Objective: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Recent literature suggests that papillary access to renal calyx is the accepted method. Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stone-free status and reduce unnecessary access. In this study, we present our results with papillary vs non-papillary access in patients with a kidney stone. Material and methods: Two hundred and seven patients with non-papillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1). Preoperative and postoperative data were collected from the patient's chart. Operative time (from starting surgery to nephrostomy tube), drop-in hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (Clavien-Dindo Classification) and stone-free status (no or < 3 mm residual stone) were also evaluated in both groups. Results: The mean operative time was similar in between two groups. The mean hematocrit decreases not differ between the two groups (p = 0.56). In papillary group, only 2 patients (3.2%) required transfusion and only one patient (1.4%) in the non-papillary group had a transfusion with no statistically significant difference (p = 0.43). The overall complication rates were 7.1% in the papillary group and 7.2% in the non-papillary group (p = 0.89). Postoperative mean creatinine level was similar between the two groups. Conclusions: In this study, we found that non-papillary access is a feasible option for PCNL in the terms of stone-free status and complication rates.

Background/Objectives: Urinary system stone disease is an important health problem both clinically and economically due to its high recurrence rates. In this study, an innovative hybrid approach based on deep learning is proposed to predict the recurrence risk of stone disease. Methods: Patient data were divided into three subsets: anthropometric measurements (Part A), derived body composition indices (Part B), and other clinical and demographic information (Part C). Each data subset was processed with autoencoder models, and low-dimensional, meaningful features were extracted. The obtained features were combined, and the classification process was performed using four different machine learning algorithms: Extreme Gradient Boosting (XGBoost), Cubic Support Vector Machines (Cubic SVM), k-Nearest Neighbor algorithm (KNN), and Decision Tree (DT). Results: According to the experimental results, the highest classification performance was obtained with the XGBoost algorithm. The suggested approach adds to the literature by offering a novel solution that makes early risk calculation for stone disease recurrence easier. It also shows how well structural feature engineering and deep representation can be integrated in clinical prediction issues. Conclusions: Prediction of the stone recurrence risk in advance is of great importance both in terms of improving the quality of life of patients and reducing the unnecessary diagnostic evaluations along with lowering treatment costs.

Happiness is one of the oldest and most intriguing topics in human history. The definition of happiness and how to achieve it have been questioned since ancient times. Research shows that the foundation of happiness lies in the level of social communication and interaction. The most basic area of interaction and communication for individuals is their family. Therefore, individuals who are happy in their family life tend to reflect this happiness in their work and other social relationships. Thus, by following certain rules and taking necessary precautions during the process of establishing and maintaining a family through marriage, we can achieve a happy family life and, consequently, a happy life. If marriage and family life bring us so much joy, we need to appreciate their value. Imagine having a latest model luxury car; you would enjoy driving it, right? But first and foremost, you must have a driver’s license. Similarly, before getting married, we must receive education on marriage and obtain a marriage license. Governments should ensure that those without a marriage license are not allowed to marry. If you neglect your vehicle’s monthly and annual maintenance and do not comply with traffic rules, an accident is inevitable. We take our damaged vehicle to a repair shop. Likewise, in marriages, it is necessary to attend marriage therapy sessions periodically and seek expert support for problems encountered during disagreements. Just as polishing and washing our car from time to time improves its appearance and provides satisfaction, spending quality and special time as a family is essential for relief and peace within the family. Achieving happiness within the family is possible by taking advantage of the wonderful opportunities offered by marriage. The most important aspects include not only dedicating special time for each other and the children but also getting to know oneself, making time for self-care, understanding the partner’s expectations through empathy, and ultimately fostering a sense of ""us."" While achieving all these, it is crucial to recognize sexuality as a beautiful fruit of marriage and to regularly enjoy this aspect. In this book, we share the secrets of how to achieve a happy family and marriage with a team of family and marriage counselors. I wish you a pleasant reading experience.