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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 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 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 Retrospective Analysis of the Factors Affecting Intraoperative and Immediate Postoperative Complications of Retrograde Intrarenal Surgery Classified by the Clavien and Satava Grading Systems(Mary Ann Liebert, Inc, 2021) Koras, Omer; Bozkurt, Ibrahim Halil; Karakoyunlu, Ahmet Nihat; Celik, Serdar; Sefik, Ertugrul; Yarimoglu, Serkan; Polat, SalihBackground: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13mm (range 10-20mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p=0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (p<0.001, p<0.001, p<0.001, p<0.001, p=0.002, and p<0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade 3 complications according to MCCS (p=0.032). However, significant predictors were stone burden (p<0.001), stone density (p=0.002), and fluoroscopy time (p<0.001) for those with Grade >= 2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.
