A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy

Worldwide Use of Antiretropulsive Techniques: Observations from the Clinical Research Office of the Endourological Society Ureteroscopy Global Study

INTRODUCTION

Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage.

METHODS

The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use.

RESULTS

Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group.

CONCLUSIONS

When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.

Devices to help combat stone retropulsion during ureteroscopic lithotripsy in 2016

Proximal migration of stones during ureteroscopic lithotripsy is a common problem that faces many urologists and reduces stone-free rates, which translates into higher costs and longer operative times. In a bid to increase stone-free rates, there are several anti-retropulsion devices on the market, to help urologists during ureteroscopic lithotripsy. We previously reviewed these anti-retropulsion devices and wish to update what is currently available on the market.

Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones

Objective

To assess the safety and efficacy of using a stone cone and an entrapment and extraction device (N-Trap®, Cook Urological, Bloomington, IN, USA) to avoid stone retropulsion during ureteroscopic lithotripsy for ureteric stones.

Patients and methods

This retrospective comparative study included 436 patients treated with ureteroscopic lithotripsy for a single ureteric stone from February 2011 to January 2014. The diagnosis of a stone was confirmed by plain spiral computed tomography in all cases. Patients were divided according to the ureteric occlusion device applied to avoid stone retropulsion during pneumatic lithotripsy into three groups; group 1 (156) had no instruments used, group 2 (140) in whom the stone cone was applied, and group 3 (140) in whom the N-Trap was used. Patient demographics, stone criteria, operative duration and complications, and success rates (complete stone disintegration with no upward migration) were reported and analysed statistically.

Results

The stone was in the lower ureter in >55% of patients in all groups. The mean (SD) of maximum stone length was 9.8 (2.5), 10.4 (2.8) and 9.7 (2.9) in groups 1–3, respectively. The use of the stone cone or N-Trap did not significantly increase the operative duration (P = 0.13) or complication rates (P = 0.67). There was a statistically significant difference (P < 0.001) favouring groups 2 and 3 for retropulsion and success rates, being 83.3% in group 1, 97.1% in group 2 and 95.7% in group 3.

Conclusion

The stone cone and N-Trap gave high success rates in preventing stone retropulsion during ureteric pneumatic lithotripsy. Both devices caused no increase in operative duration or complications when used cautiously.

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

OBJECTIVE

We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones.

MATERIAL AND METHODS

A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography.

RESULTS

Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00).

CONCLUSION

Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

Pushing the boundaries of ureteroscopy: current status and future perspectives

Substantial advances in ureteroscopy have resulted in the incorporation of this procedure into routine urological practice in many centres worldwide. Subsequently, an abundance of clinical data and technological progression have enabled the development of novel solutions that have increased the efficacy of ureteroscopy, and reduced associated morbidity and costs. In addition the indications for this retrograde approach have been expanded, and pyelocalyceal diverticulum, infundibular stenosis, urolithiasis in pregnant women or in patients with urinary diversions, as well as upper urinary tract tumours can now be managed using this methodology. New endoscopes are continuously developed, with different manufacturers choosing various technical solutions to further increase the efficacy and safety-and sometimes decrease costs-of ureteroscopy, including miniaturization, inclusion of digital optical systems and dual working channels, and the introduction of disposable apparatus. The holmium laser, currently the most-versatile energy source available, enables tissue incision, tumour ablation, and intracorporeal lithotripsy. Modern ancillary instruments are diverse, flexible, and durable, and novel devices used in daily clinical practice can minimize ascendant migration of stone fragments and, therefore, decrease the failure rate of the retrograde ureteroscopic approach. However, the peak of ureteroscopy evolution seems to remain distant, with further improvement of endoscopes and ancillary instruments, and robot-assisted ureteroscopy representing only some of the areas in which future developments are possible.

Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy

AIM

To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS).

MATERIALS AND METHODS

One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation.

RESULTS

The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444).

CONCLUSIONS

Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).

Simultaneous saline irrigation during retrograde rigid ureteroscopic lasertripsy for the prevention of proximal calculus migration

OBJECTIVE

In this paper, we analyze the clinical efficacy of a simultaneous saline irrigation method in treating upper-mid ureteral stone migration and evaluate its effectiveness during ureteroscopic lasertripsy.

METHODS

We prospectively evaluated 78 patients with a total of 95 upper-mid ureteral stones, which were treated with holmium:YAG lasertripsy. These patients were randomized into 2 groups. In Group 1 (39 cases with 44 ureteral stones), conventional ureteroscopic lasertripsy was performed. In Group 2, (39 cases with 51 ureteral stones), the simultaneous saline irrigation method was used during lasertripsy. There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by spiral computed tomography or excretory urography. Data were analyzed regarding stone migration, lengths of time, and ureteral clearing for various stages of each procedure.

RESULTS

One patient in Group 2 (2%) experienced upward stone migration, while this occurred in 8 patients in Group 1 (20%). The operative time in Group 1 ranged from 35 to 55 minutes (mean: 44.8 ± 5.3), while in Group 2 it ranged from 40 to 69 minutes (mean: 50.4±3). There was no significant different in the operative times between the two groups (p < 0.05). Ureteral perforation, urinoma and urosepsis were not seen in both groups.

CONCLUSION

The simultaneous saline irrigation method demonstrated a statistically significant advantage over conventional methods. The operation can be performed persistently under clear vision, and since the stones cannot move upward, fragmented portions are easily flushed out. Our data suggest that this method is simple, safe and effective in preventing proximal stone migration during ureteroscopic lasertripsy.