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    Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries
    (Springer Science and Business Media Deutschland GmbH, 2022) Karagöz, Mehmet Ali; Güven, Selçuk; Tefik, Tzevat; Gökçe, Mehmet İlker; Kiremit, Murat Can; Atar, Feyzi Arda; İbiş, Muhammed Arif; Yitgin, Yasin; Böyük, Abubekir; Verep, Samed; Sarıca, Kemal
    Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training.
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    Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20–30 mm) stones? A critical evaluation
    (Springer Science and Business Media B.V., 2022) İbiş, Muhammed Arif; Gökçe, Mehmet İlker; Babayiğit, Muammer; Yitgin, Yasin; Karagöz, Mehmet Ali; Böyük, Abubekir; Verep, Samed; Turan, Serdar; Tefik, Tzevat; Kiremit, Murat Can; Sönmez, Mehmet Giray; Ergül, Rıfat; Güven, Selçuk; Sarıca, Kemal
    Purpose: To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2–3 cm. Methods: A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. Results: The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1–2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3–4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. Conclusions: mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2–3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.