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Lubana AS, Priyadarshi S, Sharma G, Bansal S, Agarwal N, Vyas N. Effects of administration of local aminophylline on patients undergoing ureteroscopic lithotripsy. Urologia 2024; 91:538-542. [PMID: 38041571 DOI: 10.1177/03915603231216141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
INTRODUCTION The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline. MATERIALS AND METHODS 100 patients having ureteric calculi <20 mm in size, aged 20-60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05. RESULTS The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p-value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%). CONCLUSION The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi.
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Affiliation(s)
| | - Shivam Priyadarshi
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Govind Sharma
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Somendra Bansal
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Neeraj Agarwal
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Nachiket Vyas
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
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Somani BK, Massella V, Pietropaolo A, Ripa F, Sinha MM, Griffin S. Safety and Efficacy of "Dusting and Pop-Dusting" with High-Power Laser for Treatment of Large Pediatric Stones with Ureteroscopy and Lasertripsy: Prospective Outcomes from a University Teaching Hospital. J Endourol 2024; 38:416-420. [PMID: 38323560 DOI: 10.1089/end.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Introduction: The wide use of high-power laser has changed the landscape of ureteroscopy and lasertripsy (URSL). We wanted to look at the role and outcomes of high-power holmium:yttrium-aluminum-garnet laser for URSL in pediatric stone disease. Methods: A prospective analysis of consecutive pediatric patients treated with "Dusting and Pop-dusting" using a high-power laser was done between January 2016 and March 2022. The project was registered with our audit committee. Data were analyzed for patient demographics, stone characteristics, operative details, procedural outcomes, and complications. Stone-free rate (SFR) was defined as fragments ≤2 mm on postoperative ultrasound imaging 2-3 months after the procedure. Results: A total of 35 patients underwent 43 procedures (1.2 procedure/patient) during the study period with a mean age of 9.4 years (range 1-16 years) and a male:female ratio of 13:22. The stone location was in the kidney in 32 (91.4%) patients of which 8 were in multiple renal locations. The mean stone size was 18 mm (range 10-39 mm), with the pre- and post-stent rates of 37% and 56%, respectively. An access sheath was used in 19 (44%) procedures. The overall SFR on ultrasound scan was 94% (n = 33) with no procedural complications noted in our series and a mean length of stay of 0.9 days. Conclusion: Pediatric URSL using a high-power laser achieves a high SFR even for large and multiple renal stones with no complications noted in our prospective series. Parents must, however, be counseled about the need for staged procedures, which might be needed for large stones.
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Affiliation(s)
- Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Virginia Massella
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Mriganka Mani Sinha
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Stephen Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
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Wang Y, Wang J, Sun X. The Effect of High- and Low-power Holmium Laser Settings for Transurethral Lithotripsy in the Management of Adults with Ureteral Stone. JOURNAL OF PHYSIOLOGICAL INVESTIGATION 2024; 67:153-160. [PMID: 38904360 DOI: 10.4103/ejpi.ejpi-d-24-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
Since there is insufficient evidence to determine the best treatment of transurethral laser lithotripsy (TLL) in ureteral stones, this study compared the effectiveness and safety of TLL using high-power (HP) (100 W) and low-power (LP) (20 W) laser settings. All patients with maximally sized ureteral stones who were planned for transurethral holmium laser lithotripsy were enrolled in this open study. One of the two laser setting groups-LP or HP-was allocated to each alternate patient. Using IBM SPSS Statistics 24, the treatment groups were compared for operating time, intraoperative and postoperative problems (up to 1 year), and rates of stone-free recovery. Welch tests were employed to compare continuous data, whereas Fisher's exact or Chi-square tests were used to assess categorical variables. At P < 0.05, statistical significance was established. A total of 207 individuals were included and preoperative data were comparable between the two groups. The HP group had a considerably greater ablation rate and a significantly shorter procedure duration (42.61 ± 11.74 min) than the LP group (78.56 ± 25.91 min) ( P = 0.025). The Overactive Bladder Symptom Score and International Prostate Symptom Score were considerably higher in the HP group than in the LP group. Treatment effectiveness was considerably impacted by the location of the ureteral stone, according to univariate and multivariate logistic regression models. A HP laser setting of up to 100 W greatly shortens the duration of the process for treating ureteral stones without raising the risk of problems.
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Affiliation(s)
- Yuhuan Wang
- Department of Urology, Chengde Central Hospital, Chengde, Hebei, China
| | - Jun Wang
- Department of Urology, Chengde Central Hospital, Chengde, Hebei, China
| | - Xiaoping Sun
- The Second Ward of the Department of Critical Care, Chengde Central Hospital, Chengde, Hebei, China
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Abushamma F, Zyoud SH. Analyzing global research trends and focal points in the utilization of laser techniques for the treatment of urolithiasis from 1978 to 2022: visualization and bibliometric analysis. Urolithiasis 2024; 52:67. [PMID: 38630266 DOI: 10.1007/s00240-024-01568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Laser lithotripsy is gaining global prominence and is a dynamically progressing field marked by a continual influx of new and comprehensive research each year. Recently, there has been a noticeable shift toward the adoption of various kinds of lasers, such as holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium fiber (TFL) lasers. Consequently, we aim to conduct a bibliometric analysis to analyze key areas of research activity within scientific publications that center on the utilization of laser techniques in urolithiasis. A search of the literature spanning from 1978 to 2022 was carried out on 25 December 2023 using the Scopus database to explore research related to the application of laser techniques for urolithiasis treatment. Visualization analysis was performed using VOSviewer software (version 1.6.20). We examined 962 publications that met the specified criteria, 791 (82.22%) of which were original articles. The analysis of the retrieved publications indicated a consistent increase in research output from 1978 to 2022; a particularly noteworthy surge occurred after 2003. In particular, the U.S. claimed the leading position as the most productive country, contributing 211 articles (21.93%). However, India had the highest research productivity according to the adjustment index of 19.08. In the European region, 324 publications (33.68% of the total) originated from 25 countries. The Journal of Endourology contributed the most between 1978 and 2022 (n = 96, 9.98%). The most cited paper examined the effectiveness of holmium: yttrium-aluminum-garnet (Ho:YAG) lasers, while a subsequent study focused on the use of a thulium fiber laser (TFL), an emerging laser technology that has gained increased recognition. Co-occurrence analysis revealed three distinct clusters focusing on the types of laser technology, minimally invasive approaches, and success rate/postoperative complications. This comprehensive investigation delves into the global landscape of laser use for the treatment of urolithiasis. This review supports the emerging clinical concept of using various types of laser technology for urolithiasis treatment. Moreover, the hot issues that researchers should focus on based on the findings of this study are the use of different types of laser lithotripsy in view of the surgical approach, success rate and complications.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Chen Y, Xi H, Yu Y, Cheng X, Yang H, Deng W, Liu W, Wang G, Zhou X. Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2-3 cm renal stones. Int J Urol 2024; 31:281-286. [PMID: 38017651 DOI: 10.1111/iju.15347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To assess and compare the effectiveness and safety of flexible ureteroscopy (f-URS) with a novel flexible ureteral access sheath (f-UAS) versus mini-percutaneous nephrolithotripsy (mini-PCNL) in treating 2-3 cm renal stones. METHODS Retrospectively analyzed consecutive cases that underwent f-URS with f-UAS (12/14 Fr) from January 29, 2022, to November 30, 2022. Consecutive cases that underwent mini-PCNL (18 Fr) from June 5, 2021, to January 26, 2022, were selected as controls. The f-UAS is a novel device with a 10 cm anterior tip that passively bends along with the f-URS to enter the renal calyx. We analyzed demographic characteristics, stone parameters, operative time, stone-free rates (SFR), hospitalization time, and complication. RESULTS A total of 96 consecutive cases that underwent f-URS with f-UAS and 96 consecutive cases that underwent mini-PCNL were included in the study. There were no significant differences between the two groups in terms of operative time (p = 0.06), stone volume clearance (p = 0.533) and complete SFR (p = 0.266) on the first postoperative day or residual Stone after 1 month (p = 0.407). We observed a significantly shorter postoperative hospital stay (1.4 days vs. 2.1 days; p < 0.001) and a lower decrease in hemoglobin levels (0.39 g/dL vs. 0.68 g/dL; p < 0.001) in the f-UAS group. The mini-PCNL group had a significantly higher overall complication rate (13.5%) compared with the f-UAS group (5.2%; p = 0.048). CONCLUSIONS In the treatment of 2-3 cm renal stones, f-URS with a novel f-UAS may provide a superior alternative to mini-PCNL, potentially challenging its established status.
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Affiliation(s)
- Yujun Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Heng Yang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Kwok JL, Ventimiglia E, De Coninck V, Corrales M, Sierra A, Panthier F, Pauchard F, Schmid F, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed thulium:YAG laser-ready to dust all urinary stone composition types? Results from a PEARLS analysis. World J Urol 2023; 41:2823-2831. [PMID: 37587366 PMCID: PMC10581948 DOI: 10.1007/s00345-023-04549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/23/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE To evaluate whether stone dust can be obtained from all prevailing stone composition types using the novel pulsed thulium:YAG (p-Tm:YAG), including analysis of stone particle size after lithotripsy. METHODS Human urinary stones of 7 different compositions were subjected to in vitro lithotripsy using a p-Tm:YAG laser with 270 µm silica core fibers (Thulio®, Dornier MedTech GmbH®, Wessling, Germany). A cumulative energy of 1000 J was applied to each stone using one of three laser settings: 0.1 J × 100 Hz, 0.4 J × 25 Hz and 2.0 J × 5 Hz (average power 10 W). After lithotripsy, larger remnant fragments were separated from stone dust using a previously described method depending on the floating ability of dust particles. Fragments and dust samples were then passed through laboratory sieves to evaluate stone particle count according to a semiquantitative analysis relying on a previous definition of stone dust (i.e., stone particles ≤ 250 µm). RESULTS The p-Tm:YAG laser was able to produce stone dust from lithotripsy up to measured smallest mesh size of 63 µm in all seven stone composition types. Notably, all dust samples from all seven stone types and with all three laser settings had high counts of particles in the size range agreeing with the definition stone dust, i.e., ≤ 250 µm. CONCLUSION This is the first study in the literature proving the p-Tm:YAG laser capable of dusting all prevailing human urinary stone compositions, with production of dust particles ≤ 250 µm. These findings are pivotal for the broader future implementation of the p-Tm:YAG in clinical routine.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Urology Department, Hospital Naval Almirante Nef, 2520000, Viña del Mar, Chile
| | - Florian Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- CRISTAL Laboratory, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands.
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Juliebø-Jones P, Somani BK, Gjengstø P, Æsøy MS, Beisland C, Ulvik Ø. Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know? Curr Urol Rep 2023; 24:409-415. [PMID: 37256486 PMCID: PMC10449946 DOI: 10.1007/s11934-023-01168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW: To summarise the literature on laser safety during endourological practice. RECENT FINDINGS: Holmium and Thulium Fiber laser are the two main energy sources in the current clinical practice. The latter may have superior properties, but more clinical studies are needed to formally establish this. Laser injury to urothelium is more dependent on user experience rather than laser type. Smaller laser fibres allow for lower intra-renal temperature profiles. Operators should pay close attention to laser technique including maintaining the safety distance concept and only firing the laser when tip is clearly in view. When adjusting laser settings, pay close attention to resultant power given the associated heat changes. Prolonged periods of laser activation are to be avoided for the same reason. Outflow can be manipulated such as with access sheath to mitigate temperature and pressure changes. There is still limited evidence to support the mandate for compulsory use of eye protection wear during laser lithotripsy. Lasers are the gold standard energy source for stone lithotripsy. However, the safe clinical application of this technology requires an understanding of core principles as well as awareness of the safety and technical aspects that can help in protecting patient, surgeon and operating staff.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- EAU YAU Urolithiasis Group, Arnhem, Netherlands.
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Cozma C, Geavlete P, Multescu R, Georgescu D, Bragaru M, Geavlete B. Combined semirigid and flexible ureterorenoscopy for the treatment of large renal stones. J Med Life 2023; 16:1364-1368. [PMID: 38107720 PMCID: PMC10719790 DOI: 10.25122/jml-2023-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 12/19/2023] Open
Abstract
Ureteroscopy is recognized as a minimally invasive and readily accessible method with low morbidity, favorable outcomes, and rapid post-interventional recovery. Recent advancements in rigid and flexible ureteroscopes have enhanced their efficiency, durability, and capability to accommodate accessory instruments. In this retrospective analysis, we evaluated 75 consecutive patients with large renal stones (stone burden between 2 and 4 cm) treated using a combination of semirigid and flexible ureteroscopy between January 1, 2020, and December 31, 2021. Stone properties and anatomical information were collected from the image archives derived from computed tomography (CT) and/or KUD radiography. Multiple ureteroscopy sessions were required for bigger stones. The length of the hospital stay, operation time, stone-free rate, preoperative and postoperative complications, and complication rates were examined. The average age of the patients was 52.7 years, with a mean stone burden of 31.45 mm. Most stones were in the renal pelvis, followed by the upper calyx. The average operative time was 56.2 minutes. After the initial ureteroscopy session, the stone clearance rate was 76%, which increased to 92% after two ureteroscopy sessions. Complication rates were evaluated using the Clavien-Dindo modified system, with an overall complication rate of 18.4%. Most of the complications were Clavien Grades I and II, with no grade V complication encountered. Large renal stones can be treated by combining semirigid and flexible ureteroscopy to reduce the operative time and protect the flexible ureteroscope.
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Affiliation(s)
- Cosmin Cozma
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Razvan Multescu
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Marius Bragaru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Bogdan Geavlete
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
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Chen Y, Cheng X, Yang H, Deng W, Chen L, Wang G, Zhou X. Optimal placement of flexible ureteral access sheath in retrograde intrarenal surgery. Urolithiasis 2023; 51:106. [PMID: 37592131 PMCID: PMC10435627 DOI: 10.1007/s00240-023-01469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
This study aims to explore the optimal location of flexible ureteral access sheath (f-UAS) in retrograde intrarenal lithotripsy (RIRS). RIRS model was built by AutoCAD 2011 software, and imported COMSOL 5.6 software to computer simulation. An RIRS model was constructed in vitro to analyze the distribution pattern of stone fragments and compare the weight of stone fragments carried out by the irrigation fluid when the f-UAS is in different positions. Computer simulation showed that the highest flow of irrigation fluid was in the channel of flexible ureteroscopy (f-URS) and in the lumen of f-UAS. From the f-URS to the renal collection system and then to the f-UAS, the velocity of irrigation fluid changes gradually from high-flow to low-flow and then to high-flow. When the f-URS and the f-UAS are at the same level, the irrigation fluid is always at a state of high flow during the process from f-URS to f-UAS. When the f-URS and the f-UAS are at the same level, it can increase the local intrarenal pressure (IRP) at the front of f-URS. The stone fragments are mainly sediment in the low-flow region of irrigation fluid. More stone fragments could follow the irrigation fluid out of the body when the tip of f-URS and the tip of f-UAS are at the same level (P < 0.001). The f-UAS should be brought closer to the stone in RIRS. And more stone fragments can be taken out of the body by the effect of irrigation fluid.
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Affiliation(s)
- Yujun Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Heng Yang
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
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Pietropaolo A, Massella V, Ripa F, Sinha MM, Somani BK. Ureteroscopy and lasertripsy with pop dusting using high power holmium laser for large urinary stones > 15 mm: 6.5-year prospective outcomes from a high-volume stone center. World J Urol 2023; 41:1935-1941. [PMID: 37243719 DOI: 10.1007/s00345-023-04438-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Ureteroscopy and stone lasertripsy (URSL) is a recognized technique for treatment of urinary tract stones. Holmium:Yag laser has been successfully used for this purpose for the last two decades. More lately, pulse modulation with Moses technology and high power lasers have been introduced with the result of faster and more efficient stone lasertripsy. Pop dusting is a two-stage combined treatment using a long pulse Ho:YAG laser, initially in contact mode with the stone 'dusting' (0.2-0.5 J/40-50 Hz) followed by non-contact mode 'pop-dusting' (0.5-0.7 J/20-50 Hz). We wanted to look at the outcomes of lasertripsy for renal and ureteric stones using a high-power laser machine. METHODS Over a period of 6.5 years (January 2016-May 2022), we prospectively collected data for patients undergoing URSL for stones larger than 15 mm treated using high power Ho:YAG laser (60W Moses or 100W laser). Patient parameters, stone demographics and outcomes of URSL were analyzed. RESULTS A total of 201 patients, underwent URSL for large urinary stones. In 136 patients (61.6%) stones were multiple and the mean single and cumulative stone size was 18 mm and 22.4 mm respectively. A pre- and post-operative stent was placed in 92 (41.4%) and 169 (76%) respectively. The initial and final stone free rate (SFR) were 84.5% and 94% respectively and 10% patients underwent additional procedure to achieve stone free status. 7 (3.9%) complications were recorded, all related to UTI/sepsis, with 6 Clavien II and 1 Clavien IVa complication. CONCLUSION Dusting and pop-dusting has shown to be successful and safe with the ability to treat large, bilateral or multiple stones with low retreatment and complication rates.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | - Virginia Massella
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Mriganka Mani Sinha
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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11
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Wu Z, Wei J, Sun C, Huangfu Q, Wang B, Huang G, Qi K, Jiang Z, Zhu W, Wen J. Temperature changes of renal calyx during high-power flexible ureteroscopic Moses holmium laser lithotripsy: a case analysis study. Int Urol Nephrol 2023:10.1007/s11255-023-03611-3. [PMID: 37145376 DOI: 10.1007/s11255-023-03611-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve. METHODS The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80 Hz/0.3 J and 32 W, 80 Hz/0.4 J) were performed for each patient with room temperature (25 °C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80 Hz/0.3 J, 32 W, 80 Hz/0.4 J and 40 W, 80 Hz/0.4 J) with warmed (37 °C) and room temperature (25 °C) irrigation. RESULTS Twenty-two patients were enrolled in our study. With 30 ml/min or 60 ml/min irrigation, the local temperature of the renal calyx did not reach 43 °C in any patient under 25 °C irrigation after 60 s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25 °C. Under the irrigation of 37 °C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43 °C at the setting of 32 W, 30 ml/min and 40 W, 30 ml/min after continuing laser activation. CONCLUSION In the irrigation of 60 ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32 W or higher power holmium laser in the renal calyces for more than 60 s in the limited irrigation of 30 ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
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Affiliation(s)
- Zhiyue Wu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jingchao Wei
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chengfang Sun
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Huangfu
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bohan Wang
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangyi Huang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Kai Qi
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Zeping Jiang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Wuan Zhu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jiaming Wen
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
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Somani B. Minimally Invasive Urological Procedures and Related Technological Developments-Series 2. J Clin Med 2023; 12:jcm12082879. [PMID: 37109216 PMCID: PMC10145985 DOI: 10.3390/jcm12082879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
The world of minimally invasive urology has experienced enormous growth in recent decades with technological innovations related to new techniques and equipment, better training, and the clinical adoption of translational research [...].
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Affiliation(s)
- Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO166YD, UK
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13
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Comparison and Evaluation of Outcomes of Ureteroscopy and Stone Laser Fragmentation in Extremes of Age Groups (≤10 Years and ≥80 Years of Age): A Retrospective Comparative Analysis of over 15 Years from 2 Tertiary European Centres. J Clin Med 2023; 12:jcm12041671. [PMID: 36836206 PMCID: PMC9958601 DOI: 10.3390/jcm12041671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
AIM To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). METHODS Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year period (group 1). It was compared to consecutive data for all patients ≥80 years (group 2). Data were collected for patient demographics, stone characteristics, operative details, and clinical outcomes. RESULTS A total of 168 patients had 201 URSL procedures during this time (74 and 94 patients in groups 1 and 2 respectively). The mean age and stone sizes were 6.1 years and 85 years, and 9.7 mm and 13 mm for groups 1 and 2 respectively. While the SFR was slightly higher in group 2 (92.5% versus 87.8%, p = 0.301), post-operative stent rate was also significantly higher in the geriatric population (75.9% versus 41.2%, p = 0.0001). There was also no significant difference in pre-operative stenting (p = 0.886), ureteric access sheath use (UAS) (p = 0.220) and post-operative complications. Group 1 had an intervention rate of 1.3/patient as compared to 1.1/patient in group 2. The overall complications were 7.2% and 15.3% in groups 1 and 2 respectively (0.069), with 1 Clavien IV complication related to post-operative sepsis and brief ICU admission in group 2. CONCLUSION The paediatric population had a marginally higher incidence of repeat procedure, but the overall SFR and complications were similar, and post-operative stent insertion rates were much better compared to geriatric patients. URSL is a safe procedure in the extremes of age groups with no difference in the overall outcomes between the two groups.
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14
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Education and training evolution in urolithiasis: A perspective from European School of Urology. Asian J Urol 2023. [PMID: 37538161 PMCID: PMC10394299 DOI: 10.1016/j.ajur.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Objective With the worldwide increase in urolithiasis prevalence, the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis. Methods A PubMed search using the key words "simulation", "training", "ureteroscopy", "RIRS", "URS", "percutaneous nephrolithotomy", "PCNL", "virtual reality", "augmented reality", "artificial intelligence", "healthcare", "curriculum", and "assessment" was used to examine how education and training in urolithiasis have adapted over recent years. Focus was placed on the role of high- and low-fidelity simulation models, virtual reality and artificial intelligence, and standardised assessment and curriculum. Results This review supports the necessity to incorporate technology, simulation, and other skill enhancement training modalities into surgical training. However, these cannot solely replace mentored training with an experienced professional supervisor. Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training, it is just as important for stratification of robust curricula with validated assessment. We also propose a pathway for future training. Conclusion Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition, refinement, and improving operative outcomes. Success is achieved by maintaining a delicate balance between machine and in person mentor-based training. A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.
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15
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Tzelves L, Geraghty RM, Hughes T, Juliebø-Jones P, Somani BK. Innovations in Kidney Stone Removal. Res Rep Urol 2023; 15:131-139. [PMID: 37069942 PMCID: PMC10105588 DOI: 10.2147/rru.s386844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
Urolithiasis is a common clinical condition, and surgical treatment is performed with different minimally invasive procedures, such as ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy. Although the transition from open surgery to endourological procedures to treat this condition has been a paradigm shift, ongoing technological advancements have permitted further improvement of clinical outcomes with the development of modern equipment. Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters. Innovations in kidney stone removal have led to an exciting new era of endourological options for patients and clinicians alike.
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Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
- Correspondence: Bhaskar K Somani, Department of Urology, University Hospital Southampton NHS Trust, 19 Tremona Road, Southampton, SO535DS, UK, Tel +44-2381206873, Email
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Gadiyar N, Geraghty RM, Premakumar Y, Somani BK. Changes in Urine Composition and Risk of Kidney Stone Disease Following Bariatric Surgery: A Systematic Review over Last 2 Decades. Curr Urol Rep 2022; 23:279-295. [PMID: 36417046 DOI: 10.1007/s11934-022-01119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The association of kidney stone disease (KSD) and gastrointestinal (GI) surgery has been well established. With a rising obesity crisis, we wanted to see the correlation of urinary composition in patients undergoing bariatric surgery and their risk of KSD. The objective of this paper is to perform a systematic review and meta-analysis of literature to evaluate the changes in urinary composition and risk of KSD following bariatric surgery. RECENT FINDINGS A total of seven studies (2498 patients) underwent bariatric surgery with a mean age of 46.7 years and a male:female ratio of 1:3. The most popular bariatric surgery was the Roux-en-Y procedure. Meta-analysis of the studies showed that significant decrease in urinary calcium, citrate, and urate, and increase in urinary oxalate. There was also a nonsignificant volume reduction in the post-operative cohort. The decrease in urinary citrate and increase in urinary oxalate are both predisposing factors of stone formation. There is strong evidence that bariatric surgery results in significant changes in urine composition in keeping with the increased risk of developing KSD. This identifies useful therapeutic targets in the prophylactic management of patients who have undergone bariatric surgery.
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Affiliation(s)
- Neha Gadiyar
- General Surgery, Guys and St Thomas', London, UK
| | | | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Gauhar V, Teoh JYC, Mulawkar PM, Tak GR, Wroclawski ML, Robles-Torres JI, Chan VWS, García Rojo E, da Silva RD, Tanidir Y, Tiong HY, Sener TE, Heldwein FL, Somani BK, Castellani D. Comparison and outcomes of dusting versus stone fragmentation and extraction in retrograde intrarenal surgery: results of a systematic review and meta-analysis. Cent European J Urol 2022; 75:317-327. [PMID: 36381152 PMCID: PMC9628720 DOI: 10.5173/ceju.2022.0148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Lithotripsy during retrograde intrarenal surgery (RIRS) can be achieved either by fragmentation and extraction or dusting with spontaneous passage. We aimed to perform a systematic review on the safety and stone-free rate after RIRS by comparing the techniques of dusting vs fragmentation/extraction. MATERIAL AND METHODS This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inverse variance of the mean difference and 95% Confidence Interval (CI), Categorical variables were assessed using Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR) and 95% CI. Statistical significance was set at p <0.05. RESULTS There were 1141 patients included in 10 studies. Stone size was up to 2.5 cm All studies used holmium laser for lithotripsy. Meta-analysis showed no significant difference in surgical time (MD -5.39 minutes 95% CI -13.92-2.31, p = 0.16), postoperative length of stay (MD -0.19 days 95% CI -0.60 - -0.22, p=0.36), overall complications (OR 0.98 95% CI 0.58-1.66, p = 0.95), hematuria (OR 1.01 95% CI 0.30-3.42, p = 0.99), postoperative fever (OR 0.70 95% CI 0.41-1.19, p = 0.19) and sepsis (OR 1.03 95% CI 0.10-10.35, p = 0.98), immediate (OR 0.40 95% CI 0.13-1.24, p = 0.11) and overall stone-free rate (OR 0.76 95% CI 0.43-1.32, p = 0.33), and retreatment rate (OR 1.35 95% CI 0.57-3.20, p = 0.49) between the groups. CONCLUSIONS This systematic review infers that urologists can safely use either option of fragmentation and basket extraction or dusting without extraction to achieve similar outcomes as both techniques are similar for efficacy and safety.
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Affiliation(s)
- Vineet Gauhar
- Ng Teng Fong General Hospital, Department of Urology, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Prashant Motiram Mulawkar
- Tirthankar Super Specialty Hospital, Department of Urology, Akola, India
- University of Edinburgh, Edinburgh, United Kingdom
| | - Gopal R. Tak
- Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, BP – the Portuguese Beneficence of São Paulo, Sao Paulo-SP, Brazil
- ABC School of Medicine, Santo André-SP, Santo André-SP, Brazil
| | - José Iván Robles-Torres
- Hospital Universitario ‘Dr. José Eleuterio Gonzalez’, Department of Urology, Monterrey, México
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | | | - Yiloren Tanidir
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Ho Yee Tiong
- National University Hospital, Department of Urology, Singapore, Singapore
| | - Tarik Emre Sener
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Flavio Lobo Heldwein
- Federal University of Santa Catarina, Department of Urology , Florianopolis, Brazil
| | - Bhaskar Kumar Somani
- University Hospitals Southampton NHS Trust, Department of Urology, Southampton, United Kingdom
| | - Daniele Castellani
- Università Politecnica delle Marche , Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Urology Unit, Ancona, Italy
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18
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GEAVLETE B, POPESCU R, IORDACHE V, GEORGESCU D, GEAVLETE P. NO Residual Stones after Flexible Ureteroscopy for Renal Stones - Update 2021. A Narrative Brief Review. MAEDICA 2022; 17:680-691. [PMID: 36540580 PMCID: PMC9720644 DOI: 10.26574/maedica.2022.17.3.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Urolithiasis is a major health problem which is on the rise worldwide. New procedures and technological tools have arisen, providing the urologist with a vast arsenal of options for stone disease management. The goal of this narrative review is to summarize the most recent advancements and demonstrate their efficacy in reducing complications and increasing surgical efficacy. The latest modern advances in increasing stone rate after flexible ureteroscopy were included. The ureteral access sheet concept represents one of the most important parts in this procedure and new performances achieved in this field like suction and pressure control were evaluated. Another important aspect in flexible ureteroscopy is related to laser fibres. The latest achievements in Holmium and Thulium fibres were analysed and compared using both dusting and fragmenting techniques. After analysing these aspects, the conclusion was that suction improved visualization by removing "stone storm" and bleeding during the procedure and Thulium laser had the potential to become the new "gold standard" in the pursuit of obtaining a higher stone free rate.
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Affiliation(s)
- Bogdan GEAVLETE
- Department of Urology, Sanador Hospital, Bucharest, Romania ,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Razvan POPESCU
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Valentin IORDACHE
- Department of Urology, Sanador Hospital, Bucharest, Romania ,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos GEORGESCU
- Department of Urology, Sanador Hospital, Bucharest, Romania ,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor GEAVLETE
- Department of Urology, Sanador Hospital, Bucharest, Romania ,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
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Juliebø-Jones P, Keller EX, Haugland JN, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST). JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Øyvind Ulvik
- Department of Clinical Medicine, University of Bergen, Norway
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20
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Æsøy MS, Juliebø-Jones P, Beisland C, Ulvik Ø. Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study. Scand J Urol 2022; 56:313-319. [PMID: 35924316 DOI: 10.1080/21681805.2022.2104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model. METHODS Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 μm and 200 μm) and Ho:YAG (270 μm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W. RESULTS Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 μm fiber at 2.4 W resulted in a 2.6 °C rise from baseline (p = 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 °C (p = 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 μm was 39.6 °C compared to 44.9 °C using 200 μm, p < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers. CONCLUSION In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.
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Affiliation(s)
- M S Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - P Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - C Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Lithotripsy devices for percutaneous nephrolithotomy (PNL) - new developments. Curr Opin Urol 2022; 32:405-410. [PMID: 35674683 DOI: 10.1097/mou.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PNL) is the mainstay of surgery for renal calculi>2 cm or complex multiple calculi and is a technique that has been around since 1976. We review recent literature surrounding novel lithotripsy devices and technology used in PNL. RECENT FINDINGS At present, the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is widely accepted as the gold standard laser lithotripsy for PNL. SwissLithoClast Trilogy offers a range of probes with a trifecta of electromagnetic, ultrasonic energy with surgeon-controlled suction. The Olympus Shockpulse-SE is a similar lithotripter that relies on continuous ultrasonic energy with pulsed ballistic energy to break stones. Thulium Fiber Laser (TFL) offers an alternative laser energy source to the Holmium laser, which has been shown to be very effective at producing small stone fragments and dust. The Moses technology is another addition in a long list of improvements to the Ho:YAG laser, forming vaporization bubble through which more effective energy can be applied to stones. SUMMARY Trilogy, Shockpulse, TFL and Moses pulse modulation technology for the Holmium laser all provide improvements compared with older lithotripsy devices. In particular, they convey a safer, efficient and more effective way to manage and clear stones.
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22
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Pietropaolo A, Mani M, Hughes T, Somani BK. Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital. Ther Adv Urol 2022; 14:17562872221097345. [PMID: 35651485 PMCID: PMC9149605 DOI: 10.1177/17562872221097345] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Ureteroscopy and laser stone fragmentation [flexible ureteroscopy and laser
lithotripsy (FURSL)] has risen over the last two decades. Laser technology
has also evolved over the time, shifting from low- to high-power lasers with
the addition of MOSES technology that allows for ‘dusting and pop-dusting’
of stones. The aim of the study was to look at the outcomes of FURSL in
lower pole stones (LPS) using low- and high-power lasers. Patient and Methods: In this study, we compared the outcomes of low-power holmium laser (group A,
20 W) and high-power holmium laser (group B, including both 60 W MOSES
integrated system and 100 W lasers) for all patients with LPS treated with
laser lithotripsy. Data were collected for patient demographics, stone
location, size, pre- and postoperative stent, length of stay, complications
and stone free rate (SFR). Results: A total of 284 patients who underwent FURSL procedure for LPS were analysed
(168 group A, 116 group B). Outcomes showed that compared with group A,
group B had a higher SFR (91.6% versus 96.5%,
p = 0.13) and shorter operative time (52
versus 38 min, p < 0.001). The
median length of stay was <24 h in all groups (day-case procedures). The
complication rate was comparable between the two groups but with more
infectious complications (n = 7) noted in group A compared
with group B (n = 3) (p = 0.53). Conclusion: Compared with low-power laser, the use of high-power laser for LPS
significantly reduced the use of ureteral access sheath (UAS), postoperative
stent and procedural time. Although non-statistically significant, the SFR
was higher in the high-power group even for relatively larger stone sizes,
which was also reflected in a reduction of sepsis-related complication rates
with these lasers.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO153FD, UK
- European Association of Urology-Young Academic Urologists Urolithiasis and Endourology Working Group, Arnhem, Netherlands
| | - Mriganka Mani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Hughes
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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23
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Rice P, Somani BK. Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review. Curr Opin Urol 2022; 32:185-191. [PMID: 34930884 DOI: 10.1097/mou.0000000000000959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS). RECENT FINDINGS Of the 294 studies initially identified through database searching, nine papers published between 2019 and 2021 were included which compared laser PCNL (Standard PCNL in three, mini-PCNL in four, ultra-mini PCNL in one, micro-PCNL in one study) to other nonlaser lithotripsy, ESWL, FURS, and different PCNL sizes. Complications for laser PCNL ranged from bleeding (4.4%), perirenal haematoma (1.1%), fever (4.6%), ureteric/renal pelvic injury (2.3%), haematuria (2.7%), and infection (2.6%). The mean SFR for laser PCNL was 91.5% at 3 months. SUMMARY Percutaneous laser nephrolithotripsy is well tolerated and effective, with high-SFRs at 3 months and relatively low intraoperative and postoperative complication rates. Further research is required to assess the role of intraoperative techniques and suction to improve outcomes further.
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Affiliation(s)
- Patrick Rice
- Department of Urology, University Hospitals Southampton
- Department of Urology, University of Southampton, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton
- Department of Urology, University of Southampton, Southampton, UK
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24
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Ratajczak JM, Hladun T, Krenz B, Bromber K, Salagierski M, Marczak M. Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031114. [PMID: 35162137 PMCID: PMC8834554 DOI: 10.3390/ijerph19031114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023]
Abstract
Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.
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Affiliation(s)
- Jakub Marek Ratajczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
- Correspondence:
| | - Taras Hladun
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Bartosz Krenz
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Krzysztof Bromber
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
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25
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Tsaturyan A, Ballesta Martinez B, Lattarulo M, Adamou C, Pagonis K, Peteinaris A, Liourdi D, Vrettos T, Liatsikos EN, Kallidonis P. Could the high-power laser increase the efficacy of stone lithotripsy during retrograde intrarenal surgery? J Endourol 2022; 36:877-884. [PMID: 35018789 DOI: 10.1089/end.2021.0870] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare a high-power setting holmium yttrium aluminum garnet (Ho:YAG) laser lithotripsy to the established low-power setting approach during Retrograde Intrarenal Surgery (RIRS). MATERIAL AND METHODS Our study analyzed the data of consecutive patients managed with RIRS. The patients were divided into 2 groups according to the employed laser settings of power, energy and frequency; dusting (20W=0.5Jx40Hz) (Group1) and stone "self-popping" (60W=1.5-2Jx30-40Hz) (Group 2). Perioperative outcomes including operative time (OT) and stone disintegration time (SDT) were compared between groups. Stone-free rate (SFR) was evaluated 1 month after the surgery. RESULTS Overall, 174 patients with 179 renal units were included. The dusting mode was utilized in 98 patients (100 renal units), whereas 76 patients (79 renal units) underwent the stone "self-popping" technique. The SFR was 82.1% for both groups. The OT and SDT were 60.1 ± 18.6min and 32.6 ± 9.4min respectively for Group 1, and 44.9 ± 15.5min and 16.5 ± 4.7min respectively for Group 2. According to the final analysis, laser lithotripsy using stone the "self-popping" technique was significantly faster compared to the dusting technique with a coefficient value of 14.12min (CI = 8.8 - 19.44) and 15.84min (CI = 13.44 - 18.2) for OT and SDT, respectively. CONCLUSION The stone "self-popping" technique with the power at 60W, frequency at 30-40Hz and energy at 1.5-2.0J is a safe and effective modality for the active treatment of renal stones. In comparison to the dusting mode, it resulted in significantly faster procedures (14.12min) possessing similar SFR.
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Affiliation(s)
- Arman Tsaturyan
- Yerevan State Medical University Named after Mkhitar Heratsi, 159228, Urology, Hasratyan 9, Yerevan, Armenia, 0052;
| | | | | | - Constantinos Adamou
- University of Patras, 37795, Urology, Achaikis Sympoliteias 59, Patra, Greece, 24661;
| | - Konstantinos Pagonis
- University of Patras, 37795, Department of Urology, Patras, Western Greece, Greece;
| | | | - Despoina Liourdi
- University of Patras, Urology, University of Patras, Patras, Greece, 26500;
| | - Theofanis Vrettos
- University of Patras, Department of Anesthesiology and ICU, Rion Patras, Patras, Greece, 26504;
| | | | - Panagiotis Kallidonis
- University Of Patras, Urology, Univ. Hospital of Patras, Patras, Greece, 26504.,Greece;
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26
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Venkatachalapathy VS, Palathullil D, Sam D, Prasad A, Abraham G. Outcomes of retrograde intrarenal surgery in renal calculi of varying size. Indian J Urol 2022; 38:128-134. [PMID: 35400866 PMCID: PMC8992719 DOI: 10.4103/iju.iju_343_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/16/2021] [Accepted: 02/05/2022] [Indexed: 11/04/2022] Open
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27
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Rezakahn Khajeh N, Majdalany SE, Ghani KR. Moses 2.0 for High-Power Ureteroscopic Stone Dusting: Clinical Principles for Step-by-Step Video Technique. J Endourol 2021; 35:S22-S28. [PMID: 34910608 DOI: 10.1089/end.2021.0682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: We present our initial experience using the Moses 2.0 system for flexible-ureteroscopy (f-URS) high-frequency renal stone dusting, including a step-by-step video guide of our clinical principles for dusting technique. Materials and Methods: Twelve consecutive patients undergoing f-URS with Moses 2.0 (Lumenis) for a single renal stone by a single surgeon at an ambulatory center were reviewed. Stone-free rates (SFRs) and Clavien grade complications were assessed. Operative steps with illustrative examples are provided in an accompanying video. Results: Mean (range) stone size and lithotripsy time were 10.4 (5.3-17.2) mm and 15.0 (5-26) minutes, respectively. Complete SFR and <2 mm residual fragments were 82% and 18%, respectively. One patient had a Clavien Grade 1 complication. Operative steps reviewed include instrumentation, stone control, laser settings, and stent omission criteria. The preferred laser settings for renal stone dusting were 0.2-0.3 J and 100-120 Hz. Limitation of this early experience study is the small sample size. Larger studies are needed to confirm our initial findings. Conclusions: Early experience of Moses 2.0 for f-URS renal stone dusting demonstrated effective and efficient laser lithotripsy in patients with renal stones <2 cm.
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Affiliation(s)
| | - Sami E Majdalany
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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28
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Ballesta Martinez B, Peteinaris A, Tsaturyan A, Natsos A, Koukiou G, Vagionis A, Pagonis K, Obaidat M, Liourdi D, Vrettos T, Liatsikos E, Kallidonis P. Stone ablation rates using innovative pulse modulation technology: Vapor tunnel, virtual basket, and bubble blast. An in vitro experimental study. Lasers Surg Med 2021; 54:580-587. [PMID: 34843116 DOI: 10.1002/lsm.23503] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION AND OBJECTIVES Virtual BasketTM , Bubble BlastTM , and Vapor TunnelTM are three laser pulse modulation technologies that modify the holmium: yttrium-aluminum-garnet (Ho:YAG) laser pulse transmission through the creation of bubbles emerging from the fiber tip with different effects on the target stone. The primary outcome of the current study was to test the stone ablation rates for the different pulse modulation modes, Virtual Basket, Bubble Blast, and Vapor Tunnel, using different power, energy, and frequency settings. MATERIALS AND METHODS Quanta Cyber: Ho 150 WTM , a 365 µm PrecisionTM fiber, and hard and soft phantom BegoStonesTM were used in an in vitro experimental configuration in a saline bath. In the Virtual Basket mode, the combinations of power, energy and frequency were tested; 10 W = 0.5 J × 20 Hz, 10 W = 0.5 J × 20 Hz, 60 W = 1 J × 60 Hz and 60 W = 2 J × 30 Hz. In the Bubble Blast mode, the combinations, 12 W = 1.2J × 10 Hz, 60 W = 1.2J × 50 Hz and 60 W = 2 J × 30 Hz, were tested. Similarly, the combination of 10 W = 0.5 J × 20 Hz was tested with Vapor Tunnel mode. High-speed camera captures of the bubble formation and regular photographs of the fragmentation pattern were also taken for each mode. RESULTS High power lithotripsy was faster and related to higher ablation rates. The Virtual Basket, Bubble Blast, and Vapor Tunnel modalities showed different ablation rates for the same energy and frequency settings. For hard stones, there was an improvement in the ablation rate using 60 W = 2 J × 30 Hz compared with 60 W = 1 J × 60 Hz and 60 W = 1.2 J × 50 Hz. The highest ablation rates were recorded using the Virtual Basket mode with the high-power settings of 2 J of energy and 30 Hz of frequency. CONCLUSIONS The Virtual BasketTM pulse-modulation technology was related to the highest ablation rates for both hard and soft stones, compared to the Bubble BlastTM and the Vapor TunnelTM technologies in high-power and low-power lithotripsy respectively. For the same high power settings, higher energy seems to provide higher ablation rates.
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Affiliation(s)
| | | | | | | | - Georgia Koukiou
- Electronics Laboratory, Physics Department, University of Patras, Patras, Greece
| | | | | | | | - Despoina Liourdi
- Department of Internal Medicine, Aghios Andreas General Hospital, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Medicine, Sechenov University, Moscow, Russia
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29
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Jones P, Beisland C, Ulvik Ø. Current status of thulium fibre laser lithotripsy: an up-to-date review. BJU Int 2021; 128:531-538. [PMID: 34273234 DOI: 10.1111/bju.15551] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To perform an up-to-date review to scope the current status of the thulium fibre laser (TFL) in the setting of stone lithotripsy and provide a guide for the clinical urologist. METHODS A review of world literature was performed to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared. RESULTS To date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of miniaturised percutaneous nephrolithotomy (mini-PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, the range of settings has been 0.1-4 J × 7-300 Hz for both URS and mini-PCNL. Stones ranging from 0.4-3.2 and 1.5-3 cm have been treated with URS and mini-PCNL, respectively. The final stone-free rate for TFL has ranged from 66.6% to 100% and 85-100% for URS and mini-PCNL, respectively. The average length of stay ranged from 0.5 to 2.4 days in the URS group, but no studies have been reported this for mini-PCNL. Operative times in all the studies (both URS and mini PCNL) were <60 min. CONCLUSION Initial clinical studies reveal that TFL appears to be efficacious in the setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position, as well as determine the optimal settings for use in clinical practice.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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30
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Low-energy high-frequency Ho-YAG lithotripsy: is RIRS going forward? A case-control study. Urolithiasis 2021; 50:79-85. [PMID: 34424352 DOI: 10.1007/s00240-021-01282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
Retrograde Intra-Renal Surgery (RIRS) plays a primary role in renal stone treatment context. Energy, frequency and width of laser impulse can be modulated by surgeons to achieve better outcomes. In our study, patients with single renal stone sized 10-20 mm were retrospectively divided into two groups. Patients of Group 1 underwent RIRS with Low-Energy (LE) High-Frequency (HF) settings using Lumenis® 120-W high-power Ho:YAG laser. Patients of Group 2 (control) underwent RIRS using "standard" settings by means of Sphinx® Jr 30 W Ho:YAG system. Follow-up was conducted with a CT scan at 3 months after RIRS in both groups. Procedure success was defined as stone-free or presence of ≤ 4 mm fragments (Clinical Insignificant Residual Fragments-CIRF). A total number of 199 patients were included: 86 LE/HF RIRS (Group 1) vs 113 "conventional" RIRS (Group 2). Mean operative time was 56.6 (± 19.4) min in Group 1 vs 65.2 (± 25.2) min in Group 2 (p = 0.01). Mean hospitalization time was 2.5 ± 1.7 days for Group 1 vs 2.9 ± 3.2 days for Group 2 (p = 0.2). Peri-operative complications were counted: eight in Group 1 and 11 in Group 2 (p > 0.05). At 3-month control, stone-free rate was 69% (59/86 patients) in Group 1 vs 65% (73/113 patients) in Group 2 (p = 0.6). Success rate was 93% (80/86) in Group 1 in comparison to 82% (93/113) in Group 2 (p = 0.03). In conclusion, LE/HF RIRS seems to be a feasible and effective technique with a reduction of operative time and optimal results in terms of "stone-free" and "success" rates. Further studies are needed to ensure the validity of our results and to give evidence-based statements.
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31
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Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser. J Clin Med 2021; 10:jcm10132742. [PMID: 34206298 PMCID: PMC8268749 DOI: 10.3390/jcm10132742] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.
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32
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Ventimiglia E, Pauchard F, Quadrini F, Sindhubodee S, Kamkoum H, Jiménez Godínez A, Doizi S, Traxer O. High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series. J Endourol 2021; 35:1146-1152. [PMID: 33677987 DOI: 10.1089/end.2020.0090] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: There is no clear evidence that high-power (HP) laser generators perform better than low-power (LP) ones in terms of lithotripsy outcomes. We aimed to perform a systematic review of literature to compare the efficacy outcomes of both HP and LP during ureteroscopic lithotripsy. Materials and Methods: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting perioperative outcomes of HP and LP lithotripsy. Using the methodology recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we identified 22 nonrandomized noncomparative retrospective studies published between 2015 and 2019 that were eligible for inclusion in this systematic review. Because of the lack of comparative studies, we decided to perform two separate meta-analytic syntheses for LP and HP studies, then we compared them using a Wald-type test. Results: Overall, the selected studies included 6403 patients. Study design, exposure assessment, selection criteria, and outcome of interest were heterogeneous. LP studies were more common (n = 17, 77%), whereas HP studies were more common in the latest inclusion period. Faster lithotripsy (32.9 minutes vs 63.9 minutes, p < 0.01) was observed in HP studies. However, stone volume resulted twofold higher (2604 mm3 vs 1217 mm3, p = 0.048) in LP studies. Pooled stone-free rate was similar in both LP and HP studies, 81% and 82%, respectively, p > 0.05. No difference in complication rate was observed between the two groups, p = 0.12. Conclusions: HP laser lithotripsy appears to require shorter operative time, with similar stone-free and complication rates as compared with LP traditional lithotripsy. However, when taking into account stone burden, this advantage seems to be lost, or at least not to be comparable with what observed in laboratory studies. Because of the lack of high-level comparative evidence, further clinical studies are needed to elucidate the benefits of using HP laser generators during ureteroscopic stone treatment.
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Affiliation(s)
- Eugenio Ventimiglia
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Felipe Pauchard
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Department of Urology, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Francesca Quadrini
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Sermsin Sindhubodee
- Division of Urology, Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
| | - Hatem Kamkoum
- Urology Department, Hazm Mebaireek General Hospital (HMGH), Doha, Qatar
| | | | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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33
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Biligere S, Heng CT, Cracco C, Mangat R, Ong CSH, Thandapani K, Inoue T, Sarica K, Sabnis RB, Desai M, Scoffone C, Gauhar V. Tips and Tricks to Improve Ergonomics, Efficacy, Versatility, and Overcome Limitations of Micro Percutaneous Nephrolithotomy. Front Surg 2021; 8:668928. [PMID: 34095208 PMCID: PMC8170413 DOI: 10.3389/fsurg.2021.668928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Percutaneous Nephrolithotomy (PCNL) has evolved over the decades from Standard to Mini to Ultramini PCNL to Micro-perc, with miniaturisation being the dominant theme and supine approach gaining momentum world over. Aim: In literature, miniaturised PCNL with microperc needle access system has raised concerns of intrarenal pressure and has some limitations with its success for larger stones. Our tips and tricks explain how to overcome these pitfalls by utilising the full construct of the needle system to its maximum potential. These will in turn help make the procedure versatile, precise, ergonomical, and enhance a surgeon's experience with improved outcomes for patients especially in large renal stones. Materials and Methods: We describe the limitations of microperc needle access as stated in literature and proposals by the co-authors using microperc for miniaturised access on how to overcome the same. Results: A simplified table describing the limitations and tips and tricks on overcoming these is provided for quick reference. Conclusion: As Technological advancements and techniques for miniaturised access in urolithiasis improve, we believe our suggestions will help surgeons overcome the quoted limitations of microperc needle access for miniaturised PCNL, making this a versatile, safe and efficacious technique even in large and complex stones. A multi centre trial will be the best way to validate the suggestions proposed in this article.
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Affiliation(s)
- Sarvajit Biligere
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Chin-Tiong Heng
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Cecilia Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - Reshma Mangat
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Chloe Shu-Hui Ong
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Karthik Thandapani
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Takaaki Inoue
- Hara Genito-Urinary Hospital, Kobe University, Kobe, Japan
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | | | - Mahesh Desai
- Muljhibhai Patel Urological Hospital, Nadiad, India
| | | | - Vineet Gauhar
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
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Bhanot R, Jones P, Somani B. Minimally Invasive Surgery for the Treatment of Ureteric Stones - State-of-the-Art Review. Res Rep Urol 2021; 13:227-236. [PMID: 33987110 PMCID: PMC8110280 DOI: 10.2147/rru.s311010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
The landscape of managing ureteric stones has evolved over the last few decades and several treatment options exist depending on the stone size, location, and other patient and stone factors. While open surgery is now rarely performed, the use of medical expulsive therapy (MET) has been controversial and perhaps only recommended for large distal ureteric stones. The mainstay treatment balances between shockwave lithotripsy (SWL) and ureteroscopy (URS), with the latter usually recommended for larger stones. While the principles of ureteric stone management have remained largely unchanged, the modern era has generated new methods and means to deliver it. Advancements have occurred in all domains of endourology to try and refine treatment and balance it with cost, patient choice and quality of life. Dissemination of technologies and demonstration of their efficacy and safety will eventually result in new recommendations among international guidelines and evolution of new gold standards.
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Affiliation(s)
- Radhika Bhanot
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.,EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, the Netherlands.,Manipal Academy of Higher Education, Manipal, India
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Tzelves L, Somani B, Berdempes M, Markopoulos T, Skolarikos A. Basic and advanced technological evolution of laser lithotripsy over the past decade: An educational review by the European Society of Urotechnology Section of the European Association of Urology. Turk J Urol 2021; 47:183-192. [PMID: 35929871 PMCID: PMC8260082 DOI: 10.5152/tud.2021.21030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/09/2021] [Indexed: 03/19/2024]
Abstract
Laser disintegration of urinary stones is a cornerstone of urolithiasis treatment in the modern era. Despite the wide clinical use of stone lasers, basic and advanced technological achievements and developments are difficult to comprehend and interpret by the average urologist. A descriptive analysis of laser production and stone disintegration mechanisms was performed. We focused on physics of modern types of lithotripters, the construction of laser fibers, laser parameters, new modes, settings, and lithotripsy techniques. The main principle of laser emission remains the same since the first emitting laser was produced. Peak power density and short interaction time lead to photothermal effects responsible for stone disintegration. Modern lithotripters such as Holmium: YAG (low/high power, Moses technology) and thulium fiber laser show basic construction differences with the physical properties of the latter being superior, at least in in vitro studies. By adjusting lasing parameters, a wide spectrum of stone ablation from fragmentation to dusting can be achieved. New technology allows for the production of real dust. Knowledge of laser fiber construction and physical properties are useful in marketing and clinical use. Urologists should understand the physical and physiological background of the lasers used in their everyday practice for stone fragmentation.
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Affiliation(s)
- Lazaros Tzelves
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Bhaskar Somani
- University Hospital, Southampton NHS foundation Trust, Southampton, UK
| | - Marinos Berdempes
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Titos Markopoulos
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
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36
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Mosquera L, Pietropaolo A, Brewin A, Madarriaga YQ, de Knecht EL, Jones P, Bujons A, Griffin S, Somani BK. Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers. Urology 2021; 157:222-226. [PMID: 33891927 DOI: 10.1016/j.urology.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
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Affiliation(s)
- L Mosquera
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Brewin
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - P Jones
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - S Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, United Kingdom.
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Bhanot R, Pietropaolo A, Tokas T, Kallidonis P, Skolarikos A, Keller EX, De Coninck V, Traxer O, Gozen A, Sarica K, Whitehurst L, Somani BK. Predictors and Strategies to Avoid Mortality Following Ureteroscopy for Stone Disease: A Systematic Review from European Association of Urologists Sections of Urolithiasis (EULIS) and Uro-technology (ESUT). Eur Urol Focus 2021; 8:598-607. [PMID: 33674255 DOI: 10.1016/j.euf.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 01/29/2023]
Abstract
CONTEXT While kidney stone disease is common and ureteroscopy (URS) is perceived as minimally invasive, there is mortality associated with treatment. OBJECTIVE The aim of this review was to ascertain the number of mortalities from URS for stone disease over the past three decades, identify relevant patient risk factors and predictors of mortality, and summarise the key recommendations so that similar instances can be avoided, and lessons can be learnt. EVIDENCE ACQUISITION A systematic literature search was conducted following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology for English-language article reporting on data from 1990 to December 2020. Data collated from each study included patient and stone characteristics, number of mortalities, and cause of death. EVIDENCE SYNTHESIS Fifteen studies met our inclusion criteria and revealed a total of 72 mortalities from ten countries. The age range of reported patients varied from 21 to 89 yr, with over 60% being above 65 yr of age and 97% with some comorbidity. Based on available data, death reports in females were three times more than those in males. The stone size ranged from 10 to 38 mm. Treatment of larger stones corresponded to a longer operative time, with procedural duration varying from 30 to 120 min. Of the reported causes of mortality in 42 patients, the aetiology was sepsis in over half of the patients, with other causes being cardiac-related, respiratory-related, multiorgan failure, and haemorrhagic complications. CONCLUSIONS Although the reported URS mortality rate seems to be low, there has been a rise in deaths over the past decade. Efforts must be made to have preoperative urine culture, and reduce operative time and stage procedures in patients with a large stone burden. Care must be taken in patients with robust preoperative assessment, intraoperative techniques, and postoperative monitoring for early detection of complications with interdisciplinary management of complex cases. PATIENT SUMMARY We reviewed the risk factors associated with postureteroscopy mortality and ways to minimise this. Evidence shows that although reported mortality remains low, there seems to be an increase in mortality in the past decade and urologists must remain vigilant of this.
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Affiliation(s)
- Radhika Bhanot
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | | | | | | | | | - Olivier Traxer
- GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Ali Gozen
- Medical Clinic Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Kemal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
| | | | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Southampton, UK; Manipal Academy of Higher Education, Manipal, India.
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38
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Aldoukhi AH, Dau JJ, Majdalany SE, Hall TL, Ghani KR, Hollingsworth JM, Ambani SN, Dauw CA, Roberts WW. Patterns of Laser Activation During Ureteroscopic Lithotripsy: Effects on Caliceal Fluid Temperature and Thermal Dose. J Endourol 2021; 35:1217-1222. [PMID: 33397188 DOI: 10.1089/end.2020.1067] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Characterizing patterns of laser activation is important for assessing thermal dose during laser lithotripsy. The objective of this study was twofold: first, to quantify the range of operator duty cycle (ODC) and pedal activation time during clinical laser lithotripsy procedures, and second, to determine thermal dose in an in vitro caliceal model when 1200 J of energy was applied with different patterns of 50% ODC for 60 seconds. Methods: Data from laser logs of ureteroscopy cases performed over a 3-month period were used to calculate ODC (lasing time/lithotripsy time). Temporal and rolling 1-minute average power tracings were generated for each case. In vitro experiments were conducted using a 21 mm diameter glass bulb in a 37°C water bath, simulating a renal calix. A LithoVue ureteroscope with attached thermocouple was inserted and 8 mL/min irrigation was delivered with a 242 μm laser fiber within the working channel. In total, 1200 J of laser energy was applied in five different patterns at 20 W average power for 60 seconds. Thermal dose was calculated using the Sapareto and Dewey t43 method. Results: A total of 63 clinical cases were included in the analysis. Mean ODC was 32% overall and 63% during the 1-minute of greatest energy delivery. Mean time of pedal activation was 3.6 seconds. In vitro studies revealed longer pedal activation times produced higher peak temperature and thermal dose. Thermal injury threshold was reached in 9 seconds when 40 W was applied at 50% ODC with laser activation patterns of 30 seconds on/off and 15 seconds on/off. Conclusion: ODC was quantified from clinical laser lithotripsy cases: 32% overall and 63% during 1-minute of peak power. Time of pedal activation is an important factor contributing to fluid heating and thermal dose. Awareness of these concepts is necessary to reduce risk of thermal injury during laser lithotripsy procedures.
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Affiliation(s)
- Ali H Aldoukhi
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Julie J Dau
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Sami E Majdalany
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sapan N Ambani
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Casey A Dauw
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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39
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Panthier F, Doizi S, Corrales M, Traxer O. Pulsed lasers and endocorporeal laser lithotripsy. Prog Urol 2021; 31:451-457. [PMID: 33516610 DOI: 10.1016/j.purol.2020.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023]
Abstract
Endocorporeal laser lithotripsy (ELL) is currently the gold standard for the treatment of renal stones during retrograde intra-renal surgery (RIRS). The newly-authorised thulium fibre laser (Tm-Fibre) in now evaluated as a holmium:yttrium-aluminium-garnet (Ho:YAG) laser alternative, which is the most well-known laser source for ELL. This update aimed to present the fundamentals of pulsed lasers for EEL [technology, period, pulse characteristic (rate, duration, energy, shape), peak power, average power], and the available lithotripsy modes for both Tm-Fibre and Ho:YAG lasers.
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Affiliation(s)
- F Panthier
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - S Doizi
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
| | - M Corrales
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
| | - O Traxer
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
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40
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Saita A, Villa L, Persico F, Lughezzani G, Prezioso D, Casale P. In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy. Urolithiasis 2020; 49:239-245. [PMID: 33005998 DOI: 10.1007/s00240-020-01215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
To test in-vitro and in-vivo the Flexor® Vue™ deflecting endoscopic system (FVDES) as a new technology able to improve the removal of residual intrarenal fragments.This is an observational prospective "proof of concept" study performed in patients with renal calculi treated with flexible ureteroscopy and Ho:YAG laser lithotripsy (f-URS) in Humanitas Research Hospital (Rozzano, Italy). We assessed feasibility, efficacy and safety of FVDES as an in-vivo tool for removing residual fragments after f-URS. The stone-free rate (SFR) at 30 days post-operatively was evaluated using CT. An in-vitro model was developed to evaluate the FVDES when used for this purpose.Eleven patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces and the renal pelvis in 3 and 8 patients, respectively. Mean stone size was 18 ± 3.2 mm. The procedure with FVDES was feasible and effective in all the patients. Mean operative time was 82 ± 13.7 min and median hospitalization was of 1.5 days. The SFR after 90 days was 81% (9/11). We reported no relevant complications (Clavien-Dindo > 2); one patient had fever and was treated with antibiotics. The experimental in-vitro model demonstrated the efficacy of FVDES, allowing the removal of about 90% of fragments.Our study showed that FVDES is effective when used as a tool for retrieval of residual fragments at the end of f-URS. This technology could ensure a complete cleaning of the intrarenal collecting system and represent a safe alternative to basketing.
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Affiliation(s)
- Alberto Saita
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology URI, Ospedale San Raffaele IRCCS, Milan, Italy
| | - Francesco Persico
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Domenico Prezioso
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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41
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Emiliani E, Angerri O. High-power, High-frequency Ho:YAG Lasers Are Essential for Retrograde Intrarenal Surgery. Eur Urol Focus 2020; 7:3-4. [PMID: 32948503 DOI: 10.1016/j.euf.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022]
Abstract
Advances in Ho:YAG technology have led to the appearance of high-power and high-pulse-frequency lasers that allow a wider range of options and greater versatility when choosing settings to achieve precise and effective lithotripsy.
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Affiliation(s)
- Esteban Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
| | - Oriol Angerri
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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42
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Liang H, Liang L, Yu Y, Huang B, Chen J, Wang C, Zhu Z, Liang X. Thermal effect of holmium laser during ureteroscopic lithotripsy. BMC Urol 2020; 20:69. [PMID: 32539828 PMCID: PMC7296665 DOI: 10.1186/s12894-020-00639-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Holmium laser lithotripsy is the most common technique for the management of ureteral stone. Studies founded that holmium laser firing can produce heat which will cause thermal injury towards ureter. The aim of our current study is to explore factors affecting thermal effect of holmium laser during ureteroscopic lithotripsy. Methods An in vitro experimental model is design to simulate the ureteroscopic lithotripsy procedure. Different laser power settings (10w (0.5JX20Hz, 1.0 JX10Hz), 20w (1.0 JX20Hz, 2.0 JX10Hz), 30w (1.5JX20Hz, 3.0 JX10Hz)) with various firing time (3 s, 5 s, 10s) and irrigation flow rates(10 ml/min, 15 ml/min, 20 ml/min and 30 ml/min) were employed in the experiment. The temperature around the laser tip was recorded by thermometer. Results The temperature in the “ureter” rises significantly with the increasing laser power, prolonging firing time and reducing irrigation flow. The highest regional temperature is 78.0 °C at the experimental set-up, and the lowest temperature is 23.5 °C. Higher frequency setting produces more heat at the same power. Laser power < =10w, irrigation flow> = 30 ml/min and “high-energy with low-frequency” can permit a safe working temperature. Conclusion We clarify that the thermal effect of holmium laser is related with both laser working parameters and irrigation flow. The proper setting is the key factor to ensure the safety during ureteroscopic holmium laser lithotripsy.
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Affiliation(s)
- Hui Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China.
| | - Lijian Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Yin Yu
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Bin Huang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Jia'nan Chen
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Chaoguo Wang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Zhangguo Zhu
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Xiaozhong Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
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43
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Jones P, Mishra D, Agrawal M, Griffin S, Somani BK. Outcomes of Ureteroscopy vs Mini-Percutaneous Nephrolithotomy for Pediatric Upper Urinary Tract Calculi: Comparative Nonrandomized Outcomes from Two Tertiary Endourology Referral Centers. J Endourol 2020; 34:735-738. [PMID: 32316766 DOI: 10.1089/end.2020.0172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Pediatric upper urinary tract calculi can be treated by ureteroscopy (URS) or mini-percutaneous nephrolithotomy (mPCNL). We wanted to compare outcomes of URS and mPCNL from two tertiary referral centers that specialized in one of these treatments for pediatric stone disease. Materials and Methods: Data were collected from two tertiary centers for a 10-year period (2010-2019); one center specializing in URS and the other in mPCNL for consecutive patients ≤16 years undergoing either of these minimally invasive interventions. Upper urinary tract stones included stones in the kidney, pelviureteral junction, and proximal ureter, whereas mid or distal ureteral stones were excluded. Data were collected on patient and stone demographics. Outcomes of interest included stone-free rate (SFR) and complication rates. Results: During the study period, 55 patients underwent URS (group 1) and 40 patients underwent mPCNL (group 2). The mean stone size for groups 1 and 2 were 11.4 and 14.5 mm, respectively, whereas twice as many patients in group 1 had multiple stones. The final SFR and complication rates for groups 1 and 2 were 100% and 97.5%, and 5.4% and 12.5%, respectively. Although there were two Clavien II and one Clavien IV complication in the URS group, all five complications in mPCNL group were Clavien I. Conclusions: Our study shows excellent outcomes for upper urinary tract stones with both URS and mPCNL. Although treatment choices should be tailored to patients, each modality carries different advantages and our results reflect that high-volume centers specializing in a particular technique offer best outcomes, and this must also be borne in mind when counseling patients.
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Affiliation(s)
- Patrick Jones
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Dilip Mishra
- Department of Urology, Global Rainbow Healthcare, Agra, India.,Department of Urology, Pushpanjali Hospital & Research Centre, Agra, India
| | - Madhu Agrawal
- Department of Urology, Global Rainbow Healthcare, Agra, India.,Department of Urology, Pushpanjali Hospital & Research Centre, Agra, India
| | - Stephen Griffin
- Department of Paediatric Urology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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44
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Schembri M, Sahu J, Aboumarzouk O, Pietropaolo A, Somani BK. Thulium fiber laser: The new kid on the block. Turk J Urol 2020; 46:S1-S10. [PMID: 32479257 DOI: 10.5152/tud.2020.20093] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Laser technology in urology is currently used for both stone lithotripsy and prostate enucleation. Thulium fiber laser (TFL) is a novel laser, with initial studies showing potential benefits over other lasers both in terms of its effectiveness and safety profile. MATERIAL AND METHODS In the first part of this review, a descriptive analysis of the theoretical concepts behind TFL was performed. This part focused on the physics and laser parameters as applied to the clinical practice. These were interpreted in the context of other lasers, namely, the Holmium:YAG laser to highlight the theoretical advantages as well as potential pitfalls offered by the TFL. In the second part of the review, a narrative synthesis of in-vitro studies regarding TFL and its modifications is performed assessing stone-related parameters, namely, ablation rate, operative time retropulsion, and safety. RESULTS TFL achieved high ablation rates in most studies and performed better than Holmium:YAG laser across a range of different settings and ablation modes when the two lasers were compared. Moreover, its ability to use low pulse energy ensures minimal stone retropulsion with the retropulsion threshold estimated to be 2-4 times higher than that of Holmium:YAG laser. From a safety viewpoint, TFL poses no additional risks than other lasers, although it does potentially lead to slightly higher temperatures in the surrounding tissues during lithotripsy. CONCLUSION The unique properties of TFL have made it an attractive alternative to conventional laser techniques currently used in urology. Clinical studies are required before its application can become more widespread.
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Affiliation(s)
| | - Jayanta Sahu
- Zepler Institute for Photonics and Nanoelectrics, University of Southampton, Southampton, UK
| | - Omar Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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The surgeon's role on chemical investigations of the composition of urinary stones. Urolithiasis 2020; 48:435-441. [PMID: 32436004 DOI: 10.1007/s00240-020-01195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
The chemical analysis of an urolith is often interpreted as "stone's composition". However, it must be taken into consideration, that in most cases, only a fragment of the stone has been sent to the laboratory. In some recurrent patients, stone compositions either vary considerably between episodes or the analytical result obtained from the stone fragment does not fit with the data of e.g. current 24 h-urinalysis or urinary pH-records. The question arises, whether this outcome may be the result of an improper stone sampling scheme. On a simple layered 2D-stone model composed of two mineral phases it is shown, how the choice of a stone fragment process may influence the result of "stone composition". Depending on the initial position of fragment within the whole stone, the respective calculated analyses can relevantly differ from the whole stone composition as well as strongly between two fragments. Even under the simplified conditions of a 2D-2-component-model "grown" under defined conditions, the differences between the analyses of the different specimens taken from a stone are in part remarkable. The more it can be argued that these differences increase if a real 3D-urolith is investigated. Further sampling biases may evolve and increase the problem of proper sampling:, e.g., if an urolith's more resistant parts remain intact while ESWL or laser-based stone fragmentation ("dusting"), the weak parts became fully disintegrated and removed from the body as fine-grained sludge-the stone's fine fraction is lost although its composition may carry important information on the stone's pathogenesis. Consequently, a "stone analysis" only obtained from the harder remains reveals an incomplete result, a fact that in principle limits its clinical interpretation. Choice of stone fragment is crucial. The extent of the uncertainty of an analysis resulting from potential selection biases should not be underestimated. Thus, sampling should be considered as an important part of the processes of quality assurance and management. Errors made at this early stage of diagnosis finding will affect the analytical result and thus influence the clarification of the underlying pathomechanism. This can lead to an improper metaphylactic strategy potentially causing recurrent stone formation which otherwise would have been prevented. A decision scheme for analysis of urinary stones removed using endoscopic methods is suggested.
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Pietropaolo A, Schembri M, Somani BK. Dusting and pop-dusting for kidney stone disease: Video and outcomes. Turk J Urol 2020; 46:tud.2020.20112. [PMID: 32449671 PMCID: PMC7360160 DOI: 10.5152/tud.2020.20112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 02/28/2024]
Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Matthew Schembri
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
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Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O. What is the exact definition of stone dust? An in vitro evaluation. World J Urol 2020; 39:187-194. [PMID: 32270283 DOI: 10.1007/s00345-020-03178-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. METHODS Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. RESULTS All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm. CONCLUSION A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.
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Affiliation(s)
- Etienne Xavier Keller
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Steeve Doizi
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. .,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
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Lane J, Whitehurst L, Hameed BMZ, Tokas T, Somani BK. Correlation of Operative Time with Outcomes of Ureteroscopy and Stone Treatment: a Systematic Review of Literature. Curr Urol Rep 2020; 21:17. [PMID: 32211985 DOI: 10.1007/s11934-020-0970-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence related to the impact of increased operative times in retrograde intrarenal surgery and identify possible important factors that can facilitate ureteroscopy procedures. RECENT FINDINGS Ureteroscopy constitutes the mainstay treatment of renal stones and is characterized by a huge variation in techniques and instrumentation. It has been suggested that increased operative times can mitigate the outcomes of the procedures by increasing complication rates. Nevertheless, little is known about the time limits, above which complications are likely to occur. Furthermore, complication rates in different procedure durations have not yet been assessed. Prolonged operative times are linked to increased complication rates in ureteroscopy. Stone complexity, patient risk factors, surgeon experience, bilateral surgery, and instrumentation constitute important factors that can hamper or facilitate a procedure and should be taken into account beforehand. Keeping procedural times below 90 min can dissuade potential predicaments and achieve improved stone-free rates.
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Affiliation(s)
- Jenni Lane
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
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Reeves T, Griffin S, Pietropaolo A, Somani BK. Feasibility of dusting and pop-dusting using high-power (100W) Holmium YAG (Ho:YAG) laser in treatment of paediatric stones: results of first worldwide clincial study. Cent European J Urol 2020; 72:398-401. [PMID: 32015910 PMCID: PMC6979551 DOI: 10.5173/ceju.2019.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/06/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction As the role of paediatric ureteroscopy (URS) for stone disease increases, new methods of stone treatment such as dusting and pop-dusting have emerged. However, outcomes of treatment using these laser settings in paediatric age group is still largely unknown. We aimed to look at the feasibility and outcomes of URS and pop-dusting using a high-power 100W laser for paediatric stone patients. Material and methods Outcomes from a prospective stone database were reviewed over a period of 30 months from February 2016–July 2018. All paediatric patients (≤16 years) treated with dusting and pop-dusting were included in our study. Dusting and pop-dusting were performed using Ho:YAG laser with the energy setting ranges of 0.2–0.5 J and 0.5–0.7 J respectively with a frequency of 20–50 Hz. Results Twelve patients underwent URS and treatment using this method with mean age of 6.5 years and a male:female ratio of 7:5. The mean and cumulative single stone size was 7.1 mm (3–10 mm) and 11.9 mm (6–40 mm) respectively with half of all patients having multiple stones. Eleven patients were stone free on follow-up with no intra or post-operative complications noted. Conclusions Pop-dusting using holmium laser is a new hybrid technique that allows for more efficient dust formation even for hard stones. This is the first clinical study demonstrating the safety and efficacy of this technique in paediatric patients. It is likely there will be wider adoption of these new laser techniques for stone treatment in the paediatric age group.
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Affiliation(s)
- Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Stephen Griffin
- Department of Paediatric Urology, Southampton Children's Hospital, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, United Kingdom
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