This study aimed to compare the predictive performance of Triple-D, Quadruple-D, and Mayo Adhesive Probability (MAP) scoring systems in estimating stone-free (SF) status following extracorporeal shock wave lithotripsy (ESWL) in patients with renal stones. This retrospective cohort study was conducted on patients who underwent ESWL between January 2020 and January 2024. Pre-treatment non-contrast computed tomography was used to assess stone characteristics and calculate Triple-D, Quadruple-D, and MAP scores. Patients were categorized into stone-free (SF) and residual stone (RS) groups based on imaging performed three months after treatment. Residual fragments of < 4 mm were defined as SF. The study included 198 patients (60.6% male; mean age 45.5 ± 13.1 years). According to logistic regression analysis, a low MAP score (< 2.5) was the strongest independent predictor of SF status (OR: 15.5; 95% CI: 5.1–47.1; p < 0.001), followed by a high Quadruple-D score (> 1.5) (OR: 7.4; 95% CI: 2.2–24.1; p = 0.001) and low stone density (< 600 HU) (OR: 4.9; 95% CI: 1.1–21.8; p = 0.037). Conversely, a higher number of shockwaves and the need for additional procedures were associated with RS (both p < 0.001). Among the scoring systems, MAP score demonstrated the highest predictive accuracy with an AUC of 0.817, outperforming Quadruple-D (AUC: 0.722) and Triple-D (AUC: 0.639). MAP score was the most powerful and accurate independent predictor of SF status after ESWL, offering superior clinical utility compared to Triple-D and Quadruple-D scores in pre-treatment evaluation.

Background and Objectives: Evidence linking sarcopenia and myosteatosis to oncological outcomes in renal cell carcinoma (RCC) remains inconsistent. We aimed to evaluate whether preoperative psoas muscle measurements are associated with tumor stage, recurrence, and survival in RCC patients undergoing nephrectomy. Materials and Methods: A total of 199 patients who underwent nephrectomy with a diagnosis of RCC between 2018 and 2024 were retrospectively evaluated. Preoperative computed tomography images were used to measure the bilateral psoas muscle area at the L3 vertebral level and Hounsfield unit (HU) values. The psoas muscle index (PMI) was calculated. PMI and psoas HU values were analyzed as continuous variables, as this approach preserves statistical information and avoids misclassification bias inherent to arbitrary dichotomization, particularly given the absence of population-specific validated thresholds for Turkish RCC patients. Tumor stage, metastasis, recurrence, and survival data were analyzed. Results: The mean age of the patients was 60.29 ± 11.62 years, and 67.84% were male. The mean PMI was 5.11 ± 1.54 cm²/m² while the mean psoas HU value was 38.63 ± 8.95 HU. PMI was significantly higher in patients with advanced-stage (T3 and T4) disease than in those with early-stage (T1 and T2) disease (5.57 ± 1.49 vs. 4.30 ± 1.28, p < 0.001). A positive correlation was found between T stage and PMI (r = 0.396, p < 0.001) and between tumor size and PMI (r = 0.215, p = 0.002). Modest but significant correlations were found between age and both PMI (r = −0.274, p < 0.001) and psoas HU values (r = −0.347, p < 0.001). Conclusions: In this retrospective nephrectomy series, conducted in a cohort inherently enriched for adequate performance status and surgical fitness, PMI showed a positive correlation with pathological T stage and tumor size, intriguingly higher PMI values were observed in patients with advanced T stages. These findings suggest that the role of psoas-based muscle measurements in the prognostication of this subset of RCC patients (advanced disease but candidates for surgical treatment) may be limited.

Background and Objectives: In this study, we aimed to compare the effects of 4.8 F and 6 F JJ stents on irritative symptoms and success rate in patients with a preoperative JJ stent prior to RIRS. Materials and Methods: A total of 316 patients who underwent JJ stent implantation prior to retrograde intrarenal surgery were retrospectively analyzed. Patients were classified into Group 1 (4.8 F stent) and Group 2 (6 F stent) based on stent diameter. Urinary symptoms prior to the insertion of the JJ stent and the day before RIRS were evaluated using the Quality of Life (QoL) score (VAS), International Prostate Symptom Score (IPSS), and Visual Analog Scale. The groups were compared in terms of demographic data, stone characteristics, perioperative data, length of stay, complications, stone-free rates (SFRs) and change in total VAS score, IPSS and QoL. Results: The patients’ demographic data and the stone characteristics of the two groups were similar. There was no statistical difference between groups in the SFR, length of stay, or total complication rates (p = 0.5, p = 0.159, and p = 0.13, respectively). Operation time was similar between the groups (p = 0.13). Although the change in total VAS scores was similar between the two groups (p = 0.1), QoL was higher in Group 1 compared with Group 2 (p < 0.001). Group 2 demonstrated worse outcomes in total IPSS, as well as in the storage subscores (Q2, Q4, and Q7) and voiding symptom subscores (Q1, Q3, Q5, and Q6), with all comparisons showing statistical significance (p < 0.001 for each). Conclusions: Varying calibers of JJ stents have comparable success rates and complication outcomes. However, when the stent caliber is reduced, patients experience better QoL and fewer lower urinary tract symptoms. Smaller-diameter stents were associated with significantly better symptom-related outcomes without compromising surgical success.