{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:28:55Z","timestamp":1786613335589,"version":"build-2736575974"},"reference-count":25,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_med-2026-1506_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the effect of hydronephrosis (HN) grade on operative parameters, complication rates, and stone-free rates (SFR) in patients undergoing prone percutaneous nephrolithotomy (PCNL) performed under a standardized surgical protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1506_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included patients who underwent prone PCNL between January 2021 and June 2024. Patients with bilateral stones or anatomically abnormal kidneys were excluded. HN grade was determined by ultrasonography and confirmed with non-contrast computed tomography. Operative parameters, including operative time, number of accesses, hemoglobin drop, transfusion requirement, hospital stay, and complications, were compared among mild, moderate and severe HN groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1506_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 327 patients were retrospectively screened. After applying the exclusion criteria, 242 patients who underwent prone PCNL between January 2021 and June 2024 were included in the final analysis. The mean age was 51.4\u00a0\u00b1\u00a013.9 years. HN was mild in 40.5\u202f%, moderate in 37.6\u202f%, and severe in 21.9\u202f% of patients. Operation time increased significantly with HN grade (p=0.001), while other parameters including SFR (p=0.521) and complication rate (p=0.760) showed no significant differences. Operation time was the only independent predictor of stone-free status (p&lt;0.001). Subgroup analysis according to median stone burden demonstrated that the association between HN grade and operative time persisted only in patients with lower stone burden (\u22645.69\u202fcm\n                      <jats:sup>3<\/jats:sup>\n                      , p=0.010), whereas this relationship was not significant in patients with higher stone burden (&gt;5.69\u202fcm\n                      <jats:sup>3<\/jats:sup>\n                      , p=0.052).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1506_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HN grade does not significantly affect surgical success or complication rates after prone PCNL, although higher grades were associated with longer operative times. HN grade alone should not be considered a limiting factor for achieving complete stone clearance. However, stone burden may be a more important determinant of operative complexity in patients with higher stone burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/med-2026-1506","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:57:20Z","timestamp":1786611440000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of hydronephrosis grade on surgical parameters and stone-free rates in prone percutaneous nephrolithotomy: a retrospective multivariable study"],"prefix":"10.1515","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9951-2556","authenticated-orcid":false,"given":"Adem","family":"Tun\u00e7ekin","sequence":"first","affiliation":[{"name":"Department of Urology , U\u015fak Training and Research Hospital , U\u015fak , T\u00fcrkiye"},{"name":"Department of Urology , U\u015fak University Faculty of Medicine , U\u015fak , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5039-880X","authenticated-orcid":false,"given":"Ali Nihat","family":"G\u00f6kcan","sequence":"additional","affiliation":[{"name":"Department of Urology , U\u015fak Training and Research Hospital , U\u015fak , T\u00fcrkiye"},{"name":"Department of Urology , U\u015fak University Faculty of Medicine , U\u015fak , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-2512","authenticated-orcid":false,"given":"Erkan","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Urology , U\u015fak Training and Research Hospital , U\u015fak , T\u00fcrkiye"},{"name":"Department of Urology , Necmettin Erbakan University Meram Faculty of Medicine , Konya , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-3780","authenticated-orcid":false,"given":"Yasin","family":"Akta\u015f","sequence":"additional","affiliation":[{"name":"Department of Urology , U\u015fak Training and Research Hospital , U\u015fak , T\u00fcrkiye"},{"name":"Department of Urology , U\u015fak University Faculty of Medicine , U\u015fak , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4559-301X","authenticated-orcid":false,"given":"Hakan","family":"T\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Urology , U\u015fak Training and Research Hospital , U\u015fak , T\u00fcrkiye"},{"name":"Department of Urology , U\u015fak University Faculty of Medicine , U\u015fak , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081308571677931_j_med-2026-1506_ref_001","doi-asserted-by":"crossref","unstructured":"Hayat Khan, J, Malik, S, Patujo, YH, Haseeb Uddin Siddique, S, Moosa, M, Khan, MT, et al.. Prospective comparative evaluation of stone clearance and complications in renal stones measuring 2 to 3.5 centimeters: percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS). Cureus 2025;17:e93302. https:\/\/doi.org\/10.7759\/cureus.93302.","DOI":"10.7759\/cureus.93302"},{"key":"2026081308571677931_j_med-2026-1506_ref_002","doi-asserted-by":"crossref","unstructured":"Cheng, J, Shi, M, Sun, X, Lu, H. Therapeutic effect of hydrogen and its mechanisms in kidney disease treatment. Med Gas Res 2024;14:48\u201353. https:\/\/doi.org\/10.4103\/2045-9912.378880.","DOI":"10.4103\/2045-9912.378880"},{"key":"2026081308571677931_j_med-2026-1506_ref_003","doi-asserted-by":"crossref","unstructured":"Negri, AL, Spivacow, FR. Kidney stone matrix proteins: role in stone formation. 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Int Urol Nephrol 2024;56:2555\u201363. https:\/\/doi.org\/10.1007\/s11255-024-03969-y.","DOI":"10.1007\/s11255-024-03969-y"},{"key":"2026081308571677931_j_med-2026-1506_ref_013","doi-asserted-by":"crossref","unstructured":"Napitupulu, T, Hardja, Y, Susanto, M, Hutahaean, GD, Riantri, I, Sutapa, H, et al.. Correlation between the grade of hydronephrosis with surgical outcomes after ultrasound-guided supine percutaneous nephrolithotomy: a retrospective observational study. Medeni Med J 2023;38:120\u20137. https:\/\/doi.org\/10.4274\/MMJ.galenos.2023.85688.","DOI":"10.4274\/MMJ.galenos.2023.85688"},{"key":"2026081308571677931_j_med-2026-1506_ref_014","doi-asserted-by":"crossref","unstructured":"Zhu, H, Yu, G, Mai, Z, Li, Z, Cheng, D, Yue, G, et al.. Super multiple-tract minimally invasive percutaneous nephrolithotomy in one stage for treating complex renal stones: an initial experience. 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