Vol 14 Issue 2

Objective: Laparoscopy is a minimal invasive surgery technique and getting more important nowadays.
The success rate of the techniques used in laparoscopy education and the qualification of urology residents who finished their urology training, is unclear. In our study, qualification of Turkish urology residents for laparoscopy, the preferred educational techniques and the education models were investigated with a national survey.

Material and Methods: The laparoscopy questionnaire that is used in our study has been prepared by modification of a questionnaire which was formed by Belgium European European Society of Residents in Urology. The techniques used in laparoscopy education, qualification of the education and the expectations from laparoscopy education were the main focus. All of the questions were Turkish and was sent to a total of 295 residents who are registered to the ESRU database. A total of 70 (23%) residents answered. SurveyMonkey was used for composing and distribution. All the data gathered from the survey was statistically investigated.

Results: The biggest contribution was from the Marmara Region (39.29%). Laparoscopy is used in 91,07% of the clinics all around Turkey. The distribution of the residents in regards of year of urology training were: 14% 1st year, 23% 2nd year, 23% 3rd year, 12.7% 4th year, 25% 5th year. Training and Research Hospital and University Hospital participation rates were 46.77% and 53.23% respectively. The rate of residents who feel they will become capable of doing laparoscopic surgery after their residency period finished, was 28.5% and 71.4% of the residents expressed the laparoscopic training they take would not be sufficient. Assistance and observing are used as a training method by nearly all residents (91.07%). In addition being the primary surgeon, training videos, training boxes, animal practices are used by residents with the rate of 26.7%, 25%, 21.4%, 3.5% respectively. According to participants, to be given less opportunity, educational disinterest and limited laparoscopic cases were defined as the major 3 problems in laparoscopy training.

Conclusion: The laparoscopy education differs between the urology clinics in Turkey without any standardization. An appropriate standardization of laparoscopy training can improve laparoscopy education and urology training

Keywords: laparoscopy, resident, trainining, education

Objective: The aim of this study was to evaluate the importance of percutaneous nephrostomy in urology practice.

Material and Methods: Records of patients who underwent percutaneous nephrostomy at the urology
clinic between January 2014 and January 2021 were retrospectively examined. Patients with pyonephrosis and/or renal function elevation who underwent percutaneous nephrostomy by urologists in emergency conditions were included in the study. Age, reasons for hospital admission, the degree of hydronephrosis, primary pathologies, postoperative complications, and postoperative elective treatments were evaluated.

Results: Of the 164 patients included in the study, 98 were male and 66 were female. The mean age of the patients was 47.45 (18-90) years. Percutaneous nephrostomy catheter was inserted into a total of 208 renal units, 120 of which were unilateral and 44 of which were bilateral. Percutaneous nephrostomy was successfully inserted in 192 (95.2%) of 208 renal units, while the procedure failed in 10 (4.8%) renal units and additional intervention was required. Percutaneous nephrostomy catheter was inserted in 40.2% of patients for oncological reasons and 59.8% for non-oncological reasons. The most common minor complications after the procedure were transient hematuria not requiring transfusion (3.2%), fever (2.4%), ongoing pain after the procedure (1.6%), catheter obstruction (0.8%), and temporary urine leakage (0.8%). The most common major complication was nephrostomy dislodgement (3.2%).

Conclusion: Percutaneous nephrostomy is an effective and safe method with a high success rate that can be applied for obstructive uropathy and pyonephrosis treatment and urinary diversion. Although the procedure is performed mostly by interventional radiologists, it can also be performed successfully by urologists.

Keywords: obstructive uropathy, hydronephrosis, percutaneous nephrostomy, complication.

Objective: We aimed to determine the factors that are effective in achieving stone-free status (SFS) in patients who underwent retrograde intrarenal surgery for kidney stones.

Material and Methods: We retrospectively analyzed the data of 160 patients who underwent retrograde intrarenal surgery (RIRS) in our clinic between January 2021 and July 2021. Demographic characteristics of the patients, parameters related to stone and renal calyceal anatomy measured on computed tomography (CT) images, use of ureteral access sheath (UAS) and surgical time were analyzed. Surgery was considered successful if the residual stone on direct urinary system radiography (DUSG) or CT images at the postoperative 1st month was smaller than 2 mm or there was no stone at all. The patients were divided into two groups according to their stone free status (SFS), as stone free (Group 1) and with residual stone (Group 2). In addition, stones in the kidney were divided into lower poles (45 degrees and above and below) and non lower pole according to localization. The groups were compared according to the presence of postoperative residues.

Results: There was no difference for the distribution of gender, body mass index (BMI), side, UAS use, opacity status, infundibulopelvic angle (IPA) and infundibular length for Group 1 and Group 2 (p>0.05). Infundibular width was greater in Group 1 without stone (p>0.021). The residual in patients with more than one stone was higher than those with one stone (p>0.048). We did not find impressive results on stone-freeness for stone volume and stone density. According to the localization in the kidney, the residue was higher in those with lower poles (p>0.001). However, there was no difference between those with lower pole stones and those above and below 45 degrees (p>0.050).

Conclusion: In the treatment of retrograde intrarenal stone surgery, the presence of more than one stone, the presence of lower pole stones, and the small infundibular width can be predicted as factors that negatively affect stone clearance.

Keywords: retrograde intrarenal surgery, renal stone, stone-free