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Ge TJ, Roquero DM, Holton GH, Mach KE, Prado K, Lau H, Jensen K, Chang TC, Conti S, Sheth K, Wang SX, Liao JC. A magnetic hydrogel for the efficient retrieval of kidney stone fragments during ureteroscopy. Nat Commun 2023; 14:3711. [PMID: 37349287 PMCID: PMC10287666 DOI: 10.1038/s41467-023-38936-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Only 60-75% of conventional kidney stone surgeries achieve complete stone-free status. Up to 30% of patients with residual fragments <2 mm in size experience subsequent stone-related complications. Here we demonstrate a stone retrieval technology in which fragments are rendered magnetizable with a magnetic hydrogel so that they can be easily retrieved with a simple magnetic tool. The magnetic hydrogel facilitates robust in vitro capture of stone fragments of clinically relevant sizes and compositions. The hydrogel components exhibit no cytotoxicity in cell culture and only superficial effects on ex vivo human urothelium and in vivo mouse bladders. Furthermore, the hydrogel demonstrates antimicrobial activity against common uropathogens on par with that of common antibiotics. By enabling the efficient retrieval of kidney stone fragments, our method can lead to improved stone-free rates and patient outcomes.
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Affiliation(s)
- T Jessie Ge
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Daniel Massana Roquero
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Grace H Holton
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
| | - Kathleen E Mach
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Kris Prado
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
| | - Hubert Lau
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Kristin Jensen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Timothy C Chang
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Simon Conti
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
| | - Kunj Sheth
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
| | - Shan X Wang
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Joseph C Liao
- Department of Urology, Stanford University, Stanford, CA, 94305, USA.
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.
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Chen Y, Li C, Gao L, Lin L, Zheng L, Ke L, Chen J, Kuang R. Novel flexible vacuum-assisted ureteral access sheath(FV-UAS) can actively control intrarenal pressure and obtain a complete stone-free status. J Endourol 2022; 36:1143-1148. [PMID: 35243899 DOI: 10.1089/end.2022.0004] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the safety and effectiveness of a novel flexible vacuum-assisted ureteral access sheath (FV-UAS) and traditional ureteral access sheath (UAS) in simulating retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS Amanometric model was established in porcine kidneys to observe the change inintrarenal pressure in the FV-UAS and traditional UAS groups at different irrigation fluid velocities of 30 ml/min, 50 ml/min, 80 ml/min, and 100 ml/min. Establish a kidney stone model (with 0.2 g, dry, ≤ 5 mm stones) to simulate RIRS. A total of 20 porcine kidneys wererandomly numbered from 1 to 20 (FV-UAS group, 1-10; traditional UAS group, 11-20). The stone volume clearance rate and operation time were compared between the two groups. [" Stone volume clearance rate= (1-(residual stone volume)/(preoperative stone volume))×100%" )]. Stones volume was obtained by computed tomography (CT) preoperatively and postoperatively. RESULTS FV-UAS can follow flexible ureteroscopy (f-URS) to cross the ureteropelvic junction (UPJ) and into the renal pelvis and calyces. FV-UAS can actively make intrarenal pressure (IRP) less than 10 cmH2O by adjusting the negative values atdifferent irrigation fluid velocities. The mean residual stone volume of the FV-UAS vs. traditional UAS groups was33.7 mm3 vs. 92.5 mm3 (P = 0.017). The mean stone volume clearance rates of the FV-UAS vs. traditional UAS groups were 98.5 % and95.9 %, respectively (P = 0.017). Seven cases achieved complete stone-free status in the FV-UAS group. All patients hadresidual fragments postoperatively in the traditional UAS group. CONCLUSIONS FV-UAS can follow f-URS to cross the UPJ and into the renal pelvis and calyces, avoiding the interference of UPJ in controlling IRP. FV-UAS can actively control the IRP to be reduced to the desired range by adjusting the negative value under any irrigation fluid velocity. FV-UAS close to the stone can achieve complete stone-free in RIRS.
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Affiliation(s)
- Yujun Chen
- Jiangxi Provincial People's Hospital, 159384, urology, Nanchang, Jiangxi, China;
| | - Chen Li
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Liang Gao
- Jiangxi Provincial People's Hospital, 159384, Nanchang, Jiangxi, China;
| | - Longhui Lin
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Liangliang Zheng
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Longlong Ke
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Jie Chen
- Jiangxi Provincial People's Hospital, 159384, Urology, 152 Aiguo Street,Nanchang City,China, Nanchang, China, 330006;
| | - Renrui Kuang
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
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Yu Y, Xi H, Chen Y, Li X, Liu W, Hu J, Deng J, Liu X, Lin L, Li C, Wang M, Fu B, Wang G, Kuang R, Zhou X. Fibrin gel-assisted stone extraction in retrograde intrarenal surgery. BJU Int 2021; 129:170-173. [PMID: 34856054 PMCID: PMC9300148 DOI: 10.1111/bju.15651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yujun Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuwen Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Longhui Lin
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mengzhen Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Renrui Kuang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Jiang P, Brevik A, Clayman RV. The Life and Death of Percutaneous Stone Removal: "Looking Back-Looking Forward". Urol Clin North Am 2021; 49:119-128. [PMID: 34776046 DOI: 10.1016/j.ucl.2021.07.010] [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: 10/20/2022]
Abstract
Although percutaneous nephrolithotomy (PCNL) is less morbid than open surgery, it still carries risks of significant complications as well as injury to the renal parenchyma. Flexible ureteroscopic stone removal, although causes no appreciable damage to the renal parenchyma, has limitations, most notably, a lower stone-free rate than PCNL. Advances in our knowledge regarding ureteral physiology combined with technical developments applied to ureteral access sheath deployment and size may well propel retrograde intrarenal surgery to the forefront of kidney stone removal, regardless of stone size or location.
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Affiliation(s)
- Pengbo Jiang
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA.
| | - Andrew Brevik
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
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Hausmann T, Becker B, Gross AJ, Netsch C, Rosenbaum CM. Novel Biocompatible Adhesive to Remove Stone Dust: Usability Trial in a Kidney Model. J Endourol 2021; 35:1223-1228. [PMID: 33559523 DOI: 10.1089/end.2020.0748] [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] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: "Clinically insignificant residual fragments" are an independent predictive factor for recurrence of nephrolithiasis. To improve the stone-free rates (SFR), we tested the viability of a novel bioadhesive system for intrarenal embedding and retrieval of residual fragments <1 mm in a kidney model. Materials and Methods: All procedures were performed in a standardized setting, including a kidney model (Kidney module right, Samed GmbH, Dresden) in a plastic basin filled with water. We used a Viper URF flexible ureterorenoscope (fURS) (6.6/8F, Richard Wolf, Knittlingen). A mean amount of 138 mg (standard deviation [SD] ±32.2 mg) of sand grains (range, 0.2-0.8 mm) was inserted in renal calices of the kidney model. We assessed the extraction efficacy of fURS using the bioadhesive system. In total, eight different surgeons performed each one trial, respectively. The endoscopic and macroscopic SFR, the level of the surgeons' experience, and the overall time of stone retrieval were evaluated. Additionally, a survey of the participants was conducted, to assess the contentment with this novel system. Results: The extraction of the sand grains was only possible using the bioadhesive system, otherwise they were too small sized to grab with a retrieval basket. The total SFR was 84% (SD ±11.7%). The operation time (p = 0.052) and the percentage of extracted sand grains (p = 0.194) were not significantly different between experienced and less experienced surgeons. All participants stated that it was a promising technique, which they could imagine using on a daily basis. Conclusions: The bioadhesive system improves the SFR with fragments from 0.2 to 0.8 mm (0% vs 84%). Also, the performance of this operation is not dependent on the surgeon's experience level. This method might improve the SFR in difficult anatomic conditions, that is, lower calices or anomalous kidneys.
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Affiliation(s)
- Teresa Hausmann
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Benedikt Becker
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Clemens M Rosenbaum
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany.,Department of Urology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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Crispi CP, Crispi CP, Mendes FLF, de Andrade CM, Cardeman L, de Nadai Filho N, Portari EA, Fonseca MDF. Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions. PLoS One 2020; 15:e0219105. [PMID: 31918436 PMCID: PMC6952254 DOI: 10.1371/journal.pone.0219105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/21/2019] [Indexed: 01/20/2023] Open
Abstract
Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.
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Affiliation(s)
- Claudio Peixoto Crispi
- Surgical Training Center, SUPREMA University, Juiz de Fora, Minas Gerais, Brazil
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudio Peixoto Crispi
- Surgical Training Center, SUPREMA University, Juiz de Fora, Minas Gerais, Brazil
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Luis Fernandes Mendes
- Department of Surgery and Anesthesia, College of Veterinary Medicine, UNIFESO University, Teresópolis, Rio de Janeiro, Brazil
| | | | - Leon Cardeman
- Leon Cardeman Laboratory of Cytopathology, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nilton de Nadai Filho
- Surgical Training Center, SUPREMA University, Juiz de Fora, Minas Gerais, Brazil
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elyzabeth Avvad Portari
- Department of Women’s Health, Fernandes Figueira National Institute for Women, Children and Youth Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marlon de Freitas Fonseca
- Department of Women’s Health, Fernandes Figueira National Institute for Women, Children and Youth Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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Khaleel SS, Borofsky MS. Innovations in Disposable Technologies for Stone Management. Urol Clin North Am 2019; 46:175-184. [DOI: 10.1016/j.ucl.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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