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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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    Can serum matrix metalloproteinase-9 and SMAD-2 levels predict lamina propria invasion in bladder urothelial carcinoma?
    (WILEY, 2021) Yitgin, Yasin; Erdem, Selcuk; Serilmez, Murat; Duranyildiz , Derya; Verep, Samed; Gasimov, Kamranbay; Tefik, Tzevat; Sanli, Oner; Ozcan, Faruk
    Introduction: Matrix metalloproteinase-9 (MMP-9) has a role in the destruction of lamina propria (LP) of the bladder wall and SMAD-2 promotes cell-to-cell adhesion. This study aimed to investigate the association between LP invasion and serum protein and mRNA expression levels of MMP-9 and SMAD-2 in bladder cancer (BC) patients. Methods: Serum samples were taken from 57 patients with suspicious BC before TUR-BT (Group 1) and 20 patients with benign diseases as control (Group 2). The mRNA expression and serum protein levels of MMP-9 and SMAD-2 were analyzed using Real-Time PCR and ELISA methods, respectively. The comparison of protein and mRNA expression levels of MMP-9 and SMAD-2 were done statistically between Group 1 and 2, as well as for different T stages of BC. Results: The protein levels of MMP-9 (2448 vs 637.5 pg/mL, P = .0001) and SMAD-2 (6.85 vs 1.61 P = .0001) were significantly higher in Group 1 compared to Group 2. The mRNA expression levels of MMP-9 (P = .89) and SMAD-2 (P = .99) did not significantly differ between the groups. The protein levels of MMP-9 in T1 patients were significantly higher from both of pTa patients (P = .018) and pT2 (P = .02). The protein levels of SMAD-2 were not statistically different between T stages. Similarly, the mRNA expression levels of MMP-9 and SMAD-2 were not different between T stages. Conclusions: The protein levels of MMP-9 and SMAD-2 were increased in BC patients while mRNA expressions were not different. Furthermore, the increased protein level of MMP-9 in T1 patients was more pronounced which may be related to LP invasion of the tumor.
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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.
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    Evaluation of the optimal duration for retrograde intrarenal stone surgery to prevent postoperative complications
    (SAGE Publications Ltd, 2022) Yitgin, Yasin; Altınkaya, Nurullah; Turaliev, Nurmanbet; Güven, Selçuk; Ergül, Rıfat Burak; Böyük, Abubekir; Verep, Samed; Tefik, Tzevat; Karagöz, Mehmet Ali; İbiş, Muhammed Arif; Gökçe, Mehmet İlker; Sarıca, Kemal
    Objective: To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. Methods: Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 1[removed]60 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. Results: Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8±7.3 (0-49) sec in group 1 and 13.1±9.8 (0-81) sec in group 2. Complications according to modified Clavien–Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. Conclusion: Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications. © The Author(s) 2022.
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    Is access sheath essential for safety and effective retrograde intrarenal stone surgery ?
    (MedGen, 2021) Yitgin, Yasin; Yitgin, Emine; Verep, Samed; Gasimov, Kamranbay; Tefik, Tzevat; Karaköse, Ayhan
    Objective: To evaluate the results of retrograde intrarenal surgery (RIRS) with flexible ureteroscope (f-URS), using ureteral access sheath and without the sheath. Study Design: Descriptive study. Place and Duration of the Study: Kesan State Hospital, Edirne, Turkey, between February 2019 and May 2020. Methodology: Patients treated with RIRS for renal and proximal ureteral stone were evaluated. Two groups were formed that used ureteral access sheath or not. Operation and fluoroscopy times, postoperative complications and stone-free rates were compared. Results: Group 1 consisted of 51 patients were operated with, using ureteral access sheath; and Group 2 having 62 patients, were operated without using ureteral access sheath. The mean volume of the stones was 1135 mm3 (73-7491 mm3) in the group without access sheath and 1273 mm3 (251-3635 mm3) in the group with access sheath. The mean operation time was 55 minutes (20-115 min) in the group without access sheath, and 70 minutes (30-125 min) in the group with access sheath. Postoperative febrile UTI was found in 5 (8%) of the patients without access sheath, and in 4 (8%) of the patients with access sheath (p=0.733). The stone-free rate of the patients with radiological controls was 58 (93%) in the group without access sheath and 46 (90%) in the group with access sheath (p=0.306). Fluoroscopy timings were 2.7 seconds (0-8 sec) in the group without access sheath and 8.4 seconds (2-20 sec) in the group with access sheath (p=0.001). Conclusion: UAS usage has no marked impact on SFR, complication rate and operation time. RIRS can be performed safely and effectively without using UAS.
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    Role, importance and assessment of dietary habits in urolithiasis patient
    (Springer, 2023) Yitgin, Yasin; Asrak, Halime; Tefik, Tzevat
    Urolithiasis, which prevalence is increasing, poses a risk for chronic kidney disease in patients. Dietary habits play a significant role in stone formation, growth and recurrence. Also, comorbidities and lifestyle changes are among the factors affecting stone formation. The next step should be to detect metabolic disorders, if any, with analyzes to be made after a detailed anamnesis, and to arrange the necessary treatment. Insufficient fluid intake is considered to be the main dietary risk factor for urolithiasis. A daily fluid intake of 2.5-3.0 L/day or diuresis of 2.0-2.5 L/day is recommended to prevent recurrence of kidney stones. Not all beverages are beneficial, and some may even increase the risk of stone formation. Dietary management, vitamins and supplements, physical activity are important components in reducing the risk of recurrent urolithiasis. A detailed dietary assessment is recommended as dietary habits affect the faith of the disease. In this review we evaluated the dietary approach of urolithiasis patients with and without comorbidities, the recommended daily fluid intake, vitamin supplementation, and relation of the urolithiasis with physical activity.