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Traxer O, Pearle M. Thulium Fiber Laser Versus Holmium:Yttrium Aluminum Garnet for Lithotripsy: Which Is the Winner? Eur Urol 2024; 85:541-542. [PMID: 38570245 DOI: 10.1016/j.eururo.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Olivier Traxer
- Department of Urology, Hospital Tenon, AP-HP, Sorbonne University, Paris, France.
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Tanidir Y, Sekerci CA, Bujons A, Castellani D, Ferretti S, Gatti C, Campobasso D, Quiroz Y, Teoh JYC, Pietropaolo A, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Fong KY, Sinha MM, Griffin S, Sarica K, Somani BK, Traxer O, Gauhar V. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology 2024; 187:71-77. [PMID: 38432431 DOI: 10.1016/j.urology.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Anna Bujons
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Yesica Quiroz
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India.
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India.
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India.
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal.
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Stephen Griffin
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey.
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
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Corrales M, Hasan MN, Carioti GE, Emiliani E, Doizi S, Traxer O. Arterial pseudoaneurysm: a rare complication following laser lithotripsy-case series and literature review. World J Urol 2024; 42:280. [PMID: 38693433 DOI: 10.1007/s00345-024-04980-9] [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: 01/05/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To perform a comprehensive narrative review that will examine the risk factors and treatment outcomes of arterial pseudoaneurysm following laser flexible ureteroscopy (F-URS). METHODS A retrospective case series and a review of literature was performed. Clinical records from three patients treated for postoperative arterial pseudoaneurysm from January of 2021 to November 2023 were identified. A comprehensive literature review was also performed. The MEDLINE and Scopus databases were searched. The analysis was made by a narrative synthesis. RESULTS Three cases of postoperative arterial pseudoaneurysm were included, one from our center, one from Dubai, UAE, and one from Barcelona. The literature review identified six case reports, two after endocorporeal laser lithotripsy with thulium fiber laser (TFL) and four with Ho:YAG laser. All cases, from our series and literature review, presented with macroscopic hematuria and used high-power laser settings. All cases were treated by selective embolization. CONCLUSION Ho:YAG or TFL lasers are both capable of causing arterial pseudoaneurysms following F-URS if high-power settings are used. Selective artery embolization continues to be the treatment of choice with good outcomes.
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Affiliation(s)
- Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Mudhar N Hasan
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Department of Urology, Mediclinic City Hospital, Dubai, UAE
| | - Giada Eleonora Carioti
- Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Estenan Emiliani
- Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Steeve Doizi
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
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Eckstein JT, Wiseman OJ, Carpenter MA, Salje EKH. Acoustic emission of kidney stones: a medical adaptation of statistical breakdown mechanisms. Urolithiasis 2024; 52:36. [PMID: 38376662 PMCID: PMC10879257 DOI: 10.1007/s00240-024-01531-0] [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: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Kidney stones have a prevalence rate of > 10% in some countries. There has been a significant increase in surgery to treat kidney stones over the last 10 years, and it is crucial that such techniques are as effective as possible, while limiting complications. A selection of kidney stones with different chemical and structural properties were subjected to compression. Under compression, they emit acoustic signals called crackling noise. The variability of the crackling noise was surprisingly great comparing weddellite, cystine and uric acid stones. Two types of signals were found in all stones. At high energies of the emitted sound waves, we found avalanche behaviour, while all stones also showed signals of local, uncorrelated collapse. These two types of events are called 'wild' for avalanches and 'mild' for uncorrelated events. The key observation is that the crossover from mild to wild collapse events differs greatly between different stones. Weddellite showed brittle collapse, extremely low crossover energies (< 5 aJ) and wild avalanches over 6 orders of magnitude. In cystine and uric acid stones, the collapse was more complicated with a dominance of local "mild" breakings, although they all contained some stress-induced collective avalanches. Cystine stones had high crossover energies, typically [Formula: see text] 750 aJ, and a narrow window over which they showed wild avalanches. Uric acid stones gave moderate values of crossover energies, [Formula: see text] 200 aJ, and wild avalanche behaviour for [Formula: see text] 3 orders of magnitude. Further research extended to all stone types, and measurement of stone responses to different lithotripsy strategies, will assist in optimisation of settings of the laser and other lithotripsy devices to insight fragmentation by targeting the 'wild' avalanche regime.
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Affiliation(s)
- Jack T Eckstein
- Department of Earth Sciences, University of Cambridge, Downing St., Cambridge, Cambridgeshire, CB2 3EQ, UK.
| | - Oliver J Wiseman
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Hill's Rd., Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Michael A Carpenter
- Department of Earth Sciences, University of Cambridge, Downing St., Cambridge, Cambridgeshire, CB2 3EQ, UK
| | - Ekhard K H Salje
- Department of Earth Sciences, University of Cambridge, Downing St., Cambridge, Cambridgeshire, CB2 3EQ, UK
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Keat WOL, Somani BK, Pietropaolo A, Chew BH, Chai CA, Inoue T, Ragoori D, Biligere S, Galosi AB, Pavia MP, Milanese G, Ahn T, More S, Sarica K, Traxer O, Teoh JYC, Gauhar V, Castellani D. Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR). World J Urol 2023; 41:2881-2888. [PMID: 36929407 DOI: 10.1007/s00345-023-04362-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units-HU). METHODS Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2 mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. RESULTS 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. CONCLUSION Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR.
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Affiliation(s)
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Chu Ann Chai
- Department of Surgery, Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Maria Pia Pavia
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Giulio Milanese
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Thomas Ahn
- Department of Urology, Toowoomba Base Hospital, Toowoomba, QLD, Australia
| | - Sumit More
- Department of Urology, Sarvodaya Hospital and Research Center, Faridabad, India
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy.
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Hajiha M, Farkouh A, Amasyali AS, Buell MI, Leu R, Groegler J, Smith J, Goyne A, Baldwin DD, Moghisi R, Baldwin DD. Which Laser System Is Optimal for Cystolithotripsy of Large Bladder Calculi? J Endourol 2023; 37:1221-1227. [PMID: 37698888 DOI: 10.1089/end.2023.0078] [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: 09/13/2023] Open
Abstract
Introduction and Objective: A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. Materials and Methods: In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 μm fiber. Lasers compared were as follows: 60 W TFL, 120 W HL with MOSES, and conventional 120, 100, and 30 W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost-effectiveness was modeled using laser purchase price, fiber, and operating room (OR) time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. Results: The laser and total operating times were significantly different between the five systems (p < 0.001). The 120 W HL with MOSES was the fastest with 60.9 minutes of laser and 68.3 minutes of procedure times, while the 30 W HL was the slowest with 281.2 minutes of laser and 297.5 minutes of procedure times. The 60 W TFL was faster than the 30 W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (Rs = -0.98; p = 0.002). When estimating cost per procedure, the MOSES HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared with the 100 W HL. Conclusions: When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume.
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Affiliation(s)
- Mohammad Hajiha
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Matthew I Buell
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Rose Leu
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Jason Groegler
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - John Smith
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Arthur Goyne
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - D Daniel Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Reihaneh Moghisi
- Department of Analytics, Georgia State University, J. Mack Robinson School of Business, Atlanta, Georgia, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
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Singh A, Vaddi CM, Ganesan S, Batra R, Ramakrishna P, Swamy S, Anandan H, Babu M, Panda R, Ganpule A, Sabnis R, Desai M. A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm 3). World J Urol 2023; 41:2289-2295. [PMID: 37418016 DOI: 10.1007/s00345-023-04476-y] [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: 09/23/2022] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE Our objective was to analyse the clinical efficiency of TFL in large volume stones during retrograde intrarenal surgery. MATERIALS AND METHODS Patients with large volume renal stones (> 1000 mm3) operated at two different centres, from May 2020 to April 2021, were enrolled in this study. Retrograde intrarenal surgery was performed using 60W Superpulse thulium fibre laser™ (IPG Photonics, Russia). Demographic data, stone parameters, laser time, and total operating time were recorded, and laser efficacy (J/mm3) and ablation speed (mm3/s) were calculated. NCCT KUB was done at 3 months postoperatively to calculate stone-free rate. RESULTS A total of 76 patients were included and analysed in the study. Mean stone volume was 1753.12 ± 1245.81 (1169.27-2193.25) mm3, mean stone density was 1104.46 ± 313.09 (875.00-1317.00) HU, mean laser time was 537.79 ± 689.89 (21.00-1080.00) sec, mean operating time was 43.38 ± 12.96 (35.00-51.25) min, mean laser efficacy was 20.30 ± 15.5 (8.88-25.57) J/mm3, and mean ablation speed was 1.32 ± 0.7 (0.82-1.64) mm3/sec. A strong positive correlation was found between the stone volume and ablation speed (r = 0.659, p = 0.000), and a moderate negative correlation was found between the stone volume and laser efficacy (J/mm3) (r = - 0.392, p = 0.000). With increasing volume of the stone, J/mm3 decreased significantly and ablation speed increased significantly (p < 0.001). Complications occurred in 21.05% (16/76) patients, most of which were Clavien grades 1-2. Overall SFR is 96.05%. CONCLUSION Laser efficiency increases at higher stone volumes (> 1000 mm3), as less energy is required to ablate every mm3 of stone.
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Affiliation(s)
- Abhishek Singh
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Chandra Mohan Vaddi
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Soundarya Ganesan
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India.
| | - Rohan Batra
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Paidakula Ramakrishna
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Siddalinga Swamy
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Hemnath Anandan
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Manas Babu
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Rakesh Panda
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Ravindra Sabnis
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
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8
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Candela L, Ventimiglia E, Solano C, Chicaud M, Kutchukian S, Panthier F, Corrales M, Villa L, Briganti A, Montorsi F, Salonia A, Doizi S, Traxer O. Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review. J Clin Med 2023; 12:4907. [PMID: 37568309 PMCID: PMC10419594 DOI: 10.3390/jcm12154907] [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: 06/19/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Thulium lasers (TLs), namely the Thulium fiber laser (TFL) and the Thulium:YAG (Tm:YAG), are being increasingly adopted for the conservative treatment of upper urinary tract urothelial carcinoma (UTUC). However, to date, the real clinical impact of TLs on UTUC management remains not well-characterized. We performed a review of the literature to summarize the current evidence on TLs for UTUC treatment. MATERIALS AND METHODS We performed a systematic review in January 2023 using the Embase and Medline online databases, according to the PRISMA recommendations and using the PICO criteria. Outcomes of interest were: (i) to assess the safety and feasibility of TLs in the treatment of UTUC, and (ii) to evaluate the oncological outcomes in terms of tumor recurrence and conservative treatment failure. Moreover, we described TL characteristics and its interaction with soft tissue. RESULTS a total of 458 articles were screened, and six full texts including 273 patients were identified. All the included studies were retrospective series. Mean patient age ranged from 66 to 73 years. The indication of a conservative treatment was elective and imperative in 21.7-85% and 15-76% of cases, respectively. Laser power settings varied from 5 to 50 W. No intraoperative complications were reported, and all the procedures were successfully performed. The tumor recurrence rate was 17.7-44%, and the indication to radical nephroureterectomy was 3.7-44% during a follow-up of 6-50 months. Most of the postoperative complications were mild and transient, and ureteral strictures were reported in two studies. Major limitations were the retrospective nature of the studies, the small sample sizes, and the short follow-up. CONCLUSIONS TL is an effective and safe technology for endoscopic UTUC treatment. However, current available literature lacks prospective and multicentric studies with large population sizes and long-term follow-up.
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Affiliation(s)
- Luigi Candela
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Catalina Solano
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
| | - Marie Chicaud
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
- Department of Urology, Limoges University Hospital, 2 Avenue M.L. King, 87000 Limoges, France
| | - Stessy Kutchukian
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Miletrie, 86000 Poitiers, France
| | - Frederic Panthier
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
| | - Mariela Corrales
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Steeve Doizi
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
| | - Olivier Traxer
- Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, GRC n. 20 Lithiase Renale, 75013 Paris, France
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Somani B, Seitz C. Editorial: Future of kidney stone management. Curr Opin Urol 2023; 33:71-72. [PMID: 36710591 DOI: 10.1097/mou.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Ibis MA, Gokce MI, Gökhan O, Karagoz MA, Yitgin Y, Babayigit M, Böyük A, Verep S, Tefik T, Kiremit MC, Senocak C, Guven S, Sarica K. What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients. J Laparoendosc Adv Surg Tech A 2023. [PMID: 36827462 DOI: 10.1089/lap.2022.0513] [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: 02/26/2023] Open
Abstract
Background: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones. Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications. Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones. Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, Ataturk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Okan Gökhan
- Department of Radiology, Private Biosan Polyclinic, Istanbul, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Prof. Dr. Cemil Tascıoglu City Hospital Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yasin Yitgin
- Department of Urology, Istinye University School of Medicine, Istanbul, Turkey
| | - Muammer Babayigit
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Abubekir Böyük
- Department of Urology, Private Duygu Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | - Cagrı Senocak
- Department of Urology, Ataturk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Selcuk Guven
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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Denstedt J, Gabrigna Berto FC. Thulium fiber laser lithotripsy: Is it living up to the Hype? Asian J Urol 2022. [PMID: 37538164 PMCID: PMC10394282 DOI: 10.1016/j.ajur.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The holmium:yttrium-aluminium-garnet laser (Ho:YAG) has been the gold standard for laser lithotripsy over the last three decades. After demonstrating good in vitro efficacy, the thulium fiber laser (TFL) has been recently released in the market and the initial clinical results are encouraging. This article aims to review the main technology differences between the Ho:YAG laser and the TFL, discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy. Methods We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies. Results In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice. However, as TFL is a new technology, limited studies are currently available, and the optimal settings for lithotripsy are not yet established. Conclusion TFL has the potential to be an alternative to the Ho:YAG laser, but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness, safety, and costs.
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Gauhar V, Somani BK, Heng CT, Gauhar V, Chew BH, Sarica K, Teoh JYC, Castellani D, Saleem M, Traxer O. Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones. J Clin Med 2022; 11:jcm11195710. [PMID: 36233577 PMCID: PMC9570998 DOI: 10.3390/jcm11195710] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0−28.8) vs. 13.0 (11.8−15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0−100) minutes] as compared to the SUAS group [47.5 (41.5−60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667−1.00) vs. 1.00 (1.00−2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore 609606, Singapore
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore 609606, Singapore
| | - Vishesh Gauhar
- Global Indian International School, Singapore 828649, Singapore
| | - Ben Hall Chew
- Department Urol Sci, University of British Columbia, Urologic Sciences, Vancouver, BC V6T 1Z4, Canada
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul 34010, Turkey
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 96H2+Q9, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-71-596-3367
| | - Mohammed Saleem
- Urology Research and Daycare Center, Apis Kidney Stone Institute, Mangalore 57502, India
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France
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Perri D, Berti L, Pacchetti A, Morini E, Maltagliati M, Besana U, Pastore AL, Romero-Otero J, Saredi G, Centrella D, Sighinolfi MC, Rocco B, Micali S, Broggini P, Boldini M, Mazzoleni F, Bozzini G. A comparison among RIRS and MiniPerc for renal stones between 10 and 20 mm using thulium fiber laser (Fiber Dust): a randomized controlled trial. World J Urol 2022; 40:2555-2560. [PMID: 36029330 DOI: 10.1007/s00345-022-04133-w] [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: 05/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We performed a prospective randomized comparison among Retrograde IntraRenal Surgery (RIRS) and MiniPerc (MP) for stones between 10 and 20 mm to evaluate outcomes with the same laser device: Fiber Dust. METHODS Patients with a single renal stone between 10 and 20 mm were randomized to RIRS (Group A) versus MP (Group B). Exclusion criteria were age < 18 or > 75, presence of acute infection, coagulation impairments, cardiovascular or pulmonary comorbidities. In both groups, the Fiber Dust laser was used. A CT scan after 3 months was performed. A negative CT scan or asymptomatic patients with stone fragments < 3 mm and a negative urinary culture were the criteria to assess the stone-free status. A statistical analysis was carried out to assess success, complication and retreatment rates and need for auxiliary treatments. RESULTS Between January 2021 and January 2022, 186 patients were enrolled (90 in Group A and 96 in Group B). Mean stone size was 15.8 mm and 14.9 mm in Group A and B, respectively (p = 0.23). The overall stone-free rate (SFR) was 73.3% for Group A and 84.4% for Group B. A higher SFR was reached for upper calyceal stones in Group A (90.4%) lower calyceal stones in Group B (91.6%). Retreatment rate (p = 0.31) and auxiliary procedure rate (p = 0.18) were comparable. Complication rate was 5.5% and 5.2% for Groups A and B, respectively. CONCLUSIONS RIRS and MP are both effective to obtain a postoperative SFR with Fiber Dust. According to the stone position one treatment is superior to the other one.
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Affiliation(s)
- Davide Perri
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy.
| | - Lorenzo Berti
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Andrea Pacchetti
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Elena Morini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Matteo Maltagliati
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Umberto Besana
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Antonio Luigi Pastore
- Division of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | | | - Giovanni Saredi
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | | | | | | | - Salvatore Micali
- Division of Urology, Modena and Reggio Emilia University, Modena, Italy
| | - Paolo Broggini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Marco Boldini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Federica Mazzoleni
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Giorgio Bozzini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
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