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    Comparison of Safety and Efficiency of General, Spinal and Epidural Anesthesia Methods Used for the Endoscopic Surgical Treatment of Ureteral Stones: Which One is Better To Access The Ureter and Reach The Stone?
    (UROL & NEPHROL RES CTR-UNRC, 2020) Oztekin, Unal; Caniklioglu, Mehmet; Atac, Fatih; Kantekin, Cigdem Unal; Gurel, Abdullah; Isikay, Levent
    Purpose: The aim of this study is to evaluate the effects of anesthesia methods on the success of urethral access and stone access achievement in endoscopic treatment of urolithiasis. Materials and Methods: In this prospective randomized study, 105 patients who underwent primary ureterorenoscopy (URS) procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia method: General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared. Results: There was no statistically significant difference among the three groups in terms of the demographic values and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group. Conclusion: In patients who decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.
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    The effect of ureterorenoscopy and retrograde intrarenal surgery procedures on renovascular hemodynamics
    (BAYRAKOL MEDICAL PUBLISHER, 2020) Oztekin, Unal; Erkoc, Fatih; Sari, Sercan; Selmi, Volkan; Gurel, Abdullah; Atac, Fatih
    Aim: The aim of this prospective clinical study was to evaluate the preoperative and postoperative intrarenal vascular parameters of the kidneys undergoing URS and RIRS operations and compare the outcomes with the results of the normal contralateral kidneys. Materials and Methods: A total of 89 patients were included in the study. There were 42 and 47 patients in RIRS and URS groups respectively. The ureteral tract with stone formation was named as operated side, and the contralateral side was named as non-operated side. Preoperative gray-scale and CDUS measurements were obtained 24 h before and 8 h after the operations. The RI measurements were calculated from the upper pole, middle area, and the lower pole of the kidney and averaged. Results: There was no statistically significant difference in the demographic and peroperative features between the two groups except for irrigation fluid volume. Preoperative mean RI values were higher than the contralateral non-operated side kidney but not statistically significant (p=0,346). The.RI values were higher on the operated side in RIRS group compared with URS according to the selected surgery method (p=0,041). Discussion: Endoscopic stone surgery procedures increase renal vascular resistance by increasing intrarenal pressure. Therefore, we recommend reducing the use of irrigation fluids as much as possible during surgical applications.