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Öğe A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study)(AVES, 2022) Sönmez, Mehmet Giray; Güven, Selçuk; Tuncel, Altuğ; Karabulut, İbrahim; Kılıç, Özcan; Seçkiner, İlker; Tefik, Tzevat; Atış, Gökhan; Ergin, Giray; Tuğcu, Volkan; Erkurt, Bülent; Müslümanoğlu, Ahmet; Sarıca, KemalObjective: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium aluminum garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. Material and methods: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. Results: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r = 0.46], frequency [P = .009, r = 0.1], maximum power [P < .001, r = 0.11], total energy [P < .001, r = 0.25]), anesthesia time (P < .001, r - 0.42), surgery time (P < .001, r - 0.47), and stone size. The mean number of shots increased (P < .001, r = 0.25), and the frequency level decreased (P < .001, r = -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P = .004, r = 0.09 and P = .02, r = 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. Conclusion: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.Öğe How does the COVID-19 pandemic affect the preoperative evaluation and anesthesia applied for urinary stones? EULIS eCORE-IAU multicenter collaborative cohort study(Springer, 2020) Gökçe, Mehmet İlker; Yin, Shanfeng; Sönmez, Mehmet Giray; Eryıldırım, Bilal; Kallidonis, Panagiotis; Petkova, Kremena; Güven, Selçuk; Kiremit, Murat Can; de Lorenzis, Elisa; Tefik, Tzevat; Villa, Luca; Zeng, Guohua; Sarıca, KemalStone disease is a unique condition that requires appropriate management in a timely manner as it can result in both emergent conditions and long term effects on kidney functions. In this study it is aimed to identify the up-to-date practice patterns related to preoperative evaluation and anesthesia for stone disease interventions during COVID-19 pandemic. The data of 473 patients from 11 centers in 5 different countries underwent interventions for urinary stones during the Covid-19 pandemic was collected and analyzed retrospectively. Information on the type of the stone related conditions, management strategies, anesthesiologic evaluation, anesthesia methods, and any alterations related to COVID-19 pandemic was collected. During the preoperative anesthesia evaluation thorax CT was performed in 268 (56.7%) and PCR from nasopharyngeal swab was performed in 31 (6.6%) patients. General anesthesia was applied in 337 (71.2%) patients and alteration in the method of anesthesia was recorded in 45 (9.5%) patients. A cut-off value of 21 days was detected for the hospitals to adapt changes related to COVID-19. Rate of preoperative testing, emergency procedures, conservative approaches and topical/regional anesthesia increased after 21 days. The preoperative evaluation for management of urinary stone disease is significantly affected by COVID-19 pandemic. There is significant alteration in anesthesia methods and interventions. The optimal methods for preoperative evaluation are still unknown and there is discordance between different centers. It takes 21 days for hospitals and surgeons to adapt and develop new strategies for preoperative evaluation and management of stones.Öğe Retrograde intrarenal surgery of renal stones: A critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study)(Springer, 2021) Güven, Selçuk; Yiğit, Pakize; Tuncel, Altuğ; Karabulut, İbrahim; Şahin, Selçuk; Kılıç, Özcan; Balasar, Mehmet; Seçkiner, İlker; Canda, Erdem; Sönmez, Mehmet Giray; Tefik, Tzevat; Boz, Mustafa Yücel; Atış, Gökhan; Ergin, Giray; Soytaş, Mustafa; Şenel, Çağdaş; Kıraç, Mustafa; Kiremit, Murat Can; Akand, Murat; Tuğcu, Volkan; Erkurt, Bülent; Müslümanoğlu, Ahmet; Sarıca, KemalAims To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). Methods Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program () created by Turkish Urology Academy for Residual Stone Study. Results A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (chi 2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (chi 2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (+/- 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). Conclusions Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.Öğe Urolithiasis practice patterns following the COVID-19 Pandemic: Overview from the EULIS Collaborative Research Working Group(Elsevier, 2020) Tefik, Tzevat; Güven, Selçuk; Villa, Luca; Gökçe, Mehmet İlker; Kallidonis, Panagiotis; Petkova, Kremena; Kiremit, Murat Can; Sönmez, Mehmet Giray; De Lorenzis, Elisa; Eryıldırım, Bilal; Sarıca, KemalCOVID-19 was first reported as a novel pulmonary infectionin December 2019 [1]. Apart from being a potentially lethalcondition, COVID-19 is also affecting health care strategiesfor other medical conditions. Ficarra et al [2] have madesuggestions regarding urological surgeries during theCOVID-19 pandemic. However, the authors focused on allurological pathologies and reported information from Italy,a country that seemed to be the epicenter of the pandemicin Europe [2]. Therefore, we sought to obtain an up-to-dateperspective on how the routine practice patterns of expertEuropean endourologists changed (or adapted) during theCOVID-19 pandemic via a survey. By focusing on expertexperience coming from the field, we aimed to provide analgorithm to guide the management of urinary stonedisease during this unprecedented time of extraordinarystress on the global endourology community.
