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Leighton J, Dingwall A, Whitehead S, Luk A, Gauhar V, Somani B, Geraghty R. Effect of infundibulopelvic angle on outcomes of ureteroscopy: a systematic review and meta-analysis. World J Urol 2024; 42:413. [PMID: 39012390 PMCID: PMC11252207 DOI: 10.1007/s00345-024-05104-z] [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: 04/04/2024] [Accepted: 06/01/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE The infundibulo-pelvic angle (IPA) is reportedly a predictor of successful ureteroscopy for lower pole renal stones, however there is uncertainty at which IPA success is likely. We therefore aimed to perform a meta-analysis and determine at which the angle of likely success and failure. METHODS We performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE. RESULTS Overall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52o ± 9o), compared to the non-stone free patients (39o ± 7o), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30o no patients were stone free, whilst > 50o all were stone free. Risk of bias was moderate, and certainty of evidence was 'very low'. CONCLUSION With a very low certainty of evidence, we demonstrate that at an IPA of < 30o no patient is stone free, whilst > 50o all patients (in this review) are stone free. More evidence is therefore needed.
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Affiliation(s)
- James Leighton
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Arran Dingwall
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Sophie Whitehead
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Angus Luk
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Tremona Road, Southampton, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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2
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Bhojani N, Chew BH, Bhattacharyya S, Krambeck AE, Ghani KR, Miller LE. Effect of preoperative alpha-blockers on ureteroscopy outcomes: A meta-analysis of randomised trials. BJUI COMPASS 2024; 5:613-620. [PMID: 39022659 PMCID: PMC11249831 DOI: 10.1002/bco2.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes. Methods In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria. Results Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6 min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3 days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods. Conclusion While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.
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Affiliation(s)
- Naeem Bhojani
- Division of UrologyCentre Hospitalier de l'Université de Montréal, MontréalQuébecCanada
| | - Ben H. Chew
- Department of Urologic SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Samir Bhattacharyya
- Health Economics and Market AccessBoston ScientificMarlboroughMassachusettsUSA
| | - Amy E. Krambeck
- Department of UrologyNorthwestern University School of MedicineChicagoIllinoisUSA
| | - Khurshid R. Ghani
- Department of UrologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Larry E. Miller
- Department of BiostatisticsMiller ScientificJohnson CityTennesseeUSA
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3
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Mayer WA. Editorial Comment on "Current Perspectives on Endourological Ex Vivo Stone Interventions in Kidney Transplantation: A Systematic Review". Urology 2024:S0090-4295(24)00493-X. [PMID: 38936621 DOI: 10.1016/j.urology.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Wesley A Mayer
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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4
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Tominaga K, Inoue T, Yamamichi F, Fujita M, Fujisawa M. Impact of Vacuum-Assisted Mini-Endoscopic Combined Intrarenal Surgery for Staghorn Stones: Analysis of Perioperative Factors of Postoperative Fever and Stone-Free Status. J Endourol 2023; 37:400-406. [PMID: 36641643 DOI: 10.1089/end.2022.0579] [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: 01/16/2023] Open
Abstract
Background and Objective: This retrospective cohort study aimed to evaluate the clinical outcomes of vacuum-assisted mini-endoscopic combined intrarenal surgery (vmECIRS) for staghorn stones. Patients and Methods: We analyzed a total of 61 cases treated with initial vmECIRS using 14F/16F ClearPetra® percutaneous sheaths for staghorn stones. We primarily measured complications and stone-free rates (SFRs) to evaluate the safety and efficiency of vmECIRS. In addition, pre- and intraoperative factors in patients who experienced postoperative fever >38°C and achieved an initial stone-free status were evaluated. Results: The percentages of staghorn stones were 36.1% and 63.9% for complete and partial stones, respectively. The median stone volume was 8.48 cm3. The median operation time was 117 minutes, and the mean number of procedures was 1.54. Regarding postoperative complications, postoperative fever >38°C was reported in 18 patients (29.5%). The initial and final SFRs were 50.8% and 91.8%, respectively. Among patients with emerging fever >38°C, positive urine culture was the only significant risk factor in the multivariate analysis (odds ratio [OR], 7.500; 95% confidence interval [CI], 1.772-31.751; p = 0.006). Moreover, for achieving initial stone-free status, body mass index and stone volume were significant risk factors in the multivariate analysis (OR, 0.872; 95% CI, 0.776-0.980; p = 0.021; and OR, 0.882; 95% CI, 0.784-0.994; p = 0.039, respectively). Conclusions: These findings suggest that vmECIRS is safe and effective for treatment of staghorn stones. Although current guidelines suggest that percutaneous nephrolithotomy is the gold standard surgical technique for staghorn stones, vmECIRS could also be a treatment strategy. The Clinical Trial Registration number (ID: 2022-05-17-1).
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Affiliation(s)
- Koki Tominaga
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Japan
| | - Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Japan.,Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Fukashi Yamamichi
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Japan
| | - Masaichiro Fujita
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
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5
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Li J, Huang Y, Zhu M, Chen M, Xiong Q, Tan D, Wei Q, Cao D, Liu L. Does Moses technology enhance the efficiency and outcomes of regular holmium laser lithotripsy? Results of a pooled analysis of comparative studies. Lasers Med Sci 2023; 38:73. [PMID: 36800022 DOI: 10.1007/s10103-023-03730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023]
Abstract
Holmium laser lithotripsy is currently the optimum standard for surgical treatment of upper urinary calculi. This study aims to evaluate the clinical efficacy and safety of Moses compared with conventional holmium laser lithotripsy for the treatment of patients with upper urinary calculi. We conducted a systematic search using multiple databases (PubMed/Medline, Scopus, Web of Science, and ClinicalTrials.gov) until June 2022. Clinical trials comparing Moses and conventional holmium laser lithotripsy were included. Analysis was performed using RevMan version 5.4.4 software. Four studies with 892 patients were included. There were no significant differences regarding stone-free rate (mean difference [MD] 1.19, 95% CI 0.54, 2.64, p = 0.66), operative time (MD - 9.31, 95% CI - 21.11, 2.48, p = 0.12), fragmentation time (MD - 1.71, 95% CI - 11.81, 8.38, p = 0.74), total energy used (MD 1.23, 95% CI - 0.44, 2.90, p = 0.15), auxiliary procedures (MD 0.38, 95% CI 0.08, 1.90, p = 0.24), and overall complications (odds ratio [OR] 0.70, 95% CI 0.30, 1.66, p = 0.42) between the groups. However, the laser working time (MD - 0.94, 95% CI - 1.20, - 0.67, p < 0.001) of Moses technology was shorter than that of conventional technology. Moses technology has similar outcomes to regular technology in terms of safety and efficacy. Given the higher operating costs of the Moses technology, further study is required to determine whether there are benefits to this new technology.
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Affiliation(s)
- Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mengli Zhu
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mengqi Chen
- The Second People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Qiao Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Daqing Tan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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6
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Zeng G, Traxer O, Zhong W, Osther P, Pearle MS, Preminger GM, Mazzon G, Seitz C, Geavlete P, Fiori C, Ghani KR, Chew BH, Git KA, Vicentini FC, Papatsoris A, Brehmer M, Martinez JL, Cheng J, Cheng F, Gao X, Gadzhiev N, Pietropaolo A, Proietti S, Ye Z, Sarica K. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU Int 2023; 131:153-164. [PMID: 35733358 PMCID: PMC10084014 DOI: 10.1111/bju.15836] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of UrologyFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Olivier Traxer
- GRC Urolithiasis No. 20, Sorbonne UniversityTenon HospitalParisFrance
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of UrologyFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Palle Osther
- Department of Urology, Vejle Hospital‐a part of Lillebaelt HospitalUniversity Hospital of Southern DenmarkVejleDenmark
| | | | - Glenn M Preminger
- Division of Urologic SurgeryDuke University Medical CenterDurhamNCUSA
| | | | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Vienna General HospitalMedical University of ViennaViennaAustria
| | - Petrisor Geavlete
- Sanador HospitalBucharestRomania
- Department of UrologySf. Ioan Emergency Clinical HospitalBucharestRomania
| | - Cristian Fiori
- Division of Urology, Department of OncologyUniversity of TurinTurinItaly
| | | | - Ben H. Chew
- Department of Urologic SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Kah Ann Git
- Department of UrologyPantai HospitalPenangMalaysia
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo – FMUSPHospital das ClínicasSão PauloBrazil
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Karolinska InstitutetDanderyd HospitalStockholmSweden
| | | | - Jiwen Cheng
- Department of UrologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Fan Cheng
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Xiaofeng Gao
- Department of UrologyChanghai HospitalShanghaiChina
| | - Nariman Gadzhiev
- Department of UrologySaint‐Petersburg State University HospitalSaint‐PetersburgRussia
| | | | | | - Zhangqun Ye
- Department of Urology, Tongji Medical College, Tongji HospitalHuazhong University of Science and TechnologyWuhanChina
| | - Kemal Sarica
- Department of Urology, Medical SchoolBiruni UniversityIstanbulTurkey
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7
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Unno R, Hosier G, Hamouche F, Bayne DB, Stoller ML, Chi T. Single-Use Ureteroscopes Are Associated with Decreased Risk of Urinary Tract Infection After Ureteroscopy for Urolithiasis Compared to Reusable Ureteroscopes. J Endourol 2023; 37:133-138. [PMID: 36267020 PMCID: PMC10081697 DOI: 10.1089/end.2022.0480] [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] [Indexed: 02/07/2023] Open
Abstract
Objective: Urinary tract infection (UTI) is a common complication after ureteroscopy. Despite sterilization, there is evidence that reusable ureteroscopes can still harbor bacteria. Whether this property is associated with increased risk of UTI is unknown. The objective of this study was to compare rates of postoperative UTI after ureteroscopy for urolithiasis performed with single-use ureteroscopes vs reusable ureteroscopes. Materials and Methods: This was a single-center, retrospective cohort study of all patients who underwent ureteroscopy for urolithiasis between June 2012 and March 2021. Outcomes were compared between those who underwent stone removal with single-use and reusable ureteroscopes. The primary endpoint was postoperative UTI. The secondary endpoints were intra-operative and postoperative outcomes, and health service utilization after surgery. Results: Of 991 patients identified, 500 (50.4%) underwent ureteroscopy with a single-use ureteroscope. Rates of postoperative UTI were lower in those undergoing ureteroscopic stone removal with a single-use ureteroscope compared to a reusable ureteroscope (6.5% vs 11.9%, p = 0.018). In multivariable analysis, use of a single-use ureteroscope was associated with lower odds of postoperative UTI compared to a reusable ureteroscope when adjusting for risk (odds ratio 0.37, p = 0.015). Use of a single-use ureteroscope was associated with a higher stone clearance rate compared to a reusable ureteroscope (90.0% vs 83.9%, p = 0.005). There was no difference in operative time, overall complication rate, readmission, or emergency department visits between two groups. Conclusion: Single-use ureteroscopes are associated with a twofold decreased risk of UTI and increased stone clearance rate after ureteroscopy for urolithiasis compared to reusable ureteroscopes.
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Affiliation(s)
- Rei Unno
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Gregory Hosier
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Fadl Hamouche
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - David B. Bayne
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Marshall L. Stoller
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
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8
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Juliebø-Jones P, Ulvik Ø, Beisland C, Somani BK. Paediatric Ureteroscopy (P-URS) reporting checklist: a new tool to aid studies report the essential items on paediatric ureteroscopy for stone disease. Urolithiasis 2023; 51:35. [PMID: 36695936 PMCID: PMC9876849 DOI: 10.1007/s00240-023-01408-8] [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: 08/20/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
The burden of urolithiasis in children is increasing and this is mirrored by the number of surgical interventions in the form of ureteroscopy (URS). There exist many challenges in performing this surgery for this special patient group as well as a lack of consensus on technique. There is also large variation in how results are described and reported. There exists therefore, a need to improve and standardise the core outcomes, which are reported. To this end, we developed a new checklist to aid studies report the essential items on paediatric URS for stone disease. The Paediatric Ureteroscopy (P-URS) reporting checklist comprises four main sections (study details, pre-operative, operative and post-operative) and a total of 20 items. The tool covers a range of important elements, such as pre-stenting, complications, follow-up, stone-free rate, concomitant medical expulsive therapy and imaging, which are often lacking in studies. The checklist provides a summary of essential items that authors can use as a reference to improve general standards of reporting paediatric URS studies and increase the body of knowledge shared accordingly.
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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, The Netherlands.
| | - Øyvind Ulvik
- 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
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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9
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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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10
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Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol 2022; 82:73-79. [PMID: 35300888 DOI: 10.1016/j.eururo.2022.02.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Holmium:yttrium-aluminium-garnet (Ho:YAG) laser is the gold standard for ureterorenoscopic (URS) lithotripsy. Thulium fibre laser (TFL) has recently been introduced as a new technology and may challenge Ho:YAG as the preferred laser owing to favourable properties as demonstrated in preclinical studies. OBJECTIVE To evaluate and compare outcomes after URS lithotripsy with Ho:YAG and TFL. DESIGN, SETTING, AND PARTICIPANTS In a prospective randomised trial, patients aged ≥18 yr with ureteral and/or renal stones (≥5 mm) scheduled to undergo day-case URS lithotripsy were invited to participate. In total, 120 consecutively admitted patients with signed consent were included for randomisation. INTERVENTION URS lithotripsy with Ho:YAG or TFL. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the stone-free rate (SFR) assessed on noncontrast computed tomography at 3-mo follow-up. Secondary outcomes were the operative time and complications. Outcomes were compared between the groups using the t test and χ2 test. RESULTS AND LIMITATIONS After a single session, the SFR was 67% in the Ho:YAG group and 92% in the TFL group, p = 0.001. For ureteral stones, the SFR was 100% in both groups, and for renal stones; 49% (Ho:YAG) and 86% (TFL), p = 0.001. Operative time was shorter using TFL (49 min) compared to Ho:YAG (57 min), p = 0.008. Bleeding that impaired the endoscopic view was the most frequent intraoperative adverse event and occurred in 13 patients (22%) in the Ho:YAG group and three (5%) in the TFL group, p = 0.014. CONCLUSIONS In this study, significantly more patients with renal stones achieved stone-free status and fewer experienced intraoperative complications using TFL compared to Ho:YAG. TFL is the emerging laser of choice for stone lithotripsy. PATIENT SUMMARY We compared outcomes after ureterorenoscopic treatment of kidney and ureteral stones using two different lasers. Our results show that the new thulium fibre laser technology is superior to the current standard laser (holmium:YAG) in clearing kidney stones and reducing operative complications.
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Affiliation(s)
- Øyvind Ulvik
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Patrick Juliebø-Jones
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ulvik Ø, Sørstrand Æsøy M, Juliebø-Jones P, Gjengstø P, Beisland C. Reply to Jinze Li, Yin Huang, Dehong Cao, and Qiang Wei's Letter to the Editor re: Øyvind Ulvik, Mathias Sørstrand Æsøy, Patrick Juliebø-Jones, Peder Gjengstø, Christian Beisland. Thulium Fibre Laser Versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2022.02.027. Eur Urol 2022; 82:e72. [PMID: 35637042 DOI: 10.1016/j.eururo.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Øyvind Ulvik
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.
| | | | - Patrick Juliebø-Jones
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Ulvik Ø, Sørstrand Æsøy M, Juliebø-Jones P, Gjengstø P, Beisland C. Reply to Frederic Panthier, Alba Sierra, and Olivier Traxer's Letter to the Editor re: Øyvind Ulvik, Mathias Sørstrand Æsøy, Patrick Juliebø-Jones, Peder Gjengstø, Christian Beisland. Thulium Fibre Laser Versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2022.02.027. Eur Urol 2022; 82:e37-e38. [PMID: 35551843 DOI: 10.1016/j.eururo.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Øyvind Ulvik
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Patrick Juliebø-Jones
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ulvik Ø, Sørstrand Æsøy M, Juliebø-Jones P, Gjengstø P, Beisland C. Reply to Alan J. Yaghoubian, Jonathan A. Khusid, and Mantu Gupta's Letter to the Editor re: Øyvind Ulvik, Mathias Sørstrand Æsøy, Patrick Juliebø-Jones, Peder Gjengstø, Christian Beisland. Thulium Fibre Laser Versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2022.02.027. Eur Urol 2022; 82:e45-e46. [PMID: 35551844 DOI: 10.1016/j.eururo.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Øyvind Ulvik
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Patrick Juliebø-Jones
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Juliebø-Jones P, Æsøy MS, Gjengstø P, Beisland C, Ulvik Ø. Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting. Ther Adv Urol 2022; 14:17562872221118727. [PMID: 36032655 PMCID: PMC9403456 DOI: 10.1177/17562872221118727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the
condition can require surgical intervention in the form of ureteroscopy
(URS). Here, we report outcomes achieved at a regional (tertiary)
centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of
age) undergoing URS for stone disease between 2010 and 2021. Outcomes of
interest included stone-free rate (SFR) determined using a definition of no
residual fragments ⩾ 3 mm on imaging and complications classified according
to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone
episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was
6:17. Overall, 35% had at least one medical comorbidity. Ultrasound
determined preoperative stone status in 87%. Mean largest index and
cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm,
respectively. Overall, 32% had multiple stones. Lower pole was the commonest
stone location (39%). No patients underwent elective pre-operative stenting.
Ureteral access sheaths were not used in any cases. Access to upper urinary
tract at first procedure was successful in 94%. Initial and final SFR was
61% and 90%, respectively. No intra-operative complications were recorded.
Overall post-operative complication rate was 17.5%. Urinary tract infection
(CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without
compromising outcomes. This includes when carried out by adult
endourologists, without routine pre-stenting and omitting use of ureteric
access sheath.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | | | - 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
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