Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Introduction Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery. Materials and methods PubMed and Web of Science databases were searched systematically between April and May 2021. The scoring systems which were validated externally or studied at least by two different researcher groups were selected for further analysis. Of 59 records, 14 studies met the inclusion criteria (n = 4137). Area under curve (AUC) values of selected scoring systems were pooled in random or fixed effects. Thertest was used to quantify heterogeneity. Results Eight, 5, 8, 4 and 3 studies included in meta-analyses for the modified Seoul National University Renal Stone Complexity Score (S-ReSC), R.I.R.S., Resorlu-Unsal Score (RUS), S.T.O.N.E., and Ito's Nomogram, respectively. We found pooled AUC values 0.709 (95% CI 0.670-0.748), 0.704 (95% CI 0.668-0.739), 0.669 (95% CI 0.646 to 0.692), and 0.771 (95% CI 0.724 to 0.818), for first four of them, respectively. Heterogeneity was very high to pool AUC values for Ito's nomogram. Conclusions Although S.T.O.N.E. score showed higer pooled AUC value, this systematic review and meta-analysis has not revealed superiority of any scoring system. High heterogeneity between studies and dependencies between scoring systems make it difficult to design a comparative statistical model to generalize the findings. Also, limitations aside, neither scoring system has demonstrated good predictive/discriminative performance

Sjögren Syndrome Which Simulates Relapsing Remitting Multiple Sclerosis Clinical Features: Case Report

Sjögren syndrome (SS) is a chronic, inflammatory, autoimmune disease. It emerges as a dry mouth and eyes (sicca symptoms) because, it fundamentally affects exocrine glands, frequently, salivary gland and lachrymal gland. Neurological involvement in Sjögren syndrome is observed in the approximately 20-25% of cases. 87% of the neurological involvements are peripheral nervous system involvement and around 13% of the neurological involvements are central nervous system involvement. Cerebral involvement represents heterogeneous features in terms of both localization (focal or diffuse) and progress of the statement (acute, progressive or reversible). Affected central nervous system can show clinical and radiological signs similar to Multiple sclerosis (MS). In this paper, the case, which has a complaint of difficulty in walking and instability and MS like lesions in brain magnetic resonance imaging (MRI) and is diagnosed as Sjögren syndrome by further research, is discusse

Assessment of Early Stage Non-Motor Symptoms in Parkinson’sDisease

OBJECTIVE: In this study, our purpose is, in the early stage of PD, examining the frequency of occurrence of non-motor symptoms and discussing the effects of morbidity of disease. METHODS: Selcuk University, Meram Faculty of Medicine, Neurology outpatient clinic in the study, which is followed by the United Kingdom Brain Bank criteria for Parkinson's Disease Parkinson's Disease diagnosis and clinical staging according to Hoehn Yahr stages 1 and 2 of the 80 patients were studied. RESULTS: Cases, an increase in UPDRS scores were significantly higher non-motor symptoms. CONCLUSION: Non-motor symptoms in Parkinson's disease can often go unnoticed. Symptomatic treatment is an important part of the success. Therefore, PH and the non-motor symptoms, early detection is important to treat them in accordance wit

The Relationship Between Pain and Clinical Features in Multiple Sclerosis

OBJECTIVE: Multiple Sclerosis(MS) is an autoimmune-neurodegenerative disease of the central nervous system. The pain prevalence differentiates between 29% and 86 % in this disease and besides the neuropathic, somatic pain types might emerge together or separately. In this study we aimed to analyse the relationship between pain and other clinical featuresin MS. METHODS: 100 cases,of whom are followed in MS polyclinic and who have complaints of pain, have been included to this study.By ensuring the forms that we prepared to be filled by the cases, we examined the pain type and localization. Thereafter we applied Visual Pain Scale (VPS), Ashworth Spasticity Scale (ASS) and Beck Depression Scale(BDS). RESULTS: When female and male patients are compared, significant difference has not been observed statistically among age, disease period and EDDS scores. 77 % of the cases have suffered from neuropathic pain, 21 % of the cases have displayed Lhermitte symptoms, trigeminal neuralgia has been observed in 1 % of the cases and 55 % of the cases have had complaints of neuropathic extremity pain. In 60 % of the cases nociceptive pains, in 12 % of the cases joint-extremity-muscle pain, in 47 % headache and in 1 % painful tonic spasms have existed. Pain depending on the treatment has been observed only in 2 % of the cases. The pain score has been detected significantly on patients with spasticity and depression (p= 0.008, p= 0.001 in return). While there has been reasonable positive correlation between age, EDDS score and VPS (p= 0.010, p= 0.002 in return), poor correlation has been obtained between disease period and number of attacks (p= 0.002, p= 0.045 in return). CONCLUSION: These findings indicate that MS pain is related with spasticity, disability and depression and these clinical findings should be taken into account during pain treatment and the above factors should be treated

Tekirdağ İlindeki Ürologlar Üriner Sistem Taş Hastalığında Taş Analizi, Metabolik Değerlendirme ve Metafilaksi Yapabiliyor mu?

Objective: As the urolithiasis is an endemic situation in our country, the urologists are well-experienced about this situation. The prevention of urolithiasis recurrence is as important as the surgical treatment. For this reason metabolic evaluation and medical treatment of stone disease is extremely important. This study aimed to evaluate urological specialists' views of metabolic evaluation and medical treatment of urolithiasis. Thus, the main problems and the probable solutions about medical treatment and metabolic evaluation of urinary system stone disease can be evaluated. Methods: The urologists working at Tekirdag were invited to the study. A face-to-face questionnaire, which was composed of three parts, was performed to the participants. In the first section, the demographic characteristics of the participants were evaluated. In the second and third sections, the approach of participants to metabolic evaluation and medical treatment in urolithiasis were investigated, respectively. Results: A total of 29 urologist who routinely performed endourological surgery were included to the study. When we evaluated their endourological practice, 65.5% of the participants were performing 10-25 endourological surgery per month. When we asked the approach of participants about the metabolic evaluation, 34.5% reported that they did not perform metabolic evaluation to their adult patients and 65.5% did not perform to the children with urolithiasis. All participants believed the efficacy of medical treatment however, 66% of the participants were performing at less than half of their patients in clinical practice. Conclusions: The clinical practice about metabolic evaluation, stone analysis and metaphylaxis were lower than expected. Most of the participants were not able to make metabolic evaluation and stone analysis. Further studies are needed to resolve the problems associated with metabolic evaluation and metaphylaxis administration.Giriş: Üriner sistem taş hastalığı coğrafyamız açısından endemik bir durum olup, ülkemizdeki üroloji uzmanlarının üriner sistem taş hastalığı ile ilgili tecrübeleri oldukça yüksektir. Üriner sistem taş hastalığının cerrahisi kadar bu hastalığın nüksünü engellemek de bir o kadar önemlidir. Bu bağlamda, taş hastalığının metabolik değerlendirmesi ve medikal tedavisi son derece önem taşımaktadır. Bu çalışmada, Tekirdağ ilinde çalışan üroloji uzmanlarının, üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye bakış açılarının değerlendirmesi amaçlanmıştır. Yöntemler: Çalışmaya Tekirdağ ilindeki hastanelerde çalışan üroloji uzmanları davet edildi. Katılımcılara, toplam üç bölümden oluşan anket yüz-yüze uygulandı. Anketin ilk bölümde katılımcıların demografik özellikleri değerlendirildi. Anketin ikinci ve üçüncü bölümlerde ise sırasıyla üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye yönelik katılımcıların yaklaşımları incelendi. Bulgular: Klinik pratiğinde rutin endoürolojik cerrahi uygulayan toplam 29 üroloji uzmanı çalışmaya dahil edildi. Katılımcıların %65,5’i ayda ortalama 10-25 endoürolojik cerrahi uygulamaktaydı. Metabolik değerlendirme ile ilgili görüşleri sorgulandığında katılımcıların %34,5’i erişkinlerde ve %65,5’i çocuk taş hastalarında metabolik değerlendirme uygulamadığını belirtti. Tüm katılımcılar üriner sistem taş hastalığında medikal tedavinin etkinliğine inanmaktaydı. Ancak katılımcıların %66 ’sı klinik pratikte medikal tedaviyi hastaların yarısından azında uygulamaktaydı. Bunun sebebi sorulduğunda katılımcıların yarısına yakını, metabolik değerlendirme için olanaklarının olmadığını belirtti. Tartışma: Çalışmamızda, katılımcıların metabolik değerlendirme, taş analizi ve metafilaksi konusundaki uygulamalarının beklenilenden daha düşük olduğu görüldü. Katılımcıların çoğu metabolik değerlendirme ve taş analizi yapamadıklarını belirtti. Metabolik değerlendirme ve metafilaksi uygulanması ile ilgili problemlerin çözülmesine yönelik daha fazla çalışmaya ihtiyaç vardır

Retrograde intrarenal surgery for the treatment of lower calyx stones

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Bu çalışmada, fleksibl üreterorenoskoplar (f-URS) ile alt kalis taşları tedavisinde retrograd intrarenal cerrahi (RİRC) uygulamalarımız değerlendirildi. Gereç ve yöntem: Yirmi sekiz hastanın (20 erkek, 8 kadın; ort. yaş 49; dağılım 26-80) 31 renal ünitesinde bulunan alt kalis taşları f-URS kullanılarak RİRC ile tedavi edildi. Dokuz hastada, ikisinde iki taraflı olmak üzere, sadece semptomatik alt kalis taşı vardı. Bunların altısına, daha önce vücut dışı şok dalga tedavisi uygulanmış; ancak, taşlar kırılamamıştı. On altı hastada ise, aynı taraf ünitede bulunan üreter taşı tedavi edildikten sonra, aynı seansta alt kalis taşı (1 hastada iki taraflı) da tedavi edildi. Üç hastada ise kalis taşlarının sayısı birden fazlaydı. Alt kalis taşları, uygun olgularda Nitinol basket ile yakalanıp üst kalise taşındı ve orada kırıldı. Taşlar 0.2 mm çaplı holmium:YAG lazer probu kullanılarak kırıldı ve 2 mm’den büyük parçalar çıkarıldı. Gereken olgularda üretere JJ kateter yerleştirildi. Ameliyat sonrası 4-6 haftalar arasında 22 hastada (%78.6) radyolojik kontrol yapılabildi.Objective: We evaluated retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (f-URS) for the treatment of lower pole calyx stones. Materials and methods: Twenty-eight patients (20 males,8 females; mean age 49 years; range 26 to 80 years) underwent RIRS using f-URS for lower pole calyx Stones in 31 renal units. Nine patients had isolated but symptomatic lower calyx stones, of which two patients had bilateral involvement, and extracorporeal shock wave lithotripsy was unsuccessful in six patients. In 16 patients (1 patient had bilateral involvement) RIRS was performed in the same session following treatment of ipsilateral ureteral stones. Three patients had multiple calyx stones. In appropriate cases, the stones were taken into a Nitinol basket and displaced to the upper calyx. The stones were fragmented using a 0.2- mm holmium:YAG laser probe and fragments larger than 2 mm were removed. A JJ ureteral catheter was placed when necessary. Radiologic controls could be made in 22 patients (78.6%) in the postoperative 4 to 6 weeks

Radical retropubic prostatectomy as a solo therapy for treatment of adult rhabdomyosarcoma.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.INTRODUCTION Incidence of prostate rhabdomyosarcoma in adults is not yet known. Together with other sarcoma subtypes they cover less than 0.1% of the primary prostate malignancies.(1) We report an adult patient diagnosed with localized rhabdomyosarcoma treated with radical prostatectomy alone

Dosimetry and acute toxicity in prostate cancer patients treated with image-guided intensity modulated radiotherapy: preliminary results in the first 100 men

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Lokalize prostat kanseri olgularında uygulanan görüntü rehberliğinde yoğunluk ayarlı radyoterapinin (YART) dozimetrik ölçütlerini ve erken dönem akut yan etkilerini araştırmak amacıyla ilk 100 olgunun dosyaları retrospektif olarak incelendi. Gereç Ve Yöntem: Görüntü rehberliği amacıyla her olguda prostat içersine transüretral ultrason eşliğinde üç adet altın marker yerleştirildi, her tedavi öncesi bu markerların lokalizasyonu verifiye edildikten sonra radyoterapi uygulandı. Olguların risk gruplarına göre prostat +/- seminal veziküller +/- pelvik lenf nodları klinik hedef volüme dahil edildi. Hedef volüme ortanca 76 Gy (aralık, 74-78 Gy) radyoterapi uygulandı. Tedavi sonrası en az üç ay takip edilen olgular tedavi sırasında her hafta, tedavi sonrasında da 1. ayda akut toksisite açısından değerlendirildi ve akut yan etkiler RTOG skorlamasına göre derecelendirildi.Objectives: We aimed to analyze the dosimetric criteria and preliminary acute toxicity in the first 100 men treated with image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer. Methods: For image guidance, three fiducial gold markers were implanted in each patient under transurethral ultrasound guidance. According to the risk group classification, prostate and/or seminal vesicles and/or pelvic lymph nodes were defined as the clinical target volume. A median of 76 Gy (range, 74-78 Gy) was delivered to the planning target volume. The patients were evaluated once a week during the treatment and one month after the completion of the treatment. Acute toxicity was scored according to the RTOG scoring system

Endometrium clear cell karsinomlu bir olguda achromobacter xylosoxidans'ın sebep olduğu ürosepsis

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Achromobacter xylosoxidans, diğer adıyla Alcaligenes xylosoxidans gram negatif, aerob, oksidaz pozitif, nonfermentatif, hareketli, çomak şeklinde bir bakteridir. Doğada, toprak ve suda bulunabilen bir mikroorganizma olup, immün sistemi baskılanmış kişilerde fırsatçı enfeksiyonlara neden olmaktadır

Does extracorporeal shock wave lithotripsy before retrograde intrarenal surgery complicates the surgery for upper ureter stone? the results of the RIRSearch group

Aims To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones. Methods The patients in the study population were divided into two groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalisation time and stone-free rates were compared between the groups. Results There were 56 patients in Group 1 and 95 patients in Group 2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group 1 (P = .043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status. Conclusion Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient's last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications