Evaluation of endoscopic ureteral stone treatments in the period of decreasing severity of COVID-19 pandemic

OBJECTIVE

During the COVID-19 pandemic, people's admissions to the hospital for their current illness were delayed. We aimed to reveal how this situation has affected the endoscopic treatment of ureteral stones.

PATIENTS AND METHODS

Patients who were treated for 59 endoscopic ureteral stones in the pre-pandemic period between September 2019 and December 2019, and patients who were treated for 60 endoscopic ureteral stones between January 2022 and April 2022, when the effectiveness of the COVID-19 pandemic decreased, were evaluated in two groups. Pre-pandemic patients were classified as group 1, and patients treated during the period when the effectiveness of the pandemic decreased as group 2. The patients' ages, preoperative laboratory examinations and radiological findings, localization and size of the stones in the ureter, time until the operation, duration of the operation, length of hospital stay, preoperative ESWL history, complication rates according to the Modified Clavien classification were evaluated. The problems observed in the ureter during the operation were examined separately as edema, polyp formation in the ureter, distal ureteral stenosis, and adhesion of the stone to the mucosa.

RESULTS

In group 1, 9 patients were female and 50 were male, with a mean age of 42.19 ± 14.06 years; in group 2, 17 patients were female and 43 were male, with a mean age of 45.23 ± 12.20 years. The stone size was found to be higher in group 2. Group 1 had more patients who did not develop complications in the Modified Clavien classification, and the proportion of group 2 patients in the grade I-II-IIIA-IIIB classification was higher. Considering the waiting time before hospitalization, it was determined that the rate of group 2 patients was higher in those with a waiting period of 31-60 days (33.9-48.3%) and ≥60 days (10.2-21.7%). Except for the development of ureteral polyps, all other problems rate were found to be higher in group 2 patients compared to group 1.

CONCLUSIONS

During the COVID-19 pandemic, there was a delay in the treatment of ureteral stones in patients. In the next period, as a result of this delay, negative effects on the ureteral mucosa were detected and, accordingly, an increase in the complication rates of the operation was observed.

The evaluation of morphology of renal pelvicalyceal system's and infundibulopelvic anatomy of kidney's lower pole in post-mortem series

BACKGROUND

Urinary system stones are frequently encountered in the community. Together with technological developments, introduction of new treatment procedures such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery has furtherly reduced morbidity, mortality and hospitalization time of patients. In order to maximize success and to reduce complications of these procedures, it is necessary to evaluate anatomy and morphological differences of kidney collector system before the procedure. This study was conducted for the purpose of determining the morphology of the kidney collector system and the negative anatomic factors of the lower pole in autopsy cases performed in our institution.

MATERIALS AND METHODS

82 kidney units obtained from 41 autopsy cases conducted in Faculty of Medicine Department of Forensic Medicine, Sivas Cumhuriyet University between September 2017 and September 2018 were included in the study. Percentages were found as 78% for intrarenal pelvis, 13.4% for borderline pelvis, %6.1 for extrarenal pelvis and 2.4% for pelvic nonexistence. When pelvicalyceal anatomy was evaluated, percentages were found as 32.9% for bicalyceal, 26.8% for tricalyceal, 20.7% for multicalyceal and 19.5% for unclassified calyceality. When it is evaluated according to opening of calyces into the renal pelvis based on Sampaio classification, percentages were found as 30.5% for AI, 17.1% for Type II, 28% for BI, 18.3% for BII and 6.1% for unevaluated part. Infundibular lengths of kidney's lower pole were detected as under 3 cm in 39% and over 3 cm in 61% of all cases. Infundibulopelvic angles of kidney's lower pole were measured as under 70⁰ in 42.7% and over 70⁰ in 57.3% of all cases.

RESULTS

In our study, there was no statistically significant difference between the right and left kidneys in terms of collecting system morphology and lower pole's negative anatomical factors. Only infindibular lengths which is one of the collecting system morphology and lower pole's negative anatomical factors were statistically shorter in females than males. There was no difference in terms of other parameters.

CONCLUSIONS

In conclusion, the findings of this study are largely consistent with the results of similar studies. This reveals that renal collecting system morphology and negative anatomic factors in the lower pole collecting system in human are roughly similar. In clinical practice, pre-treatment CT and, if necessary, MR urography evaluation of the lower pole negative anatomic factors may contribute to gain preliminary information about both the clearance of stone fragments especially after SWL and RIRS procedures and perioperative complications proactively.

An explorative study of school performance and antipsychotic medication

BACKGROUND

Antipsychotic therapy can reduce severe symptoms of psychiatric disorders, however, data on school performance among children on such treatment are lacking. The objective was to explore school performance among children using antipsychotic drugs at the end of primary education.

METHODS

A cross-sectional study was conducted using the University Groningen pharmacy database linked to academic achievement scores at the end of primary school (Dutch Cito-test) obtained from Statistics Netherlands. Mean Cito-test scores and standard deviations were obtained for children on antipsychotic therapy and reference children, and statistically compared using analyses of covariance. In addition, differences in subgroups as boys versus girls, ethnicity, household income, and late starters (start date within 12 months of the Cito-test) versus early starters (start date > 12 months before the Cito-test) were tested.

RESULTS

In all, data from 7994 children could be linked to Cito-test scores. At the time of the Cito-test, 45 (0.6 %) were on treatment with antipsychotics. Children using antipsychotics scored on average 3.6 points lower than the reference peer group (534.5 ± 9.5). Scores were different across gender and levels of household income (p < 0.05). Scores of early starters were significantly higher than starters within 12 months (533.7 ± 1.7 vs. 524.1 ± 2.6).

CONCLUSION

This first exploration showed that children on antipsychotic treatment have lower school performance compared to the reference peer group at the end of primary school. This was most noticeable for girls, but early starters were less affected than later starters. Due to the observational cross-sectional nature of this study, no causality can be inferred, but the results indicate that school performance should be closely monitored and causes of underperformance despite treatment warrants more research.