy in infants: a single-center experience
    (Springer, 2016) Dede, Onur; Sancaktutar, Ahmet Ali; Bas, Okan; Daggullu, Mansur; Utangac, Mazhar; Penbegül, Necmettin; Soylemez, Haluk
    This study aimed to investigate the effectiveness and reliability of micro-percutaneous nephrolithotomy (micro-PNL) for the management of kidney stones in pediatric patients. This retrospective study included 24 infants that underwent micro-PNL for renal stones between March 2012 and April 2015. The inclusion criteria included: age younger than 2 years, stone size < 20 mm, absence of urinary tract malformations and active infection, and no coagulopathy. Stone-free rates were assessed one month postoperatively by ultrasonography (USG) and kidneys, ureters, bladder (KUB) radiography. Complications were classified according to the Clavien classification system. The mean age of the patients was 15.8 +/- A 7.8 months (range, 8-23) and the mean stone size was 13.5 +/- A 3.84 mm. Intra-renal access was achieved using USG in 11 patients and KUB fluoroscopy in 13 patients. The operation time and fluoroscopic screening time were 53.7 +/- A 10.35 and 1.4 +/- A 0.9 min, respectively. The mean hospital stay was 2.5 +/- A 0.8 days, and the mean drop in the hemoglobin level was 0.51 +/- A 0.34 g/dL. Bleeding requiring blood transfusion was not observed. A ureteral J stent was implanted perioperatively in four patients because of stone burden. Four patients complained of postoperative renal colic (Clavien grade 1) and postoperative fever was observed in two patients. Definitive success rates were as follows: the stone-free rate was 83.3 % (n = 20) and residual fragments were observed in four patients.
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    Stone Formation and Fragmentation in Forgotten Ureteral Double J stent
    (Derman Medical Publ, 2014) Bas, Okan; Sener, Nevzat Can; Ozgun, Serhat; Dede, Onur; Basar, Halil
    Am: Nowadays, ureteral stents play an essential role in various endourological and open surgical procedures and common procedures performed in daily urological practice. However, stents can cause significant complications such as migration, infection, fragmentation, stone formation and encrustation, especially when forgotten for a long period. Objectives: We present our experience in endoscopic management of forgotten ureteral stents with a brief review of current literature. Case presentation: A total of 2 patients with forgotten ureteral stents were treated with endourological approaches in our department. Indwelling durations were 18 months and 36 months. After treatment both patients were stone and stent free. Conclusion:An endourological approach is effective for stent and stone removal after a single anesthesia session with minimal morbidity and short hospital stay. However, therapeutic strategy is also determined by the technology available. The best treatment would be the prevention of this complication by providing detailed patient education.
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    Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: Both low pressure and high efficiency
    (Elsevier Sci Ltd, 2015) Dede, Onur; Sancaktutar, Ahmet Ali; Dagguli, Mansur; Utangac, Mazhar; Bas, Okan; Penbegül, Necmettin
    Introduction The management of urolithiasis in children differs from adults because of anatomic and metabolic abnormalities. At present, various minimally invasive and invasive treatment strategies have been recommended to treat urinary tract Stones, including shock wave lithotripsy (SWL), standard percutaneous nephrolithotomy (PNL), mini-PNL, retrograde intrarenal surgery (RIRS), micro-PNL, and a new technique termed ultra-mini PNL (UMP). UMP is a new method for the treatment of kidney stones. The main difference between UMP and standard PNL or mini-PNL lies in the small access sheath and in its design. A 9.5F pediatric compact cystoscope was used (Figure). A major advantage of UMP is that it provides similar stone-free rates when compared with standard PNL, with lower intrarenal pressure than micro-PNL. Objective The aim of the study was to determine the applicability and safety of UMP in the treatment of pediatric kidney stones. Patients and methods We retrospectively reviewed the files of 39 kidney stones in children who had undergone UMP between May 2011 and October 2014. The indications for UMP included stones resistant to SWL, stones requiring repeated sessions of SWL, and stones size larger than 20 mm. Results The study included 17 females and 22 males, with a mean age of 5.8 +/- 4.6 years. The mean hemoglobin loss was 0.9 +/- 0.6 mg/dL and none of the patients required a blood transfusion. The complication rate of the PNL procedure was 15.3% (n = 6). Complete clearance was achieved in 32 patients (82%) with UMP monotherapy, which increased to 34% (87.1%) 4 weeks after the operation. Discussion Management of urolithiasis necessitates a balance between stone clearance and morbidity related to the procedure. SWL often leads to persistent residual stones. The developing RIRS can minimize the risks associated with bleeding and visceral injury, but sometimes the abnormal pelvicaliceal anatomy and poor imaging of the flexible ureteroscopy may impact its success rate and applications. It has been reported that PNL can be performed safely and effectively to achieve a higher stone-free rate; however, it has serious complications such as bleeding that requires blood transfusion in 11-14% of the cases with increased risk of kidney loss. The recent development of smaller sheaths allows tract formation with minimal damage to the renal parenchyma, thereby reducing procedure-related morbidity without diminishing its therapeutic efficacy. Conclusion The most important advantage of this surgical technique that has been developed is similar stone-free rates to standard PNL and lower intrarenal pressure than micro-PNL. Our experience supports that UMP is safe and effective for the management of renal stones in children.