Background: We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus <6 cm in diameter in our tertiary referral university hospital. Materials and Methods: Three hundred thirty consecutive patients were divided into two groups according to tumor size (≥6 and <6 cm in diameter). Demographic variables, body mass index (BMI), lesion localization (right/left), tumor diameter, pathological diagnosis and surgical outcomes, including operation time, estimated blood loss (EBL), conversion to open surgery, complications, and length of hospital stay were compared between groups. Results: Between February 2008 and March 2020, 53 patients (29 male–24 female) with ≥6 cm (L group) adrenal tumor and 277 patients (105 male–172 female) with <6 cm tumor (S group) underwent transperitoneal LA. One hundred sixty-eight (50.9%) tumors localized on the left side. In L group mean tumor size in female and male patients was 87.5 ± 40.8 mm (range 50–225 mm) and 67.3 ± 18.4 mm (range 10–100 mm), respectively ( P < .05). Age, American Society of Anesthesiology scores, BMI, and mean operation time were similar between groups ( P > .05). Postoperative complications were more often in L group ( P = .005). EBL in group L and group S was 86 ± 70.4 mL (range 10–500 mL) and 55 ± 44.2 mL (range 10–300 mL), respectively ( P = .003). Length of hospital stay in group L and group S was 3.7 ± 3.5 days (range 1–26) and 3 ± 1.6 days (range 1–9), respectively ( P = .086). Significant variables in multivariate analysis, including gender (male), EBL, and postoperative complication rate, were entered into multivariate regression analysis, which presented that EBL and postoperative complication rates were independent significants for the L group. Conclusion: Six centimeters should not be considered as an upper limit of transperitoneal lateral LA and may be safely performed in centers with experience. Further studies are needed to confirm our data.

Introduction: Fusion, pelvic, and duplicated urinary tract anomalies of the kidney are rarely seen. There might be some difficulties in the stone treatment, in the administration of extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and laparoscopic pyelolithotomy procedures in these patients due to the anatomical variations in kidneys with anomalies. Aim: To evaluate RIRS results on patients with upper urinary tract anomalies. Materials and methods: Data of 35 patients with horseshoe kidney, pelvic ectopic kidney, and double urinary system in two referral centers were reviewed retrospectively. Demographic data, stone characteristics, and postoperative characteristics of the patients were evaluated. Results: The mean age of patients (n=35, 6 women and 29 men) was 50 years. Thirty-nine stones were detected. The total mean stone surface area in all anomaly groups was found to be 140 mm2, and the mean operative time was 54.7±24.7 minutes. The rate of using ureteral access sheath (UAS) was very low (5/35). Eight patients needed auxiliary treatment after the operation. The residual rate, which was 33.3% in the first 15 days, decreased to 22.6% in the third month follow-ups. Four patients had minor complications. In patients with horseshoe kidney and duplicated ureteral systems, it was observed that the risk factor increasing the presence of residual stones was the total stone volume. Conclusions: RIRS for kidneys with low and medium stone volume anomalies is an effective treatment method with high stone-free and low complication rates.

Objectives To investigate the operation time (OT) and the ureteral access sheath (UAS) usage with the infection rates and to determine a cut‐off value for OT. Methods We retrospectively analyzed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analyzed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut‐off value in OT terms, where infection rates increase more. Results A total of 575 patients were enrolled in the study. The rates of the usage UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection ( 94.1±14.2 and 68.01±23.1, for groups 1 and 2, respectively, p<0.05, Table 2). OT was statistically longer in the UAS group than unused one ( 79.3±24.4 and 66.7±22.4, for groups 1 and 2, respectively, p<0.05, Table 3). ROC analyses revealed a cut‐off point of 87.5 min for OT in terms of infection rate. Conclusion While the infection risk increases when OT exceeds 60 minutes, FURS can be safely performed up to 87.5 minutes with 89% sensitivity and 69% specificity infection risk.