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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 one 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 sec and 3 sec, 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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A JJ stent placed before retrograde intrarenal surgery (RIRS) may ease the procedure. However, it is important to note that a prolonged duration of double J stent (DJS) placement before RIRS may increase the risk of postoperative urinary tract infection (UTI). Various publications have established this association, although the duration of the DJS before surgery is scarce. Our study investigates the relationship between the pre-stenting period and postoperative UTI and establishes a cut-off period to minimize this risk. We included a total of 500 cases with preoperative DJS prior to RIRS. The patients were divided into five groups according to their preoperative stenting duration (Group 1: 0-15 days; Group 2: 16-30 days; Group 3: 31-45 days; Group 4: 46-60 days; Group 5: >60 days). Demographic and clinical data of the patients, stone properties, operation data, perioperative and postoperative complications (including fever and UTI), hospitalization time, and stone-free rates (SFR) were compared. The groups contained 53, 124, 102, 63, and 158 patients. The demographics of the patients in each group were similar. There was no statistically significant difference between DJS duration, perioperative/postoperative complications, and SFR, except for the ureteral access sheath (UAS) insertion rate. (p = 0.001). The postoperative fever/UTI rate was the lowest in Group 1 (p = 0.046) compared to other durations. Stent duration does not impact SFR. Longer stents enhance UAS insertion success but increase postoperative infection risk. Our results suggest that RIRS should be performed within two weeks, ideally 20 days following stent insertion, to minimize postoperative infection risk.

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Objective: To evaluate and compare the quality and comprehensibility of answers produced by five distinct artificial intelligence (AI) chatbots-GPT-4, Claude, Mistral, Google PaLM, and Grok-in response to the most frequently searched questions about kidney stones (KS). Materials and Methods: Google Trends facilitated the identification of pertinent terms related to KS. Each AI chatbot was provided with a unique sequence of 25 commonly searched phrases as input. The responses were assessed using DISCERN, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), the Flesch-Kincaid Grade Level (FKGL), and the Flesch-Kincaid Reading Ease (FKRE) criteria. Results: The three most frequently searched terms were "stone in kidney," "kidney stone pain," and "kidney pain." Nepal, India, and Trinidad and Tobago were the countries that performed the most searches in KS. None of the AI chatbots attained the requisite level of comprehensibility. Grok demonstrated the highest FKRE (55.6 ± 7.1) and lowest FKGL (10.0 ± 1.1) ratings (p = 0.001), whereas Claude outperformed the other chatbots in its DISCERN scores (47.6 ± 1.2) (p = 0.001). PEMAT-P understandability was the lowest in GPT-4 (53.2 ± 2.0), and actionability was the highest in Claude (61.8 ± 3.5) (p = 0.001). Conclusion: GPT-4 had the most complex language structure of the five chatbots, making it the most difficult to read and comprehend, whereas Grok was the simplest. Claude had the best KS text quality. Chatbot technology can improve healthcare material and make it easier to grasp.

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INTRODUCTION: The aim of the study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age-groups. METHODS: Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in group 1, group 2, group 3, and group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, perioperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups. RESULTS: A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in group 1, 324 (46.5%) in group 2, 217 (31.1%) in group 3, and 87 (12.5%) in group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, perioperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p = 0.001). The postoperative complication rates were significantly higher in group 1 with Clavien I-II complication predominance (p = 0.003). CONCLUSION: The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients.

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Introduction: Peyronie's disease (PD) is a common urologic illness, motivating numerous scientific investigations and publications. Scientific publications have more authors each year. A bibliometric review of the PD literature might help urologists and sexual medicine professionals comprehend publication tendencies in this subject. The current study was aimed at presenting a bibliometric analysis of PD, which is one of the important and trending subjects of andrology. Methods: On January 5, 2023, Web of Science scanned documents with the terms Peyronie's disease" "Peyronie's disease treatment", "Peyronie's disease management", "Peyronie's disease surgery" and "Peyronie's disease injection" from 1975 through 2023. Titles, years, authors, citations, citation indices, journal names, authors' countries of origin, article categories, and funding sources were recorded. Results: "Clinical Efficacy, Safety and Tolerability of Collagenase Clostridium Histolyticum for the Treatment of Peyronie Disease in 2 Large Double-Blind, Randomized, Placebo Controlled Phase 3 Studies" has the most citations and citation index. Most of the T100 articles were published in 2020, primarily in the Journal of Urology. These articles mainly focused on treatment, especially surgeries. All of these articles were in English, and the vast majority of them were by authors from the US who were most frequently collaborated with by other authors. Conclusion: This research analyzed the top 100 PD studies. This research focused on pathophysiology, innovative surgical procedures, and new approaches of PD. It also recommended bigger databases and more financing for research.

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Background: Premature ejaculation (PE) is the most prevalent sexual dysfunction in men, and like many diseases and conditions, patients use Internet sources like ChatGPT, which is a popular artificial intelligence-based language model, for queries about this andrological disorder. Aim: The objective of this research was to evaluate the quality, readability, and understanding of texts produced by ChatGPT in response to frequently requested inquiries on PE. Methods: In this study we used Google Trends to identify the most frequently searched phrases related to PE. Subsequently, the discovered keywords were methodically entered into ChatGPT, and the resulting replies were assessed for quality using the Ensuring Quality Information for Patients (EQIP) program. The produced texts were assessed for readability using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and DISCERN metrics. Outcomes: This investigation has identified substantial concerns about the quality of texts produced by ChatGPT, highlighting severe problems with reading and understanding. Results: The mean EQIP score for the texts was determined to be 45.93 ± 4.34, while the FRES was 15.8 ± 8.73. Additionally, the FKGL score was computed to be 15.68 ± 1.67 and the DISCERN score was 38.1 ± 3.78. The comparatively low average EQIP and DISCERN scores suggest that improvements are required to increase the quality and dependability of the presented information. In addition, the FKGL scores indicate a significant degree of linguistic intricacy, requiring a level of knowledge comparable to about 14 to 15 years of formal schooling in order to understand. The texts about treatment, which are the most frequently searched items, are more difficult to understand compared to other texts about other categories. Clinical Implications: The results of this research suggest that compared to texts on other topics the PE texts produced by ChatGPT exhibit a higher degree of complexity, which exceeds the recommended reading threshold for effective health communication. Currently, ChatGPT is cannot be considered a substitute for comprehensive medical consultations. Strengths and Limitations: This study is to our knowledge the first reported research investigating the quality and comprehensibility of information generated by ChatGPT in relation to frequently requested queries about PE. The main limitation is that the investigation included only the first 25 popular keywords in English. Conclusion: ChatGPT is incapable of replacing the need for thorough medical consultations.

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OBJECTIVE: To determine the relationship between bladder pain syndrome (BPS) and systemic inflammatory index (SII) and to examine the impact of treatment protocols on it. STUDY DESIGN: Observational Study. Place and Duration of the Study: Department of Urology, Tekirdag Namik Kemal University, Tekirdag, Turkiye, from January 2017 to December 2022. METHODOLOGY: A retrospective analysis was conducted on 30 BPS patients who underwent medical therapy. Upon diagnosis, the patients completed the king's health questionnaire (KHQ), beck depression questionnaire (BDQ), beck anxiety questionnaire (BAQ), and short form (SF-36) quality of life form. Peripheral blood SII was measured. After six months of regular therapy, the SII was recalculated when the patients completed the same forms again. The SII was compared between instances when patients reported more complaints, higher form scores, and instances when they reported fewer and lower scores. RESULTS: The patients had a mean age of 46.1 ± 13.6 years, with four males and 26 females. The mean follow-up duration was 76.3 ± 24.5 months. Five patients of KHQ subcategories showed statistically significant decreases following therapy (52 to 39.17, 66.66 to 54.16, 54.40 to 41.07, 75.55 to 58.14, and 60.55 to 40.47). All patients of SF-36 components increased (p = 779, p = 0.393, p = 0.007, p = 0.004, p = 0.008, p = 0.041, p = 0.010, and p = 0.767, respectively). BDQ and BAQ decreased after therapy (11.55 to 11.41 and 11.86 to 11.24, respectively). Lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII decreased significantly (p = 0.001, 0.019, 0.002 and 0.039, respectively). CONCLUSION: SII, lymphocyte count, NLR, and PLR decreased after treatment, similar to BDQ and BAQ. SII is a simple and feasible method for evaluating the treatment efficacy of BPS. KEY WORDS: Bladder pain syndrome, Lymphocyte, Neutrophil, Systemic immune inflammation index, Platelet.

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Purpose: Reusable flexible ureteroscopes may lose their mechanical functionality through overuse, which is known as "aging of the flexible ureteroscope." Although mechanical deterioration has been shown in several studies, the data about the effect of this situation on the efficacy and safety of retrograde intrarenal surgery (RIRS) are missing. The aim of our study was to evaluate the effect of the aging of flexible ureteroscopes on the efficacy and safety of RIRS. Methods: Patients who had undergone RIRS between 2017 and 2021 at a single center were retrospectively included in the study. Serial surgeries were performed using the same reusable flexible ureteroscope (Storz X2) until it was broken or malfunctioned because of the aging process. Group 1 was formed by the first 10 cases on whom the flexible ureteroscopes were used, representing the youngest period of the instruments, whereas group 2 was composed of the last 10 cases on whom the flexible ureteroscopes were used, representing the oldest phase of the instruments. The operative and postoperative data-including the operation time, hospitalization time, intraoperative complications, postoperative complications, and stone-free rates-were compared between the two groups. Results: A total of five flexible ureteroscopes were included in the study. The number of cases for each flexible ureteroscope ranged between 87 and 133, with a median number of 107 cases. The demographic and clinical properties of patients in both groups were similar. The operation time, lasering time, and total laser pulse were similar between the groups. The stone-free rates in group 1 and group 2 were 82.0% and 78.0%, respectively (p = 0.304). The complication rates were also similar between the groups (p = 0.591). Conclusion: The aging of reusable flexible ureteroscopes did not negatively affect the efficacy and safety of RIRS. Therefore, surgeons may use the reusable types of flexible ureteroscopes until they are totally broken.

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The aim of the study is to evaluate and compare the quality and readability of responses generated by five different artificial intelligence (AI) chatbots-ChatGPT, Bard, Bing, Ernie, and Copilot-to the top searched queries of erectile dysfunction (ED). Google Trends was used to identify ED-related relevant phrases. Each AI chatbot received a specific sequence of 25 frequently searched terms as input. Responses were evaluated using DISCERN, Ensuring Quality Information for Patients (EQIP), and Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics. The top three most frequently searched phrases were "erectile dysfunction cause", "how to erectile dysfunction," and "erectile dysfunction treatment." Zimbabwe, Zambia, and Ghana exhibited the highest level of interest in ED. None of the AI chatbots achieved the necessary degree of readability. However, Bard exhibited significantly higher FKRE and FKGL ratings (p = 0.001), and Copilot achieved better EQIP and DISCERN ratings than the other chatbots (p = 0.001). Bard exhibited the simplest linguistic framework and posed the least challenge in terms of readability and comprehension, and Copilot's text quality on ED was superior to the other chatbots. As new chatbots are introduced, their understandability and text quality increase, providing better guidance to patients.

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Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [-] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS- patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS- patients (27.6%) (p=0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.

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Objective: To investigate the association between psoas muscle mass (PMM) and failure of ureteral access sheath (UAS) insertion and complications from retrograde intrarenal surgery (RIRS). Materials and Methods: A multicenter retrospective case-control study was conducted that included patients who underwent RIRS despite failure of UAS insertion (Cohort 1) and confounder-matched control patients who underwent RIRS after successful UAS insertion (Cohort 2). For morphometric analysis of PMM, ipsilateral psoas muscle areas (iPMAs) were measured using the coreslicer.com webkit. After comparing demographic, clinical, and complication rates and iPMAs between cohorts, gender-specific median iPMAs were also determined to further subdivide patients in each cohort as either low iPMAs or high iPMAs. Thereafter, patients were also compared in terms of RIRS complications. Results: Cohort 1 included 86 patients whereas Cohort 2 consisted of 124 matched cases. The median (interquartile range) iPMAs were similar between the cohorts: Cohort 1, 11.05 (6.82-14.44) cm2 versus 11.12 (6.97-13.69) cm2 for Cohort 2 (P ˃ .05). There was a significant inverse relationship between iPMAs with age (r = -0.222) and Charlson comorbidity index (r = -0.180) for all patients (P ˂ .05). Perioperative and postoperative complication rates were 8.1% and 16.3% for Cohort 1 and 6.5% and 21% for Cohort 2, respectively. The complication rates were not statistically different between patients with high iPMAs and those with low iPMAs, in male or female patients (P > .05). Conclusions: These results show that failure of UAS was not associated with PMM. Furthermore, since the complication rates were similar between patients with high PMM and low PMM, RIRS may be a reliable treatment choice for sarcopenic patients as well as in nonsarcopenic patients.

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OBJECTIVE: To evaluate the sensitivity and specificity of ultrasonography (USG) and kidney ureter bladder radiography (KUB) for the determination of stone-free status of retrograde intrarenal surgery (RIRS) according to different stone-free status definitions. MATERIALS AND METHODS: The patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system USG and noncontrast abdominal tomography at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of USG and KUB on evaluating the stone-free rate were analyzed according to different stone-free status definitions. RESULTS: A total of 178 patients were included in the study. The stone-free rates according to stone-free definitions as; residual stone <4 mm, <2 mm and no residual stone were 79.2%, 64.0%, and 56.7%, respectively. According to its definition as a residual stone <4 mm, the sensitivity and specificity of USG were 64.9% and 84.3%, respectively. The sensitivity of USG was 57.1% and 52.5% as the definitions were residual stone <2 mm and no residual stone, respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity. CONCLUSION: USG had high specificity but low sensitivity for evaluating stone-free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone-free status and noncontrast abdominal tomography must be used during the clinical trials to document the exact stone-free rates of RIRS.

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Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = -0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.

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Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case-control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score-matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4-7565.9) versus 991.1 mm3 (range: 201.2-4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS.

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PURPOSE: The flexible ureterorenoscopy (FURS) is expensive and fragile equipment which easily break down during the surgery. f-URS have yet some problems with their durability that affect survival. One of the most important ways to increase the survival of a device is to improve its use in the right indications. We aimed to investigate whether the durability of the f-URS will be affected due to the volume and location of the stone and some anatomical features of the including infundibulopelvic angle (IPA), and location anomalies. MATERIALS AND METHODS: The collected data from 705 patients' data including their age, sex, stone location, and stone volume, S-ReSC score, Hounsfield unit (HU) as stone density, IPA, BMI, and the usage time of f-URS using 10f-URS were included to study. Exp(B) values and confidence intervals (95% CIs) of parameters were calculated with COX regression and Roc curve analysis was also used to determine the cut-off value. RESULTS: Renal malformation, DJstent use, previous ESL application, and UAS use did not affect contrary to expectations stone volume, HU, IPA, and S-ReSC score were among the factors statistically significant affecting the durability of the device. It was observed, Exp(B) values of the affecting factors to be 0.984, 0.268, 0.894, and 0.607, respectively. We found the most appropriate cutoff value for IPA as 41.25 degrees. CONCLUSION: The mean stone volume broken by each of the subsequent f-URS may increase, while the mean operative time may decrease as time progresses. This result shows us the importance of mastery of the device, such as the deflection maneuver, and the correct use distance of the laser, which improves with the increase in user experience, and makes us interpret that the operation time is shortened with this self-confidence. Factors including stone volume, HU, IPA, S-ReSC score affect the durability of the f-URS device and the as well as manufacturing features.

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BACKGROUND: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. METHODS: Ten courses were organized during 2017-2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. RESULTS: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). CONCLUSIONS: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time.

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Background: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. Methods: Ten courses were organized during 2017–2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. Results: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). Conclusions: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time (AU)

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Purpose: Retrograde intrarenal surgery (RIRS) has been accepted as a first-line therapeutic option for kidney stones <2 cm. Renal mobility might be a challenging situation for the surgeon targeting the laser, thereby limiting the renal mobility during surgery might affect the surgical success. The main objective of the present trial was to evaluate the effect of two different ventilation modes on the efficacy and safety of RIRS performed under general anesthesia. Materials and Methods: The patients undergoing RIRS from January 2023 to April 2023 were prospectively enrolled in the trial. In the standard ventilation (SV) mode, the tidal volume was 8 to 10 mL/kg with respirations per minute being 10-15, whereas in the high ventilation (HV) mode the tidal volume was reduced to 6 to 8 mL/kg with the frequency being increased to 15 to 18 respirations/minute. For the purposes of the trial and the randomization, the anesthesiologist was informed about the ventilation mode used, whereas the surgeon was blinded. The surgical success rates and the observed complications were compared between SV and HV modes. Results: A total of 144 patients were enrolled with the mean age 48.78 ± 14.16 years. The mean duration of operation was 62.9 ± 26.3 minutes in the SV group, whereas it was 58.4 ± 20.1 minutes in the HV group (p = 0.031). Fragmentation rate of the stones per minute was higher in the HV group with the difference being statistically significant (p = 0.003). In the preoperative period, while hematuria was seen at higher rates in the HV group, the difference was not statistically significant (p = 0.671). Stone-free rates (Grades A-B-C) and the rates of postoperative complications were comparable between the groups (p = 0.605 and p = 0.676, respectively). Conclusion: Using HV mode during the RIRS decreased the operative time and provided the surgeon with the ability to target the laser more effectively. Surgeons might prefer using the HV mode during RIRS in a mobile kidney to reduce their operative time and perform comfortable surgery. ClinicalTrials.gov: The trial is registered at ClinicalTrials.gov with the registration number of NCT05792670.

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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.

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