Vol 14 Issue 1

Objective: To evaluate the effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic nephrectomies performed in a single center on intraoperative and early postoperative results.

Material and Methods: A total of 42 patients who were scheduled for laparoscopic nephrectomy in our clinic in 2019 and 2020 were included in the study. Transperitoneal laparoscopic simple/radical nephrectomy was performed in 21 patients (15 women, 6 men) with the 3D endovision system and in 21 patients (10 women, 11 men) with the 2D endovision system. Demographic characteristics of the patients (age, gender), operation time, the difference between preoperative and postoperative hemoglobin values, length of hospital stay, and complication rate were compared.

Results: Median age was 30 (9-74 years), mean operative time was 135.7 minutes, and the difference between preoperative hemoglobin value and postoperative hemoglobin value was calculated as 1.17 g/dl in 21 patients who used 2D. Radical nephrectomy was performed in 4 patients and simple nephrectomy in 17 patients. Clavien-Dindo grade 1 complication was seen in one patient. The median age was 46 (16-73), the mean operative time was 128.6 minutes, and the difference between preoperative and postoperative hemoglobin values was 0.7 g/dl in 21 patients using 3D. Radical nephrectomy was performed in 10 patients and simple nephrectomy in 11 patients. No complications developed in the patients. In the comparison between the two groups, the difference between the preoperative hemoglobin value and the postoperative hemoglobin value was found to be significant (p: 0.041).

Conclusion: The depth perception provided by 3D endoscopic imaging systems allows for an easier understanding of anatomy and faster and easier dissection. With the ease of dissection, the amount of bleeding during the operation is reduced, bleeding areas are detected faster, and control can be achieved faster.

Keywords: three-dimensional, two-dimensional, laparoscopy, nephrectomy

Objective: Renal parenchymal volume known as an indicator of the number of nephrons in the kidney. We predict that the increase in renal parenchyma volume will increase diuresis and facilitate the excretion of fragments after RIRS procedure. Therefore, increased renal parenchymal volume might be suggested as a factor affecting the success of RIRS procedure.

Material and Methods: Out of 238 patients who underwent RIRS in our clinic, 104 patients who underwent primary RIRS due to single kidney stone and who underwent contrast-enhanced computed tomoghraphy were included in the study. The demographic, clinical and radiological (renal parenchymal volume and total renal volume) datas of all patients included were evaluated. Patients were divided into 2 groups according to the success status after RIRS, as successful and unsuccessful groups.

Results: There was no significant difference in total renal volume between the two groups (213.3±54.9 cm3 in the successful group, 204.4±65.7 cm3 in the unsuccessful group, p=0.521). While the mean renal parenchymal volume in the successful group was 168.3±46.1 cm3 , it was 125.5±29.9 cm3 in the unsuccessful group, and the difference was statistically significant (p<0.001). In the ROC analysis, the cut-off value for renal parenchymal volume predicting the presence of residual stones after RIRS was found to be ≤141.3 cm3. According to multivariate logistic regression analysis, elevated stone burden (OR=1.02; 95% Cl=1.009-1.03; p<0.001), localized stones in the lower pole (OR=31.673; 95% Cl=3.315-302.623; p=0.003 ) and RPV≤141.3 cm3 (OR=5.923; 95% Cl=2.886-19.263; p=0.008) were found to be independent risk factors for success of RIRS procedure.

Conclusion: Renal parenchymal volume is a practical and cost-effective parameter that can be used to predict success rates in patients undergoing RIRS for kidney stones.

Keywords: renal parenchymal volume; RIRS; stone; success; total renal volume

Objective: Retrograde intra renal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are common endoscopic surgical procedures. In our study, qualification of the Turkish residents for RIRS/PCNL, the education techniques and models are evaluated by a national based survey.

Material and Methods: The techniques used in education, qualification of the education and expectations about the education were main focus. Questionnaire was sent to total of 295 residents who are registered to Turkish European Society of Residents in Urology (ESRU) database. A total of 70 (23%) urology residents answered. SurveyMonkey is used for composing and distribution of the surveys. The results were evaluated statistically.

Results: Total of 70 participants involved our survey and the rates of first, second, third, fourth, fifth years of residents were 14%, 23%, 23%, 12.7%, 25% respectively. The rates of the residents from training and research hospitals and university were 46.77% and 53.23% respectively. The participants were from all over the country and there were participants from all 7 geographical regions of Turkey. The rate of residents who felt they will become capable of doing RIRS after their residency education program was 63.08% and 36.92% of the residents expressed the RIRS training they took is not enough to perform this procedure after graduation. Assistance and observation are used as the only training method for 39.2% and 49.2% of residents for RIRS and PCNL respectively. In addition, being a primary surgeon is used as a method of training by 55.38% and 50.7% of residents for RIRS and PCNL respectively. PCNL was performed by all the hospitals who were involved in the questionnaire. PCNL training course is needed by 15.38% of participants. The percentage of the residents who can’ t perform RIRS in their hospital was 15.38%. RIRS training course was needed by 15.38% of participants.

Conclusion: RIRS and PCNL are common endoscopic surgical processes in Turkey. It’s been thought to be useful to make the courses more common which residents feel important for their education and to make residents eager about PCNL/RIRS education.

Keywords: RIRS, PCNL, resident, Turkey, education

Objective: Ureteral double J (Dj) stents placed after ureterolithotripsy often have negative effects on the patient’s comfort. In our study, we aimed to compare the postoperative quality of life (QoL) and postoperative complication rates of the patients with a smaller diameter (4 Fr) Dj stent and the most frequently used 4.7 Fr Dj stent.

Material and Methods: Patients who had ureterolithotripsy at two centers between January 2021 and December 2021 and met the inclusion criteria were divided into two groups as those with 4 Fr and 4.7 Fr Dj stent placement. Patients with complete fragmentation, no residual stones, and a stone size of 10 mm or smaller were included in the study. Data were obtained from the hospital automation system and patient files. The physical and mental components of the patients were evaluated separately with the SF-12 (Short form-12) QoL scale in the first postoperative week. Postoperative complications such as emergency admission due to stent intolerance, analgesic requirement, stent migration, and postoperative urinary system infection (UTI) were also evaluated until Dj stents were removed in the third postoperative week.

Results: A total of 60 patients, 30 patients in each group, were included in the study. The physical component score of the SF-12 scale was higher in the first postoperative week in patients with a 4 Fr DJ stent (48.8 vs. 43.9, p= 0.005, respectively), and similarly, the mental component was higher in this group (53.9 vs. 46.4, p= 0.001, respectively). There was no statistically significant difference in terms of postoperative complications in both groups.

Conclusion: Although both stent types have similar post-operative complication rates, the 4 Fr Dj stent after ureterolithotripsy affects the quality of life of patients less negatively than the 4.7 Fr Dj stent.

Keywords: Postoperative complications, quality of life, stent, ureteroscopy