Ekrem Ozyuvali

Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones

OBJECTIVE We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated. RESULTS Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain. CONCLUSION According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.

Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy

PURPOSE To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated. MATERIALS AND METHODS We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL. RESULTS 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy. CONCLUSION We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Retrograd intrarenal cerrahi sonrası hastaların takibinde direkt üriner sistem grafisi ile birlikte ultrasonografinin etkinliği

Objectives: It was aimed to evaluate the effectiveness of combined use of ultrasonography (US) and plain radiography (PR) in the postoperative follow-up of patients undergoing retrograde intrarenal surgery (RIRS). Materials and methods: The charts of 207 patients who underwent RIRS for renal stones in a 3-years-period were retrospectively reviewed. Fifty-eight patients were included to study who were evaluated with combination of urinary US, PR and computed tomography (CT) at 1 month after surgery. Results: Of 58 procedures with perioperative complete stone fragmentation, 49 were completely stone-free (84.4%), while fragments (≥ 3 mm) were observed in 9 patients and hydronephrosis was detected in 5 patients (8.6%) on the CT. Of the 9 residual stones and 5 hydronephrosis, the radiologists truly diagnosed 6 stones (66.6%) and 5 hydronephrosis (100%) by using the combination of US and PR. The sensitivity, specificity, positive and nega tive predictive values of US and PR for detecting presence of residual stone and hydronephrosis were 66.6% and 100%, 98% and 98%, 85.7% and 83.3%, 94.2% and 100%, respectively. Conclusions: A combination of urinary US and plain film has clear advantages about lack of radiation exposure over CT scan and it is a highly specific and sensitive test for detecting hydronephrosis. However this procedure has limited accuracy for detecting small residual stones, so we believe that CT scan is only necessary when patient has persistent pain or sonographic evidence of hydronephrosis is present.

Üroloji Uzmanı Olmayan Doktorların Kadın Hastalarda Üriner İnkontinansa Yaklaşımları

Amac: Bu calismada uroloji uzmani olmayan doktorlarin kadin hastalarda uriner inkontinansa yaklasimlarini degerlendirmeyi amacladik Materyal ve Metod: Uroloji bransi disindaki 358 tip doktoruna 4 sorudan olusan kisa bir anket yapildi.Katilimcilara kadin hastalarda uriner inkontinansi sorgulayip sorgulamadiklari soruldu. Uriner inkontinans sorgulamasi yapanlara nasil bir yol izledikleri, sorgulamayanlara da bunun nedenlerine yonelik sorular yoneltildi. Ankete katilanlarin yas ortalamasi 31.3 yil olarak bulundu. Sonuclar: Ankete katilan doktorlarin 74’u (%20.6) tum kadin hastalarda rutin olarak uriner inkontinansi sorguladigini, 230’u (%64,2) uriner sistem semptomlari olanlarda 18’i (%3,3) ise yasli hastalarda ve eslik eden baska hastalik varliginda sorguladiklarini belirttiler. 36’si (%10) ise hastalarda uriner inkontinansi hic sorgulamadiklarini belirttiler. Uriner inkontinans sorgulamasi yapmayan hekimlerin en onemli mazeretleri ise uzmanlik alani olmamasi idi. Doktorlarin 62`si (%17.3) bunu primer isi olarak gormedigini, 60`i (%16.6) unuttugunu, 56`si (%15.6) yeterli zamani olmadigini, 20`si (%5.5) muayene ortaminin uygunsuzlugunu, 12`si (%3.3) yeterli bilgisi olmadigini, 6`si (%1.6) ise hasta tepkisinden cekindigini belirtti. Doktorlarin 102’si (%28.5) uriner inkontinans saptadiklari bayan hastalarini urolojiye, 58’i (%16.2) ise jinekolojiye konsulte ederken, 49’u (%13.6) tetkik isteyip sonuclariyla uroloji ya da kadin doguma konsulte ettigini, 8’i (%2.23) ise tetkik sonuclarina gore tedavi basladigini ifade etti. Tartisma: Bu calismada ki anket sonuclarina gore kadinlarda uroloji disindaki klinik bolumlerde uriner inkontinans yeterince sorgulanmamaktadir.