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Öğe Comparison of Guy's, STONE and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Eldery Patients(Coll Physicians & Surgeons Pakistan, 2021) Polat, Salih; Yarimoglu, Serkan; Koras, Omer; Sahan, Murat; Sefik, Ertugrul; Bozkurt, Ibrahim Halil; Degirmenci, TansuObjective: To evaluate the efficacy and reliability of Guy's (GSS), S.T.O.N.E., and CROES scoring systems developed to predict percutaneous nephrolithotomy (PCNL) outcomes in aged patients. Study Design: Descriptive study. Place and Duration of Study: Department of Urology, Ministry of Health University Izmir Bozyaka Training and Research Hospital and Department of Urology, Faculty of Medicine, Amasya University, Turkey, from April 2011 to January 2020. Methodology: Patients aged 65 years and over, who underwent PCNL for kidney stones, were retrospectively analysed. The patients' clinical and perioperative characteristics and the radiological features of the stones were obtained from the prospectively recorded data. GSS, S.T.O.N.E. and CROES nephrolithometry scores were calculated for each patient and their relation with stone-free status, complications, and perioperative findings were analysed. Results: A total of 147 patients were included in the study. Stone-free status was achieved in 76.0% of the patients, and complications developed in 27.2%. All three scoring systems were associated with stone-free status and complication development. GSS (OR=0.213,p=0.005) and S.T.O. N.E. (OR=0.601, p=0.042) scores were detected as independent markers for stone-free status, while the CROES score was not an independent marker. Only diabetes mellitus was determined to be an independent marker for the development of complications (OR=2.375, p=0.045). Conclusion: PCNL is an effective and safe treatment method with high stone-free rates in the treatment of large renal stones, but care should be taken in terms of cardiac risks. The results of this study showed that GSS and S.T.O.N.E. scoring systems were effective and reliable in predicting stone-free status.Öğe The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients(Wiley, 2021) Yarimoglu, Serkan; Sahan, Murat; Polat, Salih; Koras, Omer; Erdemoglu, Onur; Degirmenci, TansuObjectives In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. Materials and Methods Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. Results There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67 years in both the groups (P = .192). The stone size were 22.2 +/- 3.5 mm and 19.9 +/- 7.1 mm in the PCNL and RIRS group, respectively (P = .082). Stone-free rates were significantly higher in PCNL group (P = .021, P = .034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P = .016, P = .029). Conclusion Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.Öğe Does Access Location Influence Outcome of Percutaneous Nephrolithotomy in Staghorn Stones?(Coll Physicians & Surgeons Pakistan, 2021) Yarimoglu, Serkan; Sahan, Murat; Polat, Salih; Cesur, Gurkan; Koras, Omer; Degirmenci, TansuObjective: To assess the effect of lower and middle calyceal accesses on the outcomes of percutaneous nephrolithotomy (PCNL) in staghorn stones. Study Design: Observational study. Place and Duration of Study: Department of Urology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Turkey, from April 2012 to January 2019. Methodology: Patients who underwent PCNL for staghorn stones were retrospectively analysed. The patients were grouped as Group-1 (middle calyceal access) and Group-2 (lower calyceal access). Demographic and stone characteristics (size, density), perioperative and postoperative data, and stone-free rates were compared between these two groups. Postoperative detection of > 4 mm stones was defined as residual stones. Results: There were 249 patients in the study; 108 in middle calyceal access group and 141 in lower calyceal access group. The mean stone burden was 765 (524-1322) and 777 (490-1445) mm(2) in group-1 and group-2, respectively (p=0.876). The number of stone-free patients was 50 (46.3%) in middle calyceal access group and 93 (66.0%) in lower calyceal access group. The rate of stone-free status was significantly higher in lower calyceal access group (p=0.002). The overall complication rate was similar between the groups (p=0.132). The binary analysis showed that stone burden, and calyx of entry were predictive factors for success. Conclusion: Although the choice of the calyx to be entered does not affect the complication rate in staghorn stones, the stone-free rate is significantly higher in lower calyceal access.Öğe External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi-institutional study with 949 patients(Wiley, 2021) Bozkurt, Ibrahim Halil; Karakoyunlu, Ahmet Nihat; Koras, Omer; Celik, Serdar; Sefik, Ertugrul; Cakici, Mehmet Caglar; Degirmenci, TansuObjectives To externally validate and compare Resorlu-Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito's nomogram, and Retrograde Intra-Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. Materials and Methods We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. Results Of 949 patients 603 were male and 346 were female with a mean age of 47.2 +/- 14.3 (range 2-84 years). Mean stone burden was 102.6 +/- 42.2 (48-270 mm(2)). All nomograms predicted stone-free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito's nomogram was able to predict Clavien >= 2 complications. Conclusion All four scoring systems (RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S.) could predict stone-free status after f-URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.Öğe A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy(Brazilian Soc Urol, 2022) Sahan, Murat; Yarimoglu, Serkan; Polat, Salih; Nart, Bilal; Koras, Omer; Bozkurt, Ibrahim Halil; Degirmenci, TansuIntroduction: The present study aimed to investigate the factors of prolonged urinary leakage (PUL) after percutaneous nephrolithotomy (PCNL) and develop a new and simple scoring system to predict it. Patients and Methods: We retrospectively reviewed patients with renal stones who underwent PCNL at the University of Health Sciences Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020. The patients were divided into two groups according to the presence of PUL, and their preoperative and perioperative data were compared. A multivariate regression analysis was applied to examine the relationship between perioperative descriptors and PUL, and a nomogram was developed using significant predictors. Then, the individual components of the nomogram were assigned points to form a scoring system. Results: There were 92 and 840 patients in the groups with and without PUL, respectively. The results of the univariate logistic regression analysis showed that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy catheter were significantly associated with PUL. Subsequently, a multivariate regression analysis was carried out with these four factors as possible independent risk factors of PUL after PCNL. Based on the results of this analysis, a nomogram prediction model was developed with an area under the curve value of 0.811, which was consequently used to develop a new simple score system consisting of three characteristics: parenchymal thickness (1-5 points), duration of nephroscopy (1-3 points), and hydronephrosis grade (1-3 points). Conclusion: A novel scoring system is a useful tool for predicting PUL in patients who have undergone percutaneous nephrolithotomy.Öğe On-demand use of fesoterodine: a new paradigm for extended release antimuscarinics(Springer London Ltd, 2022) Bozkurt, Ibrahim Halil; Sefik, Ertugrul; Celik, Serdar; Yesilova, Arda; Koras, Omer; Degirmenci, TansuIntroduction and hypothesis We aimed to compare on-demand and continuous use of fesoterodine 4 mg concerning efficacy and adverse effects. Methods A total of 100 patients who were diagnosed with non-neurogenic overactive bladder (OAB) syndrome were included in the study. All patients were evaluated with MMSE, ICIQ-SF, SEAPI quality of health and OAB-V8 questionnaires, at the beginning, 1st month and 4th month. Fesoterodine 4 mg was started for treatment. At the end of the 1st month, patients who obtained benefit from the treatment were 1:1 randomized into two groups. In group 1, fesoterodine 4 mg was given 1 x 1 in a standard manner whereas in group 2 patients took the pills on demand. Both groups were evaluated for efficacy and adverse events at 4 months. Results Final analyses included 69 patients. At 4-month follow-up, OAB-V8 scores were significantly improved compared to 1 month in both groups. Again at h months, no difference was detected between the two groups for MMSE, ICIQ-SF and SEAPI scores. In continuous usage group, 4th month MMSE scores were significantly lower than 1st month scores. At 4 months, dry mouth and constipation were lower in the on-demand group compared to continuous usage group. Conclusions Compared to standard continuous usage, on-demand usage of fesoterodine showed similar efficacy with fewer adverse events.Öğe Safety and Efficacy of Flexible Ureterorenoscopy Surgery in Different Age Groups(Coll Physicians & Surgeons Pakistan, 2021) Koras, Omer; Bozkurt, Ibrahim Halil; Karakoyunlu, Ahmet Nihat; Polat, Salih; Yarimoglu, Serkan; Degirmenci, TansuObjective: To comparatively investigate the efficacy, safety and complications of flexible ureterorenoscopy (f-URS) in the treat-ment of patients of different age groups ( 60, 60-74 and 60 years (Group 1), 60-74 years (Group 2) and _75 year (Group 3). The patients' American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), anticoagulant use, stone-free rates and surgical and medical complication rates were examined for each group. Results: There were 688 patients in Group 1, 230 in Group 2, and 38 in Group 3. A significant difference was observed between the age groups in terms of CCI and anticoagulant use (p<0.001 for both). The highest rate of medical complications was observed in Group 3 at 42.1%, followed by Group 2 at 17.8%, while the lowest rate was observed in Group 1 at 2.3% (p<0.001). As a result of the multivariate analysis, receiving anticoagulant treatment (p=0.002) and having a high CCI (p=0.005) were independent predictors of medical complication development. Conclusion: It was clearly demonstrated that f-URS could be used as a safe and effective alternative for the treatment moderate-size kidney stones in all age groups.
