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    Lower Pole Stones Are Associated with Low Stone-Free Rates in Retrograde Intrarenal Surgery: A Myth or Fact? - A Matched Case-Control Study from the RIRSearch Group
    (Karger, 2024) Simsekoglu, Muhammed Fatih; Ozman, Oktay; Cakir, Hakan; Teke, Kerem; Cinar, Onder; Akgul, Murat; Tuna, Mustafa Bilal
    Introduction: There are conflicting results in the literature regarding the efficacy of retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups. Methods: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status 1 month after RIRS. Results: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40-58) in Group 1 and 50 years (IQR: 35-60) in Group 2 (p = 0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1-858.2) and 503.3 mm3 (IQR: 282.5-864), respectively (p = 0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2%) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p = 0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p = 0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p = 0.393), and median operation time (60 min in both, p = 0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 s and 3 s, respectively, p = 0.013). Conclusions: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones.
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    Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study
    (Karger, 2023) Sahin, Mehmet Fatih; Ozman, Oktay; Cakir, Hakan; Cinar, Onder; Akgul, Murat; Basatac, Cem; Simsekoglu, Muhammed Fatih
    Introduction: Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. Materials and Methods: The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. Results: The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). Conclusions: This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.