Background: Preoperative bladder urine culture (PBUC) analysis has become a standard application before any stone surgery. When growth is detected in PBUC, it is contraindicated to perform flexible ureterorenoscopy (f-URS). The results of the PBUC susceptibility test do not correlate well with those of the renal pelvic urine culture (RPUC) analysis. Previous studies have demonstrated the positivity of RPUC as an important marker for the development of infections after endoscopic operations. In the current study, we aimed to evaluate the consistency between PBUC and RPUC and to identify preoperative markers associated with a positive RPUC. Methods: Data from 129 patients who underwent f-URS on renal and proximal ureteral stones in two centers between 2015 and 2020 were prospectively recorded in a database and retrospectively analyzed. PBUC was obtained from all the patients preoperatively, and RPUC was taken at the beginning of the f-URS operation. The results of the two cultures were compared. Results: There was growth in PBUC in 25 (19.4%) patients and RPUC in 35 (27.1%) patients. Possible predictive markers in predicting a positive RPUC were evaluated using multivariate logistic regression analysis. Preoperative urine density at the renal pelvis [odds ratio (OR): 0.848, p<0.001],grade≥2 hydronephrosis (OR:18.970,p=0.001), and lower calyceal stone localization (OR:0.033,p=0.017) were determined as independent predictive factors for a positive RPUC. The ability of pelvis urine density to predict positive RPUC positivity was evaluated using the receiver operating characteristic analysis, in which the area under the curve value was determined to be 0.858 (0.780-0.936). The cut-off value of pelvis urine density in the prediction of RPUC positivity was 4.5, at which it had 80% sensitivity and 77.7% specificity. Conclusions: PBUC may not represent true colonization. Although bladder urine culture is negative before the operation, patients with preoperative hydronephrosis and low pelvis urine density may have RPUC growth.

Purpose: To evaluate the correlation between PI-RADSv2.1 and International Society of Urologic Pathologists (ISUP) score for patients who underwent multiparametric-MRI(MpMRI) prior to transrectal ultrasound (TRUS) guided cognitive fusion biopsy (CF-Bx). And to investigate inter-observer agreement of PI-RADSv2.1. Methods: Patients who underwent MpMRI of prostate prior to first TRUS-guided CF-Bx, were included in this prospective study. MpMRI examinations were evaluated by two radiologists before biopsy according to the PI-RADSv2.1. Interobserver agreement was recorded and the final PI-RADS categorization was performed by consensus. Correlation of histopathological results with PI-RADSv2.1 score was evaluated. Lesions with Gleason Score(GS)≥6 were considered as prostate cancer (PCa). Results: A total of 84 patients with 106 lesions were included in the study. The ratio of PCa in the PI-RADS groups 1,2,3,4,5 was 0%, 0%, 22.2%, 56%, 94.45%, respectively. There was a positive correlation with a value of 0.814 between the PI-RADSv2.1 and the ISUP score. When PI-RADS≥3 is accepted as the cut-off value in peripheral zone(PZ) and the whole gland, the NPV for malignancy was 100.00%. For PI-RADS ≥4, it was 76.47% for PZ, and 80.65% for the whole gland. For the whole gland; sensitivity, specificity, and PPV of the PI-RADS≥3 were 100%, 12.9%, and 44.33%, respectively; for PI-RADS≥4, these values were 72.09%, 80.65%, and 72.09% respectively. Without applying cut-off values, the interobserver agreement for PI-RADS score was κappa:0.562. Conclusions: PI-RADSv2.1 was created in the framework of v2 to facilitate to evaluate MpMRI and to increase interobserver agreement. We believe that further studies will be necessary.

Objective: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and upper ureteral stones at two institutions between March2015 and June2020. Intraoperative complications were assessed using SCC and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The female/male ratio of 949 patients was found to be 346 (36.5)/603(63.5). The median stone size was determined as 13 mm. The stone-free rate was 83.6%after the first intervention, and the final stone-free rate was 94.4% after re-procedure. According to SCS, the intraoperative event and complication incidence was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.9%, p=0.006). Besides, stone localization, size, number and density were associated with the development of complications (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). In addition, the multivariate analysis revealed that for the patients with grade≥3 complications according to MCCS, only stone-free status was a significant predictor of complication development (p=0.044) whereas for those with grade ≥2b complications according to SCS, significant predictors were stone size (p<0.001), stone density (p=0.022), and fluoroscopy time (p<0.001). Conclusion: This study showed that abnormal kidney anatomy, multiple stones, operative time, and stone-free status were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

Objectives: To externally validate and compare Resorlu-Unsal stone score(RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito’s nomogram and R.I.R.S. scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. Materials and Methods: We performed a retrospective analysis of 949 patients who were underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito’s nomogram and R.I.R.S. scores were calculated for each patient by same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. Results: Of 949 patients 603 were male and 346 were female with a mean age of 47.2±14.3 (range 2-84years). Mean stone burden was 102.6±42.2 (48-270mm2). All nomograms predicted stone-free status (AUC were 0.689, 0.657, 0.303 and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286 and 0.664 for RUSS, modified S-ReSC, Ito’s nomogram, R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito’s nomogram was able to predict Clavien ≥2 complications. Conclusion: All four scoring systems (RUSS, modified S-ReSC, Ito’s nomogram and R.I.R.S.) could predict stone-free status after f-URS, however the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.