Endourology - Grand Journal of Urology

Endourology

Original Article (5) Case Report (2) Letter to the Editor (1)

Original Article

Grand J Urol 2025;0(0):, DOI: 10.5505/GJU.2026.97658

Risk Factors Predicting the Need for Urgent URS in Patients Undergoing SWL for Proximal Ureteral Stones

Tugay Aksakallı, Adem Utlu, Şaban Oğuz Demirdöğen, Ahmet Emre Cinislioğlu, Feyzullah Çelik, İbrahim Karabulut

Objective: To evaluate the clinical, anatomical, and stone-related factors in patients who underwent shock wave lithotripsy (SWL) for proximal ureteral stones and to identify the risk factors associated with the subsequent need for urgent ureteroscopy (URS). Materials and Methods: Patients who underwent SWL for proximal ureteral stones were included in the study. Demographic and clinical characteristics, including age, body mass index (BMI), serum creatinine, white blood cell count, hemoglobin, and platelet count, were recorded. Stone characteristics and anatomic factors were determined using parameters obtained from non-contrast lower upper abdomen computed tomography scans: stone density (HU), stone diameter, renal pelvis urine density (HU), perirenal stranding, stone-skin distance, and ureteral wall thickness. Patients who underwent emergency URS were grouped. Logistic regression analysis was used to identify risk factors predicting the need for urgent URS in patients. Results: Among the study population, 232 patients (83.8%) did not require urgent URS (Group 1), while urgent intervention was necessary in 45 patients (16.2%) (Group 2). Patients in the urgent URS group demonstrated a significantly higher body mass index (26 [24-27] vs. 25 [24-26] kg/m², p = 0.002). Non-contrast CT findings revealed that renal pelvis urine density and stone–skin distance were markedly greater in the URS group (13 [9-36] vs. 8 [6-11] HU, p < 0.001 and 12 [6- 16] vs. 9 [7-13] cm, p < 0.001, respectively). Stone density was also higher among patients requiring URS (862 [784-1014] vs. 786 [665-956] HU, p = 0.002). In multivariable analysis, BMI (OR 1.245, 95% CI 1.025–1.512, p = 0.028), stone density (OR 1.003, 95% CI 1.001–1.004, p = 0.002), renal pelvis urine density (OR 1.032, 95% CI 1.009–1.055, p = 0.006), and stone–skin distance (OR 1.654, 95% CI 0.986–1.846, p = 0.004) remained as independent predictors. Conclusion: BMI, stone density, renal pelvic urine density, and stone–skin distance parameters may serve as useful guidance when considering SWL for patients with proximal ureteral stones. Prospective studies with larger samples are needed to support the findings.

Grand J Urol 2025;5(1):013-017, DOI: 10.5505/GJU.2025.47450

Analysis of 79 Patients with Forgotten Ureteral Stents: 10-Year Experience in a Single Tertiary Care Center

Mubariz Aydamirov, Kadir Karkin, Zafer Gökhan Gürbüz

Objective: Double J (DJ) stents are frequently used, especially in urological surgeries, to relieve obstruction and provide urine flow from the kidney to the bladder, to heal the ureter, and to prevent complications. In the literature, it was determined that up to 12% of patients with ureteral stents have forgotten ureteral stents. In this study, we aimed to present our 10-year experience of forgotten uretereal stents (FUS) treatment. Materials and Methods: The medical records of patients treated with the diagnosis of FUS (those with stents for >6 months) between January 2014 and June 2024 were retrospectively reviewed. The reasons for the DJ stent placement, the center where the stent was placed (those placed in our own clinic and forgotten or those placed in an external center and forgotten and referred to us), duration of the stent, symptoms at presentation, and treatments performed were noted. Results: The study included 79 patients. The mean age of the patients was 49.4±21.3 years, with a range of 25-90 years. Of patients, 60.8% were unaware of the presence of a stent. The mean stent duration was 24±39.4 months (range 6-300 months) and 52 (65.8%) patients had encrustation. There were 4 (5.1%) patients with solitary kidneys. The mean postoperative hospitalization time was 5.6±4.5 days. The majority of patients underwent DJ stent placement after ureteroscopic lithotripsy (34.2%) and due to obstructed ureteral stones (31.5%). The most common symptoms at presentation were storage lower urinary tract symptoms (22.8%), dysuria (21.5%), recurrent urinary tract infection (16.5%) and flank pain (15.2%). Three (3.8%) patients underwent open nephrectomy due to non-functioning kidney. All remaining patients were treated endoscopically. Conclusion: FUS often causes more morbidity than treatment of the primary disease. Although it can be successfully treated with endourological surgeries, the main goal should be to prevent the development of this complication.

Grand J Urol 2021;1(1):18-21, DOI: 10.5222/GJU.2021.47966

The Effects of Previous Renal Stone Surgery on Percutaneous Nephrolithotomy Outcomes

Joshgun Huseynov, Nadir Kalfazade, Ekrem Guner

Objective: We aimed to compare outcomes of percutaneous nephrolithotomy (PNL) surgery in patients who had and had not undergone renal stone surgery before PNL. Material and Methods: We retrospectively analyzed the medical records of all patients who underwent PNL in our department between 2010 and 2019. Examined parameters consisted of patient demographics, medical and surgical history, stone size, stone density, stone site, estimated intraoperative blood loss, duration of operation, hospital stay and stone-free status. Results: A total of 193 patients were included the study. The mean age of the patients was 45±13 years. The mean duration of surgery was 69±11.5 minutes. The mean stone area was 720.2±600.4 mm2 and the mean stone attenuation was 982.8±327.7 HU. The mean postoperative hemoglobin decrease was 1.8±1.3 g/dL. 66 patients had previous stone surgery including open stone surgery, PNL and retrograde intrarenal surgery (RIRS). There was no statistically significant difference between patients who had and had not previousşy undergone renal stone surgery in terms of age, gender, body mass index and stone area. Operative time, estimated intraoperative blood loss, postoperative hemoglobin decreases and hospital stay were comparable between patients who had, and hed not undergone previous renal stone surgery. Stone-free rate was significantly higher in primary PNL patients compared to patients with a history of renal stone surgery (92.1% vs 77.3%, p=0.006). Conclusion: PNL has a similar complication rate in patients with and without previous kidney stone surgery. However, achieving stone-free status may be challenging in patients with a history of ipsilateral renal stone surgery.

Grand J Urol 2023;3(2):038-041, DOI: 10.5505/GJU.2023.60362

Bipolar vs Monopolar Transurethral Resection of the Prostate in Iraqi Patients: A Prospective Study

Jihad Anad Khalef, Ahmed Hadi Essa

Objective: Bipolar transurethral resection of the prostate (TURP) is a minimally invasive procedure that causes fewer problems, and a faster resection, but requires more expensive equipment. It is the treatment of choice for benign prostatic hyperplasia. In this study, its outcomes will be compared to those of conventional monopolar TURP. Materials and Methods: Twenty-seven patients aged between 52 and 65 years underwent either monopolar TURP (Group 1, n: 15) or bipolar TURP (Group 2, n: 12). Preoperative and perioperative data were recorded and analyzed, including the maximal flow rate (Qmax), prostate volume, intraoperatively resected tissue volume, resection velocity, and operation time. Results: Preoperative mean prostate volumes in Groups 1, and 2 were 82.6 ± 21 ml and 78.8 ± 12 ml, respectively (p=0.117). Preoperative mean serum sodium levels were 140.4 ± 2.3 mmol/l in Group 1 and 139.8 ± 2.2 mmol/l in Group 2. Preoperative mean serum hemoglobin values were 15 ± 0.8 g/dl in Group 1, and 14.5 ± 2.2 g/dl in Group 2. Postoperative mean serum sodium levels were 130.6 and 136.7 mmol/l, in Groups 1, and 2, respectively. Eight patients from the monopolar TURP group exhibited a notable drop in serum sodium levels. In the monopolar TURP group, there were 5 occurrences of TUR syndrome and 2 patients needed blood transfusions due to a mean decrease of 5 g/dl in hemoglobin levels. Complications were identified in 7 cases. Conclusion: Compared to monopolar TURP, bipolar TURP is associated with a shorter hospital stay, and lower transfusion and complication rates.

Grand J Urol 2023;3(3):085-089, DOI: 10.5505/GJU.2023.85047

Comparison of Intrarenal Retrograde Surgery Results Between Different Age Groups

Ferhat Yakup Suceken, Murat Beyatli, Resul Sobay, Eyup Veli Kucuk, Abdurrahman Inkaya

Objective: In this study, we aimed to investigate whether there is a difference in the reliability and efficacy of the method according to age in patients divided into 3 different age groups who underwent RIRS due to kidney stones. Materials and Methods: Patients who underwent Retrograde Intra Renal Surgery (RIRS) for kidney or ureteral stone disease at the Urology Clinic of Health Sciences University Umraniye Health Application and Research Hospital between May 2017 and January 2021 were retrospectively screened, and those aged 20-80 years were included in the study. The demographic and clinical data of the patients and stone-related data were recorded. Patients aged 20-40 years were classified as Group 1, those aged 41- 60 years as Group 2, and those aged 61-80 years as Group 3. Results: After the inclusion and exclusion criteria were applied, the sample consisted of a total of 320 patients, of whom 121 (37.8%) were in Group 1, 133 (41.5%) were in Group 2, and 66 (20.6%) were in Group 3. The mean operative times and stone-free rates were similar between the groups. However, the mean hospital stay was significantly longer in Groups 3 compared to Groups 1 and 2. The minor complication rates were 2.4% in Group 1, 3% in Group 2, and 13.6% in Group 3, indicating a statistically significantly higher value in Group 3 compared to the remaining two groups (p=0.03). The major complication rates of Groups 1, 2, and 3 were 0.8%, 0.7%, and 7.5%, respectively. Accordingly, Group 3 had a significantly higher rate than Groups 1 and 2 (p=0.04). Conclusion: RIRS can be performed on the elderly with success rates comparable to other age groups. However, the elderly, who represent a higher-risk patient population with more comorbidities, have increased rates of minor and major complications both in the perioperative and postoperative periods.