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Purpose: To compare the Triple-D and Quadruple-D scores in predicting the success of shock-wave lithotripsy (SWL).

Material and methods: We retrospectively reviewed a total of 328 patients who had undergone SWL for stones with an average size of 10-15 mm in the renal pelvis, lower, middle, and upper calyces at the Urology Clinic of Kartal Dr. Lütfi Kırdar City Hospital between 2021 and 2023. Patients were divided into two groups - stone-free and residual - based on pre-and post-SWL imaging. Age, gender, stone location, ellipsoid stone volume (ESV) and side (right/left), stone density (SD), stone-skin distance (SSD), body-mass index (BMI), Triple-D score (TrD-S), and Quadruple-D score (QrD-S) values were recorded and compared. For TrD-S, SV <150 mm³, SD <600 Hounsfield (HU), and SSD <12 cm were scored in the range of 0-3. For QrD-S, lower calyx localization was scored as "0", and pelvis, middle calyx, and upper calyx stones were scored as "1" in the range of 0-4.

Results: Of a total of 328 patients, 219 (66.8%) were stone-free, 109 (33.2%) had residual stones, 211 were male, and 117 were female. Of the stones, 149 were located in the lower calyx, 118 in the middle calyx, 55 in the renal pelvis, and 6 in the upper calyx. ESV was 95.5 and 120 µ/L in the two groups, (p:0.001). Cutoff values of TrD-S and QrD-S were 1.5 and 2.5, and area under the curve (AUC) values were 0.65 and 0.67, respectively, (p:0.001).

Conclusions: The Quadruple-D score is at least as successful as the Triple-D score in predicting SWL success.

Counselling regarding a planned provision of medical aids is currently neither reimbursed nor regulated in Germany. It is offered by a range of providers with employees with varying levels of qualification and may be provided in a personal conversation, by phone, or remotely. In many cases, counselling is omitted entirely between the prescription and trial use or delivery of the product. The quality of medical aids counselling, which plays a key role in temporary, supportive or palliative care for urinary incontinence, is therefore considered problematic.In 2019, the working group "Geriatric Urology" of the German Society for Urology published the first guideline on the counselling process related to the provision of medical aids. An updated version is currently available and has been listed by the Association of the Scientific Medical Societies. The underlying idea was to define quality standard in Germany for the individual components of the counselling process - from identifying the type of incontinence and its severity to product trial use, the counselling setting, the counselling itself, the qualification of the counselling personnel, and the communication between prescribing physicians, service providers, and patients.This article presents the published guideline sections regarding the content of the medical aids prescription, the characteristics of the counselling setting, and the quality of counselling and product trial use.As medical aids counselling is expected to be financed from the low reimbursement rates provided by statutory health insurers for what is defined as an "appropriate and sufficient" supply - typically amounting to less than EUR 15 a month - more and more providers are withdrawing entirely from the sector of medical aids provision. Others continue to supply medical aids but offer no counselling at all or only to a very limited extent. The guideline "Medical Aids Counselling for Urinary Incontinence" developed by the working group "Geriatric Urology" of the German Society for Urology is meant to define quality standards, also with a view to a political discussion on reimbursement rates.

Introduction: To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients.

Methods: We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26.

Results: The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications.

Conclusion: Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.