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Prof.Dr. R. Gökhan ATIŞ
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Original Article
The Effect of Ureteral JJ Stent Removal Methods on Pain Intensity in Male Patients Under Local Anesthesia
Emre Hepşen, İsmail Emre Ergin
Abstract
Objective: Ureteral stents are commonly used, especially in the treatment of ureteral stones, and are removed endoscopically after a certain period following the procedure. The removal of these stents under local anesthesia, particularly in male patients, can cause pain. Rigid cystoscopes are typically used, but the use of thinner and more flexible endoscopic instruments is considered an alternative to reduce pain. This study aims to compare the pain experienced during Double-J stent removal using a rigid cystoscope versus a semirigid ureterorenoscope (URS).
Materials and Methods: Our study included patients who underwent unilateral endoscopic ureteral stone treatment followed by Double-J stent placement. Patients were divided into two groups based on whether their stent removal was performed using a rigid cystoscope or a semirigid URS. All stent removals were performed by the same surgeon. Immediately after the ureteral stent removal, the pain score was evaluated and recorded by the operating physician using the Visual Analog Scale (VAS).
Results: Among the 120 patients included in the study, 57 (47.5%) were in the cystoscopy group (group 1) and 63 (52.5%) were in the URS group (group 2). There was no significant difference between the groups in terms of stent side (p=0.47) and average age (p=0.16). However, group 1 had a significantly higher VAS score (3.6±1.7) compared to group 2 (1.9±0.8) (p<0.001).
Conclusion: Due to the long and complex structure of the male urethra, men may experience more pain than women during ureteral stent removal under local anesthesia. Our study found that the use of semirigid URS caused less pain than a rigid cystoscope. Flexible cystoscopes are not commonly used due to their high cost and durability issues, while semirigid URS presents a more cost-effective alternative. The single-center and small sample size of our study indicates the need for larger-scale studies. In conclusion, semirigid URS causes less pain compared to rigid cystoscopes in male patients and is better tolerated.
Keywords: local anesthesia, stent removal, ureteral stone, VAS score
Original Article
Factors Affecting Forgotten Ureteral Stents
Çağrı Coşkun, Uğur Aydın, Kayhan Tarım, Engin Dereköylü
Abstract
Objective: Ureteral double-J (DJ) stents are frequently used in urology. Overdue or forgotten DJ stents are associated with many complications. This study will examine the factors affecting the stent forgetting period of patients with forgotten DJ stents.
Materials and Methods: It was reviewed by Ağrı İbrahim Çeçen University Scientific Research Ethics Committee and approved with the decision numbered 108 dated 27.03.2025. Data from 12 patients with DJ stent indwelling longer than 6 months between January 2017 and December 2024 at Ağrı Training and Research Hospital, a rural tertiary center in Türkiye, were examined. Two groups were formed according to the median stent indwelling time: short-term (group 1) and long-term (group 2). The patient’s age, gender, DJ stent placement indication, additional endourological procedure need and duration, restenting rates, and distances to the hospital were compared.
Results: There was no difference between the two groups regarding gender, indication for stent placement, additional endourological procedures, and restenting rate after additional endourological procedures. The mean age was 43.5 years (SD: 11) in group 1 and 61.3 years (SD : 9.5) in group 2 (p: 0.012). Median additional endourological procedures’ duration was 37.5 minutes (IQR:27.5-40) in group 1 and 67.5 minutes (IQR: 52.5-87.5) in group 2 (p = 0.005). Median distance to the hospital was 38.5 kilometers (IQR: 19.25-77.75) in group 1 and 85.5 kilometers (IQR: 75.75-91.5) in group 2 (p = 0.037).
Conclusion: Our study concluded that patients whose DJ stents were forgotten for longer were older and resided in a center farther from the hospital. It would be beneficial to be careful, especially in this patient group.
Keywords: distance, encrustation, forgotten ureteral stent
Original Article
Relationship of Muscle Mass Based on Psoas Muscle Index and Skeletal Muscle Index with Recurrence and Mortality Risk in Localized Renal Cell Carcinoma: A Comprehensive
Yusuf Arıkan, Deniz Noyan Özlü, Büşra Emir, Hakan Polat, Mehmet Zeynel Keskin
Abstract
Objective: We aimed to determine the relationship between the Psoas Muscle Index (PMI) and Skeletal Muscle Index (SMI) and the risk of recurrence and mortality in patients with localized Renal Cell Carcinoma (RCC).
Material and Methods: SMI and PMI values were obtained from non-contrast computed tomography (NCCT) measurements on slices at the L3 level, normalized by height. Available survival data, including overall survival (OS) and recurrence-free survival (RFS), were collected at postoperative follow-up. Disease recurrence was defined as radiological evidence of disease on computed tomography (CT), magnetic resonance imaging, or bone scan.
Results: In the ROC analysis, the optimal cut-off value for PMI was ≤ 5.1 cm²/m² and ≤ 3.1 cm²/m² in male and female patients, while the cut-off value for SMI was ≤ 44 cm²/m² and ≤ 30 cm²/m² in male and female patients. In multivariate analyses, female gender, recurrence, clinical T stage ≥ T3b, pathological T stage ≥T3b, and sarcopenia according to PMI and SMI were independent predictors of worse OS and RFS (p < 0.001). In Kaplan-Meier analysis, OS in patients with and without sarcopenia was 74 vs 85 months (p < 0.001), respectively. RFS were shorter in patients with sarcopenia (PMI: 76 vs 84, SMI: 74 vs 85 months, both p < 0.001)
Conclusion: In patients with localized RCC, sarcopenia was associated with earlier recurrence, shorter OS, and RFS. Patients with sarcopenia had a worse prognosis in preoperative staging.
Keywords:psoas muscle index, renal cell carcinoma, sarcopenia, skeletal muscle index
Original Article
Does Timing of Retrograde Intrarenal Surgery Following Extracorporeal Shock Wave Lithotripsy Failure Influence the Outcomes?
Özgür Arıkan, Ferhat Keser, Ayberk İplikçi, Özgür Kazan, Ahmet Keleş, İlkin Hamid-zada, Muhammet Talha Nuroğlu, Adnan Başaran, Meftun Çulpan, Asıf Yıldırım
Abstract
Objective: The objective of this study is to determine the impact of the timing of retrograde intrarenal surgery (RIRS) following extracorporeal shock wave lithotripsy (SWL) on renal stone treatment outcomes.
Material and Methods: This retrospective study included 138 patients who underwent RIRS for renal stones after at least two failed SWL sessions between 2020 and 2024. Patients were divided into three groups based on the time interval between SWL and RIRS: 7-14 days (group 1), 15-22 days (group 2), and 23-30 days (group 3). Demographic data, stone characteristics, operative time, stone-free rate, and complication rates were compared.
Results: Stone-free rates were similar across the three groups (group 1: 85.4%, group 2: 84.8%, group 3: 86.3%, p=0.978). There were no statistically significant differences between the groups in terms of median operative time (p=0.249), median length of hospital stays (p=0.865), perioperative complications (p=0.884), or postoperative complications (p=0.962).
Conclusions: The timing of RIRS after failed SWL does not appear to impact treatment outcomes for renal stones significantly, and these findings suggest flexibility in scheduling RIRS after SWL failure.
Keywords: endourology, extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, timing, urolithiasis
Original Article
The Effects of Holmium Laser Enucleation of the Prostate (HoLEP) on Urodynamic Parameters and Bladder Function: A Retrospective Analysis
Yunus Çolakoğlu, Çağrı Şevik, Emre Korkmaz, Metin Savun, Abdülmuttalip Şimşek
Abstract
Objective: This study evaluates the impact of Holmium Laser Enucleation of the Prostate (HoLEP) on urodynamic parameters and bladder function in patients with benign prostatic hyperplasia (BPH).
Material And Methods: A retrospective analysis was conducted on 44 patients with urodynamically confirmed BPH who underwent HoLEP in a tertiary care center. Preoperative and 6-month postoperative assessments included the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual (PVR) volume, and urodynamic studies measuring detrusor pressure, maximum flow rate (Qmax), bladder outlet obstruction index (BOOI), and detrusor overactivity (DO). Statistical comparisons were conducted using paired t-tests, Wilcoxon signed-rank tests, and McNemar’s test.
Results: Significant improvements were observed post-HoLEP, including a reduction in IPSS (22.0 ± 7.0 to 6.1 ± 5.0, p<0.001), daytime frequency (7.4 ± 1.5 to 5.8 ± 1.2, p=0.01), nocturia (3.2 ± 0.8 to 1.1 ± 0.5, p<0.001), and PVR (175.0 ± 50.0 to 45.4 ± 15.0 mL, p<0.001). Qmax increased from 6.8 ± 2.0 to 19.7 ± 4.5 mL/s (p<0.001), maximum bladder capacity from 180.0 ± 45.0 to 375.0 ± 75.0 mL (p<0.001), and maximum cystometric capacity from 280.0 ± 56.0 to 415.0 ± 83.0 mL (p<0.001). BOOI decreased from 75.9 ± 15.0 to-8.5 ± 5.0 (p<0.001). Poor bladder compliance and DO prevalence decreased (13.6% to 6.8%, p=0.30; 25.0% to 11.3%, p=0.10), though not statistically significant.
Conclusion: HoLEP significantly improves urodynamic parameters and bladder function in BPH patients, particularly in those with complex urodynamic profiles. These findings support HoLEP as an effective treatment for relieving bladder outlet obstruction and improving lower urinary tract symptoms, with potential benefits for detrusor overactivity and bladder compliance.
Keywords: benign prostatic hyperplasia (BPH), holmium laser enucleation of the prostate (HoLEP), lower urinary tract symptoms, urodynamic parameters
Original Article
Comparison of Spinal and General Anesthesia Outcomes in Geriatric Patients Undergoing Retrograde Intrarenal Surgery
Demirhan Örsan Demir, Salih Bürlükkara, Turgay Kaçan, Ali Kaan Yıldız, Yusuf Gökkurt, Ömer Furkan Erbay, Tolga Karakan
Abstract
Objective: This study aims to investigate the feasibility of spinal anesthesia (SA) in retrograde intrarenal surgery (RIRS) among patients aged over 65 years, and to compare the effectiveness of spinal and general anesthesia (GA) techniques on postoperative pain.
Material and Methods: A retrospective analysis was conducted on 281 patients who underwent RIRS. Patients were divided into two groups: those who received SA (Group 1) and those who received GA (Group 2). Perioperative and postoperative outcomes of RIRS were compared between the groups. Additionally, postoperative pain levels in both the early and late periods were assessed using the Visual Analog Scale (VAS).
Results: Group 1, which received SA, consisted of 166 patients, while Group 2, which received GA, included 115 patients. There was no statistically significant difference between the two groups in the demographic data and stone characteristics. The complication rates, classified according to the modified Clavien-Dindo system, were comparable between the two anesthesia techniques. The mean early postoperative VAS score was 2.26 ± 0.99 in Group 1 and 3.58 ± 1.13 in Group 2, with the difference being statistically significant (p < 0.001). However, there was no statistically significant difference in late postoperative VAS scores between the groups (p = 0.362). Postoperative analgesic requirement was observed in 10.24% of patients in Group 1, compared to 27.82% in Group 2, and this difference was statistically significant (p < 0.001).
Conclusion: SA may be a viable alternative to GA in geriatric patients undergoing RIRS, as it provides favorable outcomes in postoperative pain control and may protect patients from certain potential morbidities associated with GA.
Keywords: general anesthesia, post operative pain, regional anesthesia, spinal anesthesia
Original Article
Comparison of the Flush-out Technique and the Basket for Retrieving Stone Fragments in Distal Ureteral Stones After Ureterolithotripsy: A Prospective Randomized Study
Metin Savun, Ertuğrul Arıkız, Harun Özdemir, Emin Taha Keskin, Murat Şahan, Halil Lutfi Canat
Abstract
Objective: This prospective randomized study evaluated the efficacy and safety of the flush-out technique in comparison with conventional basket retrieval for the clearance of stone fragments during semi-rigid ureteroscopy in patients with distal ureteral stones.
Materials and Methods: Eighty-four patients diagnosed with distal ureteral stones were randomly assigned to two equal groups. Group 1 underwent stone retrieval using a nitinol basket. In contrast, group 2 was treated with the flush-out technique, which entails passive fragment expulsion facilitated by irrigation pressure and strategic withdrawal of the ureteroscope. Demographic data, stone characteristics, operative outcomes, and complication rates were recorded.
Results: Demographic data and stone characteristics were comparable between the two groups. The Group 2 exhibited a significantly reduced median operation time (30 vs. 45 minutes, p=0.020) and stone retrieval time (1 vs. 10 minutes, p=0.001) in comparison to the Group 1. The stone-free rates on postoperative day one were similar between the groups (97.6% vs. 100%, p=1.000). Intraoperative and postoperative complication rates were analogous, with no significant differences observed in the distribution of the Satava and Clavien-Dindo classifications.
Conclusion: The flush-out technique is a safe and efficacious alternative to basket retrieval for managing distal ureteral stones, yielding comparable clinical outcomes while reducing both operative and stone retrieval times. Its simplicity and cost-effectiveness may facilitate broader adoption in routine urological practice, particularly in high- volume and resource-constrained settings.
Keywords: lithotripsy, laser, surgical instruments, ureteral calculi, ureteroscopy
Original Article
Clinical Outcomes of Rezum Treatment in High-Risk Elderly Patients with Long-Term Urinary Catheters: A Retrospective Study
Ali Egemen Avcı, Basri Cakıroglu
Abstract
Objective: This study aimed to evaluate the efficacy and safety of Rezum water vapor therapy in elderly male patients with long-term urinary catheterization and high anesthetic risk, as indicated by American Society of Anesthesiologists (ASA) scores of 3–4.
Material and Methods:We retrospectively analyzed 15 elderly male patients with ASA scores of 3–4 who had been using indwelling urinary catheters and underwent Rezum therapy between January and December 2023. Outcomes assessed at 1 and 6 months post-treatment included the International Prostate Symptom Score (IPSS), quality of life (QoL), prostate volume (PV), and post-void residual urine (PVR) volume. Time to catheter removal was also recorded. Results:The study cohort consisted of 15 elderly male patients with a mean age of 83.2 years (73-90 years old). Catheter removal was attempted at an average of 21 ± 4.5 days post-procedure. While 13 patients tolerated catheter removal successfully, two patients developed acute urinary retention and required re-catheterization. In these patients, the catheter was maintained for at least an additional 14 days. By the third postoperative month, all patients had achieved catheter independence.
At 1 month post-treatment, the mean IPSS was 20.07 ± 1.62, improving to 18.13 ± 1.51 at 6 months. QoL scores increased from a baseline of 1.60 ± 0.51 to 3.33 ± 0.49 at 1 month and further to 3.67 ± 0.49 at 6 months PVR decreased from 136.7 ± 53.7 mL at 1 month to 92.0 ± 33.4 mL at 6 months. PV reduced from 91.07 ± 18.7 mL to 65.27 ± 13.4 mL. No Clavien-Dindo grade ≥2 complications were observed.
Conclusions: Rezum therapy appears to be a safe and effective minimally invasive alternative for high-risk elderly male patients with indwelling catheters who are not suitable candidates for conventional surgical interventions.
Keywords: ASA score, benign prostatic hyperplasia, elderly patients, high surgical risk, minimally invasive therapy, urinary catheter, Rezum
Original Article
Assessment of Laparoscopic Radical Nephrectomy Videos on YouTube Using LAP-VEGaS Criteria: A Cross-Sectional Analysis
Resul Sobay, Hasan Samet Güngör, Abdurrahman İnkaya, Murat Beyatlı, Mehmet Umut Evci, Ahmet Tahra, Eyüp Veli Küçük
Abstract
Objective: YouTube has become an increasingly important platform for surgical education; however, the quality of laparoscopic surgery videos is variable. The LAParoscopic Surgery Video Educational Guidelines (LAP-VEGaS) provides a standardized framework for assessing surgical video quality.
Material and Methods: A systematic search was conducted on YouTube using relevant search terms. English-narrated laparoscopic radical nephrectomy videos were included. Each video was evaluated using the 9-item core LAP-VEGaS checklist.
Results: Twenty-one videos were included. The mean LAP-VEGaS score was 9.14 ± 3.72 (range 3–16). Videos originated from 11 different countries, with India contributing 38.1% (n=8). No significant correlation was found between popularity metrics and educational quality (p>0.05).
Conclusion: Laparoscopic radical nephrectomy videos on YouTube demonstrate a moderate level of educational quality. The lack of association between popularity and educational value highlights the necessity of quality assessment tools in surgical education.
Keywords: laparoscopic surgery, LAP-VEGaS, nephrectomy, video quality assessment, YouTube
Case Report
Foreign Body Complication After Endourological Intervention: A Rare Case Report
Hakan Tekinaslan, Sacit Nuri Görgel, Yiğit Akın
Abstract
Percutaneous nephrolithotomy (PNL) is a widely used minimally invasive surgical technique for the treatment of large and complex renal stones. Although nephrostomy catheters placed after the procedure play a crucial role in drainage and hemostasis, they may rarely lead to serious complications. Herein, we report a rare case of distal fragment retention of a Malecot nephrostomy catheter following PNL, which was successfully removed through open surgery.
Keywords: complication, foreign body, nephrostomy catheter, percutaneous nephrolithotomy
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