To evaluate whether or not using a ureteral access sheath (UAS) affects the perioperative outcomes after retrograde intrarenal surgery (RIRS) performed in patients with renal stones.An observationa...

Advances in laser technology and surgical telescopic systems have propelled retrograde intrarenal surgery (RIRS) to the forefront as a viable alternative to percutaneous nephrolithotomy (PCNL). Currently, RIRS is being increasingly utilized as a treatment option, even for kidney stones larger than 2 cm. In this narrative review, we aimed to take a snapshot of current practice in renal stone treatment and the latest technological and technical developments and to evaluate the efficacy of RIRS in larger renal stones. With low complication rates and acceptable stone-free rates, RIRS offers patients a less invasive option with favorable outcomes. There are insufficient data comparing PCNL with RIRS using a new-generation high-power laser and suctioning ureteral access sheath (UAS). Further studies with novel lasers and UAS could provide superiority in terms of RIRS. It is crucial to take into account various patient-specific considerations, such as stone location and burden, when deciding on the appropriate treatment approach. Cite this article as: Tonyali S, Haberal HB, Esperto F, et al. The prime time for flexible ureteroscopy for large renal stones is coming: is percutaneous nephrolithotomy no longer needed?. Urol Res Pract. 2023;49(5):280-284.

Introduction Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. In this study, we aimed to evaluate efficacy and factors affecting the success of retrograde intrarenal surgery (RIRS) in children. Materials and Methods Patients who underwent RIRS were evaluated retrospectively. Two different flexible ureteroscopes (F-URS) were used (7.5F F-URS and 7.95F with a 4.9F bullet-shaped tip). Irrespective of size, all residual fragments were considered as failure. Age, stone size, stone localisation, Hounsfield Unit (HU), stone-free rate (SFR) and complications were evaluated. Results Forty-six patients (29 boys and 17 girls) with a median age of 70.5 months (6-214 months) were treated with RIRS between August 2014 and November 2019. The median operative time was 60 minutes (45-120 minutes). The median follow-up was 26 months (3-65 months). Fourteen patients had lower pole and 10 patients had multiple stones. Ureteral access sheath (UAS) was used in 16 (35%) patients. SFR was 61%. The median number of general anaesthesia was 2 (min 1, max 5). Auxiliary semirigid URS, PCNL and repeat RIRS were required in 4, 6 and 5 patients, respectively. Two patients had postoperative febrile urinary tract infection (UTI) as a complication. Age was associated with post-operative febrile UTI. Presence of stones with HU lower than 700, being operated 4.9F F-URS and without UAS were associated with better SFR. Conclusions RIRS is a minimally invasive method with low complication rates in the treatment of childhood stone disease. Higher stone-free rates are obtained in low HU stones and cases in which we used 4.9 F tip F-URS.

Objectives: Among males, prostate cancer (PCa) is the most common cancer in Europe and the second most common cancer worldwide, especially in those aged > 70 years. With the advent of novel alternative treatments, survival in patients with advanced PCa has increased. PCa is now considered a chronic disease. Survival is an important endpoint in advanced PCa, as is quality of life (QoL). The effects of the disease and its treatment on patient health-related QoL must be taken into account when selecting the most appropriate treatment options. The present literature review aimed to provide an overview of metastatic castration-resistant prostate cancer treatment modalities, with an emphasis on side effect profiles and general health-related QoL. Methods: PubMed was searched using the keywords metastatic castration-resistant prostate cancer, docetaxel, cabazitaxel, enzalutamide, abiraterone acetate, and QoL. Conclusion: Based on the studies reviewed herein, abiraterone acetate and enzalutamide provide favorable outcomes, in terms of hematological adverse events. As enzalutamide and abiraterone acetate can be taken orally, they might have a positive effect on patient QoL.