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Öğe 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, KemalAlthough 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.Öğe 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, FarukIntroduction: 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.Öğe A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150?ml(SAGE Publications, 2021) Karaköse, Ayhan; Yitgin, YasinIntroduction: To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90–150?ml. Methods: In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Results: Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. Conclusions: BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90–150?mlÖğe Correlation of resistive index of prostatic capsular artery to clinical symptoms in men with chronic prostatitis/chronic pelvic pain syndrome(Wiley, 2023) Yitgin, Yasin; Karakose, AyhanObjectives To evaluate the relation between resistive index (RI) of prostatic capsular arteries by transrectal Doppler ultrasonography in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its correlation with lower urinary tract symptoms, erectile dysfunction and premature ejaculation parameters of CP/CPPS. Methods In total, we included 68 patients presenting with chronic prostatitis/chronic pelvic pain syndrome. We formed two groups, as Group 1 of 35 patients with a RI = 0.7 and Group 2 of 33 patients with RI < 0.7. All patients were assessed with International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), premature ejaculation diagnostic tool (PEDT) and National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). In addition, the RI of the prostate capsular artery was measured in all patients using Doppler ultrasound. Statistical analyses were performed with SPSS version 18. A p value < .05 was considered significant. Results Demographic characteristics were similar in the two groups. IPSS was 11.3 +/- 6 in Group 1 and 9.7 +/- 5.3 in Group 2. IIEF-5 was 18.6 +/- 2 in Group 1 and 20.4 +/- 2.3 in Group 2. PEDT was 12.4 +/- 5.6 in Group 1 and 11.2 +/- 4 in Group 2. CPSI (total) was 19.3 +/- 12.3 in Group 1 and 10.6 +/- 7.7 in Group 2. There was significant statistical difference in IPSS, IIEF-5, and CPSI between the two groups (p < .001, p < .001, p < .001 respectively). However, we found no significant difference in PEDT between the two groups (p = .19). Conclusions There is a significant correlation between the lower urinary tract symptoms and erectile dysfunction parameters and the RI of the prostatic capsular artery in CP/CPPS and RI is an effective and noninvasive method to assess the severity of the disease.Öğe 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, KemalPurpose: 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.Öğe Effects of repeated use of disposable FURS on efficiency, safety and cost analysis(Ondokuz Mayis Universitesi, 2022) Yitgin, Yasin; Karaköse, AyhanIn this study, we aimed to examine cost analysis and evaluate the results of retrograde intrarenal surgery (RIRS) performed with reusable and disposable flexible ureteroscope (FURS) devices in our clinic. In total, we included 96 patients who underwent RIRS surgery for kidney stones with reusable FURS (n = 49) and disposable FURS (n = 47). There were noted preoperative demographic data and stone characteristics of the patients. Also, operation time, fluoroscopy time, hospitalization time, urethral catheter removal time, return to work time, complication rates and cost per procedure were collected and analyzed. There were no significant differences between each groups in terms of demographic characteristics of retrospectively analyzed the data of 96 patients. In addition, the comparison made in terms of operative and postoperative results in both groups was similar. We determined significant difference for mean cost per case compared two groups. There were cost per case $ 293,87 in group 1 and $ 191,48 in group 2. We determined that the repeated use of disposable FURS compared in terms of cost analysis is a safe, effective and low cost method without increasing the infection frequency. © 2022 Ondokuz Mayis Universitesi. All rights reserved.Öğe EFFICACY AND SAFETY OF POSTOPERATIVE INTRAVESICAL ADMINISTRATION OF TRANEXAMIC ACID AFTER TRANSURETHRAL RESECTION OF THE PROSTATE(Istanbul Univ, Fac Medicine, Publ Off, 2023) Yitgin, Yasin; Karakose, AyhanObjective: To evaluate the safety and efficacy of postoperative intravesical administration of tranexamic acid after transurethral resection of the prostate.Material and Method: The data of 112 patients who underwent surgery for lower urinary tract symptoms associated with benign prostatic obstruction (BPO) were retrospectively analysed. We formed two groups. Group 1 consisted of 57 patients who received tranexamic acid by irrigation fluid after the operation; group 2 consisted of 55 patients who did not receive tranexamic acid. Demographic data of patients and prostate characters, as well as operative and postoperative data were analysed. Postoperative bleeding in all patients was evaluated using the haemoglobin levels at the preoperative, and at 0-and 24-h postoperative were evaluated and noted.Result: The mean ages of the patients were 66.9 +/- 7.2 (55-81) years in the intervention group, and those in the control group were 68.6 +/- 7.6 (55-80) years. There were no significant differences between the groups for demographic data, prostate volume and IPSS. The reduction in Hb at 24 hours postoperatively was greater in the control group compared to the TXA group. Statistically significant differences were found between the two groups in terms of postoperative haemoglobin decrease, bladder irrigation time and total amount of irrigation fluid. There were no statistically significant differences between each group regarding the operation, weight of resected adenoma, hospitalization time and catheter removal time.Öğe 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, KemalObjective: 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.Öğe Inguinal Fistula by Suture Granuloma Post Microsurgical Varicocelectomy: A Rare Entity(2022) Yitgin, Yasin; Karaköse, AyhanVaricocele is dilatation and tortuosity of the vessels in the pampiniform plexus of spermatic cord and occurs in 11.7% of adult men. Varicocelectomy may lead to various complications such as hydrocele, testicular atrophy, haematoma, infection, damage of nerves and recurrence. A 22-year-old man presented after varicocelectomy with a rare postoperative complication of a fistula. The fistula tract was removed en bloc. The patient had a history of varicocelectomy, suggesting suture reaction. The fact that it is a rare complication of varicocelectomy makes our case interesting.Öğe 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, AyhanObjective: 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.Öğe A new alternative approach to management of acute phase Peyronie's disease: low intensity extracorporeal shockwave therapy and platelet-rich plasma(Edizioni Minerva Medica, 2023) Karakose, Ayhan; Yitgin, YasinBACKGROUND: The aim of this study was to investigate the efficacy, safety, and outcomes of the combination of low intensity external shock wave therapy (Li-ESWT) and platelet-rich plasma (PRP) therapy in acute phase Peyronie's disease (PD). METHODS: The datas of patients admitted with acute phase Peyronie's between January 2014 and January 2022 were reviewed retrospectively. In total, we included total 159 patients who used combination of vitamin E 600 mg/day plus colchicine 1.5 mg/day plus oral daily 5 mg tadalafil (N.=77) in group 1 and received Li-ESWT+PRP combination therapy plus oral daily 5 mg tadalafil (N.=82) in group 2. We noted characteristics of fibrous plaques, pain status, penile curvature degree, and erectile function parameters. All patients were visited at the 3rd and 12th months after the treatment. RESULTS: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in the mean plaque size, penile curvature degree, IIEF-5 and VAS scores in the intervention group after the treatment. Ecchymosis and hematoma were not observed at the injection site and Li-ESWT application areas in the intervention group. No local or systemic drug reactions were noted in either group. CONCLUSIONS: Combination of Li-ESWT and PRP are highly effective and safety to early treatment in the acute phase PD.Öğe Our experience of retrograde intrarenal surgery in the treatment of upper urinary tract stones(DergiPark, 2021) Yitgin, Yasin; Karaköse, Ayhan; Akdeniz, EkremAmaç: Bu çalışmada böbrek veya proksimal üreter taşı nedeniyle retrograd intrarenal cerrahi (RİRC) uyguladığımız hastaların sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Mart 2019 ile Mayıs 2020 tarihleri arasında böbrek ve proksimal üreter taşlarına yönelik RİRC uygulanan 99 hastanın demografik, klinik, operatif ve postoperatif verileri retrospektif olarak değerlendirildi. Tüm hastalara kontrastsız bilgisayarlı tomografi yapılarak taş lokalizasyonu ve taş boyutu değerlendirildi. Postoperatif kontrolde, radyolojik olarak taş olmaması veya 2 mm ve altı fragmanlar taşsızlık olarak kabul edildi. Bulgular: Çalışmaya yaş ortalaması 44,9 ± 13,1 yıl olan toplam 99 hasta alındı. Hastaların 60’ı (60,6%) erkek ve 39’u (39,4%) kadındı. 48 (%48,4) hastaya sağ, 50 (%50,5) hastaya sol ve bir (%1,1) hastaya bilateral RİRC operasyonu yapıldı. 78 (% 78,8) hastanın taşı böbrekte iken, 21 (% 21,2) hastanın taşı proksimal üreterdeydi. Ortalama taş büyüklüğü 18,5 ± 6,9 mm ve ortalama ameliyat süresi 70,6 ± 23,8 dakika olarak bulundu. Ameliyat sırasında ve sonrasında hastalarda majör bir komplikasyon gelişmedi. Toplam 90 hastada taşsızlık sağlandı ve genel başarı oranımız % 90,9 olarak bulundu. Sonuç: Gelişen teknoloji ve artan deneyim ile birlikte RİRC üst üriner sistem taşlarının tedavisinde düşük komplikasyon ve yüksek taşsızlık oranları ile oldukça başarılı bir tedavi yöntemi olduğunu düşünmekteyiz.Öğe Retrograde Intrarenal Surgery Without JJ Stent Placement in Selected Cases of Renal Stones of 1 cm or Less Requirement of Ureteral Catheterization: Retrospective Observational Study(2023) Karaköse, Ayhan; Yitgin, YasinABS TRACT Objective: To evaluate the safety, efficacy of without JJ stent of retrograde intrarenal surgery (RIRS) for the management of renal stones of 1 cm or less, and to determine the advantages and disadvantages. Material and Methods: The data of 103 patients who underwent uncomplicated RIRS for kidney stones of 1 cm or less were retrospectively analyzed. We formed 3 groups. Group 1 consisted of 33 patients were not placed JJ stent, Group 2 consisted of 36 patients were placed open-tip ureteral stent and Group 3 consisted of 34 patients were placed JJ stent in the RIRS procedure. Demographic data of patients and stone characters, as well as operative and postoperative data were analysed. Postoperative pain in all patients was evaluated using visual analog scale (VAS). Results: There were no significant differences between the groups for demographic data and stone characteristics. While the VAS scores were significantly higher in Group 1 in the early postoperative period (first 24 hours), a significant higher was found in Group 3 in the postoperative 1st week control. There were no significant difference between the 3 groups in terms postoperative febrile urinary tract infection. Conclusion: Although there may be an increase in the need for analgesia in the early postoperative period, we support that effective and safe RIRS can be performed without JJ stent placement in selected cases. It should be kept in mind that there are no JJ stent symptoms and no additional intervention is required for its removal.Öğe Role, importance and assessment of dietary habits in urolithiasis patient(Springer, 2023) Yitgin, Yasin; Asrak, Halime; Tefik, TzevatUrolithiasis, 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.Öğe Üst üriner sistem taşları tedavisinde retrograd intrarenal cerrahi deneyimlerimiz(DergiPark, 2021) Yitgin, Yasin; Karaköse, Ayhan; Akdeniz, EkremAmaç: Bu çalışmada böbrek veya proksimal üreter taşı nedeniyle retrograd intrarenal cerrahi (RİRC) uyguladığımız hastaların sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Mart 2019 ile Mayıs 2020 tarihleri arasında böbrek ve proksimal üreter taşlarına yönelik RİRC uygulanan 99 hastanın demografik, klinik, operatif ve postoperatif verileri retrospektif olarak değerlendirildi. Tüm hastalara kontrastsız bilgisayarlı tomografi yapılarak taş lokalizasyonu ve taş boyutu değerlendirildi. Postoperatif kontrolde, radyolojik olarak taş olmaması veya 2 mm ve altı fragmanlar taşsızlık olarak kabul edildi. Bulgular: Çalışmaya yaş ortalaması 44,9 ± 13,1 yıl (20 - 74) olan toplam 99 hasta alındı. Hastaların 60’ı (60,6%) erkek ve 39’u (39,4%) kadındı. 48 (%48,4) hastaya sağ, 50 (%50,5) hastaya sol ve bir (%1,1) hastaya bilateral RİRC operasyonu yapıldı. 78 (% 78,8) hastanın taşı böbrekte iken, 21 (% 21,2) hastanın taşı proksimal üreterdeydi. Ortalama taş büyüklüğü 18,5 ± 6,9 mm (7 - 35) ve ortalama ameliyat süresi 70,6 ± 23,8 dakika (40 - 125) olarak bulundu. Ameliyat sırasında ve sonrasında hastalarda majör bir komplikasyon gelişmedi. Toplam 90 hastada taşsızlık sağlandı ve genel başarı oranımız % 90,9 olarak bulundu. Sonuç: Gelişen teknoloji ve artan deneyim ile birlikte RİRC üst üriner sistem taşlarının tedavisinde düşük komplikasyon ve yüksek taşsızlık oranları ile oldukça başarılı bir tedavi yöntemi olduğunu düşünmekteyiz.Öğe What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients(Mary Ann Liebert, Inc, 2023) Ibis, Muhammed Arif; Gokce, Mehmet Ilker; Goekhan, Okan; Karagoz, Mehmet Ali; Yitgin, Yasin; Babayigit, Muammer; Boeyuek, AbubekirBackground: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones.Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications.Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones.Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.
