| Autor: |
Özman O; Department of Urology, Gaziosmanpasa Training and Research Hospital, Urology Clinic, İstanbul, Turkey.; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Çınar Ö; Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey., Çakır H; Department of Urology, Fulya Acıbadem Hospital, Urology Clinic, İstanbul, Turkey., Başataç C; Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey., Akgül HM; Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey., Demirbilek M; Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey.; Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey., Sancak EB; Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey., Yazıcı CM; Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey., Başeskioğlu B; Department of Urology, Eskişehir Acıbadem Hospital, Urology Clinic, Eskişehir, Turkey., Önal B; Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey.; Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey., Akpınar H; Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey. |
| Abstrakt: |
Objectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless ( n = 110, Group 1) and those who proceeded without UAS after insertion failure ( n = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS ( p = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) ( p = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p = 0.001). Stone burden (odds ratio [OR]: 1.002, p = 0.019) and stone density (OR: 1.002, p = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases. |
