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Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.

Introduction: Perimeatal flap (Mathieu) and tubularized incised-plate (Snodgrass) methods were compared regarding success rate, postoperative complications, and cosmetic appearance in primary and recurrent distal hypospadias cases with normal urethral plates. Patients and Methods: Between 1995 and 2001 Snodgrass-type repair was done in 32 primary and in 24 recurrent hypospadias cases (total 56 patients; mean age 5.8, age range 3–17 years), and Mathieu-type repair was done in 33 primary and in 21 recurrent distal hypospadias cases (total 54 patients; mean age 5.2, age range 2–19 years). There was no statistically significant difference between groups regarding demographics. Patients with primary hypospadias either without or with minimal chordee and patients with recurrent hypospadias only with a normal urethral plate were included in the study. The mean postoperative follow-up period was 24 months. Results: Meatal stricture formation, fistula formation, wound dehiscence, and flap necrosis were seen in 2, 4, 4, and 2 patients, respectively, treated with the Mathieu technique and in 5, 4, 3, and 0 patients, respectively, treated with the Snodgrass technique. Wound dehiscence and flap necrosis were seen less frequently, whereas meatal stenosis was more common in the Snodgrass group (p < 0.05, p < 0.05, and p > 0.05, respectively; χ² test). There was no difference between groups regarding fistula formation. Mean hospital stay, time to stent withdrawal, and urinary diversion period were shorter in the Mathieu group (7.5 ± 1.19 vs. 5.7 ± 1.38 days, 7.1 ± 0.67 vs. 5.4 ± 0.85 days, and 14.1 ± 1.17 vs. 10.2 ± 1.72 days, respectively; p < 0.001 for all). The total success rates were similar (78.6% in the Snodgrass group and 77.8% in the Mathieu group). Cosmetic appearance was highly satisfactory in the Snodgrass group. Conclusions: We believe that the Snodgrass method should be preferred for primary and recurrent hypospadias cases without chordee or with minimal chordee and with a normal urethral plate due to its lower complication rate and its satisfactory cosmetic appearance. However, when a healthy urethral plate is not available, Mathieu-type repair can be preferred.