Browsing by Author "Eryildirim, Bilal"

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The Impact of Anterior Calyceal Stones on the Outcomes of Percutaneous Nephrolithotomy for Complex Kidney Stones: a Comparative Study
(Edizioni Minerva Medica, 2021) Sahan, Ahmet; Dincer, Erdinc; Ozkaptan, Orkunt; Cubuk, Alkan; Ertas, Kasim; Eryildirim, Bilal; Akca, Oktay
BACKGROUND: This study aimed to evaluate the possible effect of anterior calyceal stones on the surgical outcomes of percutaneous nephrolithotomy. METHODS: Consecutive patients with complex kidney stones from 2012 to 2020 were evaluated retrospectively. In total, 219 patients were divided into 2 groups based on the presence of anterior calyceal stones (group 1; N.=89) or not (group 2; N.=130). The groups were compared in terms of surgical outcomes (i.e., stone-free rate [SFr], operation time, and hemoglobin drop) and complications. RESULTS: The patient demographics and stone characteristics were similar between the groups. Multiple access was more frequently done in group 1 than it was in group 2 (47.2% vs. 30.8%; P=0.014), and the SFR was lower in group 1 (51.7%) than it was in group 2 (67.7%; P=0.017). Of the anterior calyceal stones in group 1, 42.6% could not be cleaned. However, when excluding patients who have only anterior residual stones from the statistical analysis, the groups had similar SFRs (68.5% vs. 67.7% for group 1 and group 2, respectively). CONCLUSIONS: The presence of complex kidney stones with anterior calyceal extension are associated with higher residual stones rates in the anterior calyx. Also, it increases multiple access, the operation time, and level of hemoglobin drop.
Safety of Upper Pole Puncture in Percutaneous Nephrolithotomy With the Guidance of Ultrasonography Versus Fluoroscopy: a Comparative Study
(Karger, 2020) Sahan, Ahmet; Cubuk, Alkan; Ozkaptan, Orkunt; Canakci, Cengiz; Eryildirim, Bilal; Toprak, Tuncay; Ertab, Kasim
Introduction:The aim of this study was to compare the safety of ultrasonography-guided (UG) puncture and fluoroscopy-guided (FG) upper pole access (UPA) in percutaneous nephrolithotomy (PCNL).Methods:Consecutive patients with a solitary UPA were enrolled into the study from 2012 to 2020 and analyzed in a retrospective manner. In total, 177 patients were divided into 2 groups according to the method during the puncture phase of the access: FG (n= 105) and UG (n= 72). The UG and FG groups were compared in terms of complications (i.e., pleural injury and blood transfusion rate) and surgical outcomes.Results:Gender, side, grade of hydronephrosis, type of access (i.e., supracostal vs. subcostal), Guy's stone score, age, stone diameter, skin-to-stone distance, and stone density were similar in the 2 groups (p> 0.05). Only in 25.9% of cases, UPA was done using a subcostal approach. The overall complication rates were similar between the groups (p> 0.178). For the UG and FG groups, the rate of pleural injury (8.5 vs. 4.1%) and the blood transfusion rate (8.5 vs. 2.8%) were also similar (p> 0.05). The fluoroscopy time and mean hemoglobin drop were significantly lower in the UG group than in the FG group (134.2 vs. 82.2 s, respectively,p= 0.001; 20.8 +/- 9.8 vs. 16.8 +/- 7.9 g/L, respectively,p= 0.001). Stone-free rate (SFR) was also similar in the FG and UG groups (77.1 vs. 75.0%, respectively,p= 0.742).Conclusion:While it is commonly expected that the complication rates are lower in UG puncture for UPA in PCNL than they are in FG puncture, the present study failed to show this difference. However, the radiation exposure time seemed to be lower in UG puncture than FG puncture and had a similar stone-free rate (SFR) for UPA in PCNL.