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Tuoheti KB, Wang XH, Wang T, Wang YZ, Wu ZH, Liu TZ. Clinical Efficacy Evaluation of a Novel Negative Pressure Ureteroscopic Lithotripsy for Ureteral Stones. Urology 2024; 187:1-5. [PMID: 38373576 DOI: 10.1016/j.urology.2023.12.031] [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: 09/06/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the clinical efficacy of a novel negative pressure ureteroscopic lithotripsy (NP-URL) compared to standard ureteroscopic lithotripsy (S-URL) for treating ureteral stones. METHODS A total of 284 patients diagnosed with ureteral stones and who underwent ureteroscopic lithotripsy between December 2020 and May 2022 at our hospital were included in the study. Among them, 146 cases underwent NP-URL and 138 cases underwent S-URL. The negative pressure device used in NP-URL consists of a 5F ureteric catheter and a tee joint. We evaluated the operative duration, stone-free rate, incidence of postoperative complications, stone retropulsion rate, and adjunct procedure rate between the two groups. RESULTS The mean operative duration was significantly shorter in the NP-URL group compared to the S-URL group (30.17 ± 5.84 minutes vs 34.84 ± 6.62 minutes; P<.05). Additionally, the NP-URL group had a lower incidence of postoperative fever (1.4% vs 8.7%; P<.05), reduced stone retropulsion rate (3.4% vs 11.6%; P<.05), and a statistically lower rate of adjunct procedures (5.5% vs 14.5%, P<.05). The NP-URL group also demonstrated a higher primary stone-free rate (91.8% vs 81.9%; P<.05). However, there was no significant difference in the final stone-free rate between the NP-URL and S-URL groups (P>.05). CONCLUSION NP-URL potentially reduces operative duration, significantly decreases the incidence of postoperative complications, and achieves better primary stone-free rates compared to S-URL.
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Affiliation(s)
- Kuer-Ban Tuoheti
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong-Zhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhong-Hua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Wu ZH, Wang YZ, Liu TZ, Wang XH, Zhang C, Zhang WB, Zheng H, Zhang YG. Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones. World J Urol 2022; 40:2347-2352. [PMID: 35849171 DOI: 10.1007/s00345-022-04075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/09/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. METHODS Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200 μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. RESULTS When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37 min vs. 46.65 ± 5.66 min; P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%; P = 0.011). There were no significant differences in stone-free rates 1 month after surgery between groups (94.7% vs. 92.7%; P = 0.748). CONCLUSIONS VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.
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Affiliation(s)
- Zhong-Hua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Yong-Zhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Ci Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Wei-Bing Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Hang Zheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yin-Gao Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
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Fathelbab TK, Abdelhamid AM, Anwar AZM, Galal EM, El-Hawy MM, Abdelgawad AH, Tawfiek ER. Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques. Arab J Urol 2020; 18:252-256. [PMID: 33312737 PMCID: PMC7717714 DOI: 10.1080/2090598x.2020.1805966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare a modified technique using the Dormia basket vs Stone Cone for stone entrapment to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy of ureteric stones. Patients and methods Our study included all patients with ureteric stones of <15 mm who underwent ureteroscopic pneumatic lithotripsy from January 2015 to September 2018. The study had two arms that were conducted over two consecutive periods; the first included 72 patients in whom we used the Stone Cone (Group 1) and the second included 86 patients in whom we started to use a Dormia basket with a modification (Group 2) to guard against proximal stone migration. Results Both groups were comparable for gender, age, and stone characteristics. Lower ureteric stones were the most prevalent as they represented 62.5% and 60.5% in groups 1 and 2, respectively; while upper ureteric stones were respectively found in 16.7% and 17.4%. Chemical stone analysis revealed that calcium oxalate stones were most predominant accounting for 51.3% and 51.1% in groups 1 and 2, respectively. Most of the stones were radio-opaque stones representing 57% and 58.1% in groups 1 and 2, respectively. There was a significant difference in operative time, with a mean (SD) operative time was 50.9 (11.2) in Group 1 vs 58.3 (12.4) min in Group 2 (P < 0.001). The success rate, defined as no retropulsion of stone fragments, was 97.7% in Group 2 vs 91.7% in Group 1 (P < 0.01). Complications were minor and comparable between the groups. There was no difference in hospital stay between the groups, but the cost assessment favoured Group 2. Conclusion We found that our modified-basket stone entrapment technique compared favourably with the Stone Cone to guard against stone retropulsion during ureteroscopic pneumatic lithotripsy. Our modification to the basket was found to be feasible, efficient, safe, reproducible and cost-effective in preventing proximal stone migration. This procedure is particularly suitable in cost-limited environments.
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Affiliation(s)
| | | | | | - Ehab M Galal
- School of Medicine, Minia University, Minia, Egypt
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Giusti G, Proietti S, Rodríguez-Socarrás ME, Saitta G, Bellinzoni P, Gaboardi F. Semirigid Ureteroscopy: Step by Step. J Endourol 2020; 34:S13-S16. [PMID: 32459149 DOI: 10.1089/end.2018.0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This article aims to demonstrate a step-by-step technique of semirigid ureteroscopy (URS) for the treatment of ureteral stones, urothelial tumors, and ureteral stenosis. Operating room setup, camera settings, access to the bladder, and negotiation of the ureteral orifice, lasertripsy, basketing of the stone fragments, endoscopic treatment of ureteral tumors and ureteral stenosis, flexible URS at the end of semirigid URS, and Double-J stent placement are described step by step.
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Affiliation(s)
- Guido Giusti
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Silvia Proietti
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | | | - Giuseppe Saitta
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Piera Bellinzoni
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Franco Gaboardi
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
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Kroczak T, Ghiculete D, Sowerby R, Ordon M, Lee JY, Pace KT, Honey JR. Dual usage of a stone basket: Stone capture and retropulsion prevention. Can Urol Assoc J 2018; 12:280-283. [PMID: 29989913 DOI: 10.5489/cuaj.5021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Stone migration during ureteroscopy (URS) for proximal ureteric calculi is a constant challenge. Several retropulsion prevention devices have been developed to optimize URS outcomes. Our technique involves capturing the stone within a four-wire Nitinol stone basket and then performing laser lithotripsy to dust the stone while it is engaged in the basket. The dusted fragments wash out with the irrigation fluid and once small enough, the remaining stone is removed intact. METHODS A retrospective chart review was performed of all proximal semi-rigid URS procedures for a solitary calculus (2000-2016). We compared our new technique introduced in 2010 to URS control procedures that did not use retropulsion prevention techniques or devices. RESULTS One hundred and forty patients underwent URS for proximal ureteric calculi. Mean stone diameter was 9.3±3.4 mm, with similar impaction rate between both groups (44.1% vs. 43.1% control; p=n/s). The mean surgical procedure time was 53.3±17.9 minutes for the new technique and 65.2±29.2 minutes for the control group (p=0.005). Compared to the new technique, the control group had a higher rate of retropulsion (33.3% vs. 14.7%; p=0.01) and required flexible URS more often to exclude or remove residual fragments (24.1% vs. 59.1%; p=0.001). Using the new technique, stone-free rates were higher (79.1% vs. 69.4%; p=n/s) and there was a lower likelihood of leaving residual fragments both <3 mm and ≥3 mm (p=0.001). CONCLUSIONS Our novel technique results in shorter operative times, lower retropulsion rates, and decreases postoperative residual stone fragments.
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Affiliation(s)
- Tadeusz Kroczak
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Daniela Ghiculete
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Robert Sowerby
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael Ordon
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Jason Y Lee
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Kenneth T Pace
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - John R Honey
- Department of Surgery, Division of Urology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
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Sanguedolce F, Montanari E, Alvarez-Maestro M, Macchione N, Hruby S, Papatsoris A, Kallidonis P, Villa L, Honeck P, Traxer O, Greco F. Use of XenX™, the latest ureteric occlusion device with guide wire utility: results from a prospective multicentric comparative study. World J Urol 2016; 34:1583-1589. [DOI: 10.1007/s00345-016-1806-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022] Open
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Elashry OM, Tawfik AM. Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol 2012; 9:691-8. [DOI: 10.1038/nrurol.2012.204] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bastawisy M. A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy. Ther Adv Urol 2011; 3:203-10. [PMID: 22046198 PMCID: PMC3199590 DOI: 10.1177/1756287211419551] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intracorporeal lithotripsy modalities and stone removal devices have been created to facilitate endoscopic management of ureteral stones. These devices, along with improved techniques, have resulted in stone-free rates greater than 95% with low morbidity. However, problems remain that preclude consistent 100% stone-free rates with endoscopic treatment of ureteral calculi. Retrograde migration during ureteroscopic procedures remains a significant problem. OBJECTIVES The aim of this study was to compare the Stone Cone device and instillation of lubricating lidocaine jelly as two methods to prevent retrograde stone migration during ureteroscopic lithotripsy. PATIENTS AND METHODS This study included patients suffering from ureteral stones that were treated with intracorporeal lithotripsy using the pneumatic Lithoclast. These patients were divided into two groups. In group I, the Stone Cone device was used, while in group II, lidocaine jelly 2% concentration was used. RESULTS This study included 40 patients with a mean age of 38.6 ± 9.3 years (20 patients in each group). There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by excretory urography. The pneumatic Lithoclast allowed successful fragmentation of all calculi into small fragments. Upward stone migration did not occur in patients in the Stone Cone group, while in the lidocaine jelly group it occurred in three patients (15%). The operative time in the Stone Cone group ranged between 30 and 55 minutes (mean, 41.8 ± 5.3), while in the lidocaine jelly group it ranged between 40 and 71 minutes (mean, 51.4 ± 3.4), and this difference was statistically significant (p < 0.05). CONCLUSION The Stone Cone is safe and efficient in preventing proximal stone migration during ureteroscopic pneumatic lithotripsy. It maintained continuous ureteral access and demonstrated a statistically significant advantage over the lidocaine jelly in terms of proximal stone migration, operative time, and the need for auxiliary procedures.
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Affiliation(s)
- Mohamed Bastawisy
- Department of Urology, Tanta University, 20 Bahr Street, Tanta, Egypt
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