Okan Istanbulluoglu

Contemporary Management of Medium-Sized (10–20 mm) Renal Stones: A Retrospective Multicenter Observational Study

PURPOSE To evaluate contemporary management approaches to medium-sized (10-20 mm) renal stones. PATIENTS AND METHODS A total of 935 patients treated for medium-sized renal stones (10-20 mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. RESULTS The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. CONCLUSION Although SWL is the preferred treatment option for patients with medium-sized (10-20 mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.

Laparoscopy-assisted tubeless percutaneous nephrolithotomy in previously operated ectopic pelvic kidney with fragmented J–J stent

Nephrolithiasis management within an ectopic kidney presents a challenge to the urologists. Several treatment modalities are possible in this group of patients. Although percutaneous nephrolithotomy (PNL) is an accepted treatment modality in anatomically normal kidneys, ectopic pelvic kidneys require a different and more complicated approach for PNL. We recently treated a 24-year-old patient with calculus and an encrusted J–J stent fragment in pelvic ectopic kidney with a previous history of open pyelolithotomy. Laparoscopy-assisted tubeless percutaneous nephrolithotomy was performed. The technique and the patient characteristics are reported.

Evaluation of applied laparoscopic urology course using validated checklist.

The applied short-term laparoscopic course is an effective format particularly for laparoscopic skills in which suturing and knot tying are essential.

Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi.

OBJECTIVE We aimed to present the technique of combination of standard percutaneous nephrolithotomy (PNL) with microperc for achieving higher success rates without increasing complication rates in the management of complex renal calculi. MATERIAL AND METHODS The patients who underwent microperc procedure as a complementary procedure to standard PNL for complex kidney stones in two reference hospitals between 2013 and 2015, were evaluated retrospectively. RESULTS All patients underwent a total of two accesses one for standard PNL and one for microperc. The mean stone size was measured as 54.3 mm. The procedures were completed after an average operative time of 88.2 minutes and fluoroscopy time of 5.3 minutes. Stone free status was achieved in 18 cases (78.2%) and small residual fragments (≤4 mm) were detected in 3 cases (13.1%). Complications were seen in three patients (13%) as hemorrhage in one and postoperative fever in two patients. CONCLUSION Despite the limitations of this study, the combination of standard PNL and microperc might reduce the complication rates and increase the success rates when treating complex kidney stones. Future prospective and comparative studies are needed.