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    The Effect of Ventilation Mode in Anesthesia on Renal Mobility During Retrograde Intrarenal Surgery: A Single-Blind Randomized Study
    (Urol & Nephrol Res Ctr-Unrc, 2023) Dogan, Cagri; Akgul, Murat; Sahin, Ayhan; Yazici, Cenk Murat; Sahin, Mehmet Fatih; Altin, Enes; Keles, Anil
    Purpose: Renal mobility can present challenges for surgeons during stone fragmentation. The respiratory setup of the mechanical ventilator during RIRS might affect renal mobility. This study aimed to evaluate the effect of high ventilation (HV) and standard ventilation (SV) modes on renal mobility during RIRS.Materials and Methods: Patients who underwent RIRS at a single center between November 2020 and November 2021 were retrospectively included in the study. Renal mobility was measured under fluoroscopic view in HV and SV modes during retrograde pyelography. The surgeon, who was blind about mechanical ventilation modes, was asked to assess the renal movement grade. After the ventilation mode was changed, the surgeon reassessed renal mobility. The data and the surgeon's assessment were recorded and compared to each other.Results: A total of 86 patients with a mean age of 48.6 +/- 15.7 years were included in the study. There was a significant difference between the SV and HV modes in terms of renal mobility in fluoroscopic view (17.1 +/- 6.1 mm and 13.6 +/- 5.2mm, respectively; p = 0.007). According to the surgeon's assessments, the grade of renal mobility was found to be significantly higher in the SV group 2.8 +/- 1.1 compared to the HV group 2.2 +/- 0.8 (p = 0.001). Renal movement increased significantly under fluoroscopic vision as the renal grading of the surgeon increased (p = 0.013). This data demonstrated that the surgeon's assessment of renal mobility was significantly correlated with fluoroscopic kidney movement.Conclusion: Kidney movement was decreased significantly in HV mode during RIRS according to both fluoroscopic findings and surgeon assessment. Most surgeries of mobile kidneys were performed in HV mode, due to the surgeon's preference.
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    The Results of Urodynamics and Pressure Flow Study of Patients with Neurological Disease in a Single Center for 12 Years: Neurogenic Bladder Etiology
    (Galenos Publ House, 2023) Dogan, Cagri; Akgul, Murat; Yazici, Cenk Murat; Malak, Arzu; Altin, Enes; Seramet, Serkan; Dayisoylu, Hulusi Sitki
    Aim: Generally, urodynamic-pressure flow study (U-PFS) is performed on patients with lower urinary tract symptoms (LUTS) for verifying the diagnosis and evaluating the rate of response for treatment. The aim of the study was to assess the results of the U-PFS of patients according to the etiology of neurological disorders. Materials and Methods: The data of 2,489 patients who underwent U-PFS in our clinic between 2010-2022 were analyzed retrospectively. A total of 535 patients with LUTS and neurogenic disorder were included in the study. Patients were divided into subgroups according to their diagnosis. The patient's age, gender, and U-PFS data (sensation of first urine, maximum cystometric capacity (MSC), maximum detrusor pressures in the filling phase, presence of urgency, and bladder compliance status) were evaluated and compared according to neurological disorders. Results: Cervical and lumbar disc disorder was found in 204 (38.1%) patients, multiple sclerosis (MS) in 103 (19.2%), and cerebrovascular incidents in 74 (13.8%) patients (SVI), spinal cord injury in 48 (8.9%), polyneuropathy in 43 (8.0%), Parkinson's disease (PD) in 30 (5.6%), diabetic neuropathy in 18 (3.4%), and operated spine bifida (oSB) in 15 (2.8%) was detected. Detrusor pressures in the filling phase were compared according to neurological disorders, and detrusor pressures were statistically significantly higher in patients with oSB and PD (52.66 +/- 40.78 mmHg; 45.30 +/- 34.43 mmHg, respectively; p<0.001). When the MSCs were compared, it was observed that the bladder capacity was significantly lower in PD and ASD patients, whereas bladder capacity was relatively increased in lomber and servical disc disorder, spinal cord injury and polyneuropathy patients (respectively 308.71 +/- 190.25 mL, 264.81 +/- 140.25 mL, 491.90 +/- 167.49, 474.52 +/- 182.92, 447.67 +/- 168.03, p<0.001). Conclusion: These specific patient groups (oSB and spinal cord injury) are hazardous groups for the development of end-stage kidney failure. Clinicians should take into consideration that patients and their relatives have to be informed about possible long-term complications.