Background/Objectives: Acute obstructive pyelonephritis (AOP) is a urological emergency requiring urgent decompression. We aimed to develop and internally validate an interpretable admission-based score (AP-Score) to predict the likelihood of undergoing percutaneous nephrostomy (PCN) and to test whether it outperforms hydronephrosis grade alone. Methods: We retrospectively analyzed 231 adults with AOP treated with antibiotics alone, double-J stenting, or PCN at a single center. Four admission variables (temperature, C-reactive protein [CRP], serum creatinine, and hydronephrosis grade) were evaluated by multivariable logistic regression and likelihood ratio testing. Discrimination was compared against hydronephrosis grade alone using the DeLong test; calibration and clinical usefulness were assessed, and optimism was estimated using 1000 bootstrap resamples. Results: In the likelihood ratio test, while adding CRP to hydronephrosis grade significantly improved model fit (p < 0.001), serum creatinine provided a smaller additional contribution (p = 0.013). The AP-Score (0–8 points) combined these three variables included in the model; in the categorical model, the grade of hydronephrosis and CRP appeared as independent predictors, whereas creatinine was included due to its contribution on a continuous scale. The score achieved an AUC of 0.830 (95% CI 0.771–0.886), performing significantly better than the model using only the grade of hydronephrosis (AUC 0.772; ΔAUC = +0.058, DeLong p = 0.010; IDI = 0.061, p = 0.002). The optimism-corrected AUC was calculated as 0.827, and calibration was found to be adequate (Hosmer–Lemeshow p = 0.342). A threshold value of ≥4 points yielded a sensitivity of 85.3% and a specificity of 65.0% (OR = 10.79, 95% CI 5.12–22.70); no patients scoring 0–1 points (n = 37) underwent nephrostomy. Conclusions: The AP-Score—which combines a structural parameter (degree of hydronephrosis) with two systemic markers (CRP and creatinine)—is a simple and well-calibrated score that performs significantly better than the degree of hydronephrosis alone. The AP-Score was also associated with additional clinical outcomes, suggesting that it captures aspects of the underlying clinical course in addition to local treatment patterns. However, because the primary endpoint reflects the drainage modality selected under a single-center institutional protocol, the score should be considered hypothesis-generating until externally validated in independent, preferably multicenter cohorts with different drainage practices.

Background: Upper urinary tract transitional cell carcinoma (UUT-TCC) is traditionally managed with nephroureterectomy as the gold standard treatment. However, less invasive approaches such as retrograde ureteroscopic laser ablation may be considered in selected patients. External beam radiotherapy can also serve as an adjunctive or alternative option in non-surgical candidates. Case Presentation: A 94-year-old female patient presented with synchronous pathologies, including a ureteral and bladder tumor on one side and a ureteral stone on the contralateral side. She underwent emergency intervention due to acute postrenal renal failure. Although nephroureterectomy is the standard of care for ureteral tumors, it was not feasible in this patient due to advanced age and clinical condition. Therefore, ureteroscopic laser ablation was performed. As complete remission could not be achieved, adjuvant external beam radiotherapy was subsequently administered. The bladder tumor was monitored with cystoscopic follow-up, and the patient has been managed with long-term JJ stenting. Conclusion: There is no standardized treatment algorithm for UUT-TCC in cases where nephroureterectomy is not a viable option for the patient. Minimally invasive approaches such as ureteroscopic ablation may be effective in low-grade and small tumors, while radiotherapy may represent a viable option in high-grade or larger lesions. Individualized, multimodal management should be considered in such complex cases.

Amaç: Hem-o-Lok klipsi (HOLK), uygulama kolaylığı ve güvenli klempleme yapılabilmesi nedeniyle minimav invaziv ürolojik cerrahide yaygın olarak kullanılmaktadır, ancak bu teknikle ilişkili nadir komplikasyonlar göz ardı edilmemelidir. Laparoskopik pyeloplastinin oldukça nadir bir komplikasyonu klipsin renal pelvise yer değiştirmesi ve taş oluşumu için bir nidus görevi görmesidir. Bu şekilde 40x28 mm boyutunda böbrek taşı olan ve cerrahi olarak taşı ve HOLK’u temizlenen hastayı sunmayı amaçladık. Olgu içeriği Özeti: Sunulan vakamızda, laparoskopik pyeloplastiyi takiben 12 yıl sonra yan ağrısı ile başvuran erkek hastanın sağ böbrekte 40x28 mm boyutunda taş ve hafif hidronefroz saptandı. Hastaya perkütan nefrolitotomi (PNL) yapıldı ancak operasyon sırasında taşın bir miktar kırılmasıyla içerisinde 2 adet üst üste gelmiş HOLK olduğu görüldü ve timsah pens ile çıkarıldı. Pyeloplasti esnasında kanama durdurucu olarak veya sütür ucuna konulan HOLK'un spontan olarak böbrek pelvisine geçtiğini ve uzun süre içerisinde nidus görevi görerek böbrek taşı oluşturduğunu tahmin ediyoruz. Sonuç: Laparoskopik pyeloplasti esnasında HOLK kullanılması gerekliyse anostomoz hattına yakın olarak yerleştirmekten kaçınılmalı ve gevşek uygulanan HOLK’ler çıkarılmalıdır. Primer sütürizasyon daha güvenli bir yöntem olabilir. HOLK’ler ve eşlik eden böbrek taşları PNL ile çıkarılabilir.