Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults?

INTRODUCTION

The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS.

METHODS

We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, n: 55) and adult (group 2, n: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR.

RESULTS

A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (p = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (p = 0.002; p = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (p < 0.001). Total CR was 13.8% and mostly Clavien I-II, and no difference was observed between the 2 groups (p = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; p = 0.554). On multivariate analysis, stone size (p < 0.001) and lower calyx stone (p < 0.001) were the negative predictive factors for SFR.

CONCLUSION

There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.

Which Endoscopic Methods in Prepubertal Patients with 10-20 mm Bladder Stones: Transurethral Cystolithotripsy or Percutaneous Cystolithotripsy?

BACKGROUND

The aim of this study was to evaluate the efficacy and safety of transurethral cystolithotripsy(TUC) and percutaneous cystolithotripsy(PCC) in prepubertal patients with 10-20 mm bladder stones.

MATERIALS AND METHODS

The files of patients the age of 12 and under who were admitted our clinic for bladder stones from January 2007 to January 2021 were reviewed retrospectively. Inclusion criteria were patients who were 12 years of age and under with 10-20 mm bladder stones, and who underwent endoscopic surgery(TUC or PCC). None of the patients had prior bladder or stone surgery. The patients were divided into two groups(Group 1:PCC group, and Group 2:TUC group) and collected data(preoperative, intraoperative, and postoperative characteristics) were compared between the groups.

RESULTS

This present study was enrolled 51 patients(21 patients in Group 1 and 30 patients in Group 2).The mean ages of the groups were similar (Group 1:4.7±3.6; Group 2:4.6±3.2; p:0.936). The mean stone size was 15.8±3.5 in Group 1, and 12.1±2.4 mm in Group 2. It was higher in the PCC group than TUC group(p<0.001). The operative time was lower in Group 1 than Group 2(36.4±12.9 min vs. 42.7±16.3 min, respectively), but there was no statistically significance difference between the groups (p:0.117).We achieved SFR for all the patients in both groups. Complications were observed in four (7.7%) cases. One female patient was in Group 1 and three male patients were in Group 2. There was no difference for complication rates between the groups(p:0.634).

CONCLUSIONS

Endoscopic surgeries have almost become a routine method in the treatment of bladder stones. Despite larger stone size, PCC provides similar SFR compared with TUC along with a tendency of shorter operative time. However, the use of the TUC method in toddler males could increase the risk of postoperative urinary retention. Hence, stone size and patient age should be considered in the selection of a surgical approach.

Easily accessible, up-to-date and standardised training model in Urology: E-Learning Residency training programme (ERTP)

OBJECTIVES

There is no standardised and up-to-date education model for urology residents in our country. We aimed to describe our National E-learning education model for urology residents.

METHODOLOGY

The ERTP working group; consisting of urologists was established by the Society of Urological Surgery to create E-learning model and curriculum in April 2018. Learning objectives were set up in order to determine and standardise the contents of the presentations. In accordance with the Bloom Taxonomy, 834 learning objectives were created for a total of 90 lectures (18 lectures for each PGY year). Totally 90 videos were shot by specialised instructors and webcasts were prepared. Webcasts were posted at uropedia.com.tr, which is the web library of the Society of Urological Surgery. The satisfaction of residents and instructors was evaluated with feedbacks. An assessment of knowledge was measured with the multiple-choice exam.

RESULTS

A total of 43 centres and 250 urology residents were included in ERTP during the academic year 2018/2019. There were 93/55/43/34/25 urology residents at 1st/2nd/3rd/4th and 5th year of residency, respectively. Majority of the residents (99.1%) completed the ERTP. The overall satisfaction rate of residents and instructors were 4.29 and 4.67 (min: 1 so bad, max: 5 so good). An assessment exam was performed to urology residents at the end of the ERTP and the mean score was calculated as 57.99 points (min: 20, max: 82).

CONCLUSION

As a result of the COVID-19 pandemic, most of the educational programmes had to move online platforms. We used this reliable and easily accessible e-learning platform for the standardisation of training in urology on national basis. We aim to share this model with international residency training programmes.

Can expressed prostatic secretions effect prostate biopsy decision of urologist?

Objectives:

To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy.

Materials and Methods:

178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy.

Results:

The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01).

Conclusions:

The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.