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Wei W, Chen M, Xie L, Mai Y, Zhu H, Xu Z. Comparison of temperature and renal tissue thermal damage by holmium laser with different energy parameters during lithotripsy: in vitro porcine kidney model. Int Urol Nephrol 2024; 56:2539-2545. [PMID: 38480602 DOI: 10.1007/s11255-024-03943-8] [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: 11/08/2023] [Accepted: 12/31/2023] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Holmium laser percutaneous nephrolithotripsy was simulated by porcine kidney calculus model in vitro to investigate thermal damage of renal tissue by different energy parameters of the holmium laser. METHODS We placed human kidney calculus specimen in fresh vitro porcine kidney, then insert thermocouple temperature probes into the submucosa of the renal pelvis and reheated in a 37 °C water bath. A percutaneous nephrological sheath was used to penetrate the renal parenchyma with a moderate irrigation rate of 30 ml/min at 18 ℃. The Holmium laser was used to fragment the stones under a nephroscope, and the temperature was recorded. RESULTS The four independent models were lithotripsy with 30 W and 60 W laser for 5 and 10 min, respectively; the mean temperature of 30 W vs. 60 W within 5 min was 36.06 °C vs. 39.21 °C (t = 5.36, P < 0.01) and the highest temperature was 43.60 °C vs. 46.60 °C; the mean temperature of 30 W vs. 60 W within 10 min was 37.91 °C vs. 40.13 ℃ (t = 5.28, P < 0.01), maximum temperature 46.80 ℃ vs. 49.20 ℃. Pathologically, each kidney was observed to have different degrees of thermal damage lesions, and the higher power and longer time the more severe the injury, but the injury was mainly limited to the uroepithelial and subepithelial tissues, with rare damage to renal tubules. CONCLUSION The higher laser excitation power and longer duration raised the intrarenal temperature significantly and caused a certain degree of thermal damage to the kidney tissue, but overall it was found to be safe and reliable. Urologists can avoid further side effects through surgical expertise.
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Affiliation(s)
- Wei Wei
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Ming Chen
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Le Xie
- Department of Pathology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yuan Mai
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Huacai Zhu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Zhanping Xu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
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He M, Dong Y, Cai W, Cai J, Xie Y, Yu M, Li C, Wen L. Recent advances in the treatment of renal stones using flexible ureteroscopys. Int J Surg 2024; 110:4320-4328. [PMID: 38477158 PMCID: PMC11254199 DOI: 10.1097/js9.0000000000001345] [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: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing FURS for the treatment of renal calculi in order to generate insights for further research.
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Affiliation(s)
- Min He
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yonghui Dong
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
| | | | - Jiale Cai
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yaming Xie
- General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College
| | - Mingke Yu
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Changjiu Li
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
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3
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Kose E, Bostanci Y, Gulsen M, Sahin F, Kalayci O, Ozden E, Yakupoglu YK, Sarikaya S. Monitoring Intrarenal temperature changes during Ho: YAG laser lithotripsy in patients undergoing retrograde intrarenal surgery: a novel pilot study. Urolithiasis 2024; 52:86. [PMID: 38869637 DOI: 10.1007/s00240-024-01592-1] [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: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
Ho: YAG laser lithotripsy is widely used for urinary stone treatment, but concerns persist regarding its thermal effects on renal tissues. This study aimed to monitor intrarenal temperature changes during kidney stone treatment using retrograde intrarenal surgery with Ho: YAG laser. Fifteen patients were enrolled. Various laser power settings (0.8 J/10 Hz, 1.2 J/12 Hz) and irrigation modes (10 cc/min, 15 cc/min, 20 cc/min, gravity irrigation, and manual pump irrigation) were used. A sterile thermal probe was attached to a flexible ureterorenoscope and delivered into the calyceal system via the ureteral access sheath. Temperature changes were recorded with a T-type thermal probe with ± 0.1 °C accuracy. Laser power significantly influenced mean temperature, with a 4.981 °C difference between 14 W and 8 W laser power (p < 0.001). The mean temperature was 2.075 °C higher with gravity irrigation and 2.828 °C lower with manual pump irrigation (p = 0.038 and p = 0.005, respectively). Body mass index, laser power, irrigation model, and operator duty cycle explained 49.5% of mean temperature variability (Adj. R2 = 0.495). Laser power and operator duty cycle positively impacted mean temperature, while body mass index and specific irrigation models affected it negatively. Laser power and irrigation rate are critical for intrarenal temperature during Ho: YAG laser lithotripsy. Optimal settings and irrigation strategies are vital for minimizing thermal injury risk. This study underscores the need for ongoing research to understand and mitigate thermal effects during laser lithotripsy.
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Affiliation(s)
- Ertugrul Kose
- Department of Urology, Gazi State Hospital, Ilkadım, Samsun, Turkey.
| | - Yakup Bostanci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Gulsen
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Fevzi Sahin
- Department of Mechanical Engineering, Faculty of Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Onur Kalayci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ender Ozden
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Saban Sarikaya
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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4
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Juliebø‐Jones P, Gauhar V, Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Bujons A, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Sekerci CA, Tanidir Y, Teoh JY, Somani BK. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting. BJUI COMPASS 2024; 5:558-563. [PMID: 38873356 PMCID: PMC11168767 DOI: 10.1002/bco2.357] [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: 01/30/2024] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Materials and Methods Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of UrologyUniversity Hospital SouthamptonSouthamptonUK
| | - Vineet Gauhar
- Department of UrologyNg Teng Fong HospitalSingaporeSingapore
| | - Ee Jean Lim
- Department of UrologySingapore General HospitalSingaporeSingapore
| | - Olivier Traxer
- Department of Urology Hôpital TenonSorbonne UniversityParisFrance
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero‐Universitaria Ospedali Riuniti Di AnconaUniversità Politecnica Delle MarcheAnconaItaly
| | - Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Anna Bujons
- Urology DepartmentAutonomous University of Barcelona, Fundació PuigvertBarcelonaSpain
| | - Deepak Ragoori
- Department of UrologyAsian Institute of Nephrology and Urology, Banjara HillsHyderabadIndia
| | - Anil Shrestha
- Department of Urology, National Academy of Medical SciencesBir HospitalKathmanduNepal
| | | | | | - Cagri Akin Sekerci
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Yiloren Tanidir
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Jeremy Yuen‐Chun Teoh
- Department of Surgery, S.H. Ho Urology CentreThe Chinese University of Hong KongSha TinHong Kong, China
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Gauhar V, Traxer O, Castellani D, Sietz C, Chew BH, Fong KY, Hamri SB, Gökce MI, Gadzhiev N, Galosi AB, Yuen SKK, El Hajj A, Ko R, Zawadzki M, Sridharan V, Lakmichi MA, Corrales M, Malkhasyan V, Ragoori D, Soebhali B, Tan K, Chai CA, Tursunkulov AN, Tanidir Y, Persaud S, Elshazly M, Kamal W, Tefik T, Shrestha A, Tiong HC, Somani BK. Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Outcomes at 30 Days from a Large, Prospective, Multicenter, Real-world Study by the European Association of Urology Urolithiasis Section. Eur Urol Focus 2024:S2405-4569(24)00073-7. [PMID: 38789313 DOI: 10.1016/j.euf.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to evaluate the stone-free status (SFS) rate and complications after flexible ureteroscopy (fURS) for treatment of renal stones using a flexible and navigable suction (FANS) ureteral access sheath. METHODS Data for adults undergoing fURS in 25 centers worldwide were prospectively collected (August 2023 to January 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. All patients had computed tomography scans before and within 30 d after fURS with a FANS ureteral access sheath. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments >4 mm. Data for continuous variables are presented as the median and interquartile range (IQR). Multivariable logistic regression was performed to evaluate predictors of grade A SFS. KEY FINDINGS AND LIMITATIONS The study enrolled 394 patients (59.1% male) with a median age of 49 yr (IQR 36-61). The median stone volume was 1260 mm3 (IQR 706-1800). Thulium fiber laser (TFL) was used in 45.9% of cases and holmium laser in the rest. The median lasing time was 18 min (IQR 11-28) and the median operative time was 49 min (IQR 37-70). One patient required a blood transfusion and 3.3% of patients had low-grade fever. No patient developed sepsis. Low-grade ureteral injury occurred in eight patients (2%). The grade A SFS rate was 57.4% and the grade A + B SFS rate was 97.2%, while 2.8% of patients had grade C or D SFS. Eleven patients underwent repeat fURS. Multivariable analysis revealed that a stone volume of 1501-3000 mm3 (odds ratio 0.50) and of >3000 mm3 (odds ratio 0.29) were significantly associated with lower probability of grade A SFS, while TFL use was associated with higher SFS probability (odds ratio 1.83). Limitations include the lack of a comparative group. CONCLUSIONS AND CLINICAL IMPLICATIONS fURS using a FANS ureteral access sheath resulted in a high SFS rate with negligible serious adverse event and reintervention rates. PATIENT SUMMARY We looked at 30-day results for patients undergoing telescopic laser treatment for kidney stones using a special type of vacuum-assisted sheath to remove stone fragments. We found a high stone-free rate with minimal complications.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Olivier Traxer
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
| | - Christian Sietz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Nariman Gadzhiev
- Department of Urology, St. Petersburg State University Hospital, St. Petersburg, Russia
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Steffi Kar Kei Yuen
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Raymond Ko
- Nepean Urology Research Group, Kingswood, Australia
| | | | | | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | - Mariela Corrales
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Vigen Malkhasyan
- Endourological Department, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Hyderabad, India
| | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
| | - Karl Tan
- Department of Surgery, Section of Urology, Veterans Memorial Medical Center, Quezon City, Philippines
| | - Chu Ann Chai
- Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Satyendra Persaud
- Division of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | - Wissam Kamal
- Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia
| | - Tzevat Tefik
- Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Heng Chin Tiong
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
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Yuen SKK, Traxer O, Wroclawski ML, Gadzhiev N, Chai CA, Lim EJ, Giulioni C, De Stefano V, Nedbal C, Maggi M, Sarica K, Castellani D, Somani B, Gauhar V. Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath. Diagnostics (Basel) 2024; 14:1034. [PMID: 38786332 PMCID: PMC11120421 DOI: 10.3390/diagnostics14101034] [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: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
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Affiliation(s)
- Steffi Kar Kei Yuen
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France;
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil;
- BP—A Beneficência Portuguesa de São Paulo, São Paulo 01451-010, Brazil
| | - Nariman Gadzhiev
- Urology Department, Saint-Petersburg State University Hospital, 197342 St. Petersburg, Russia;
| | - Chu Ann Chai
- Urology Unit, Surgery Department, University Malaya Medical Center, Petaling Jaya 50603, Malaysia;
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Carlo Giulioni
- Department of Urology, Casa di Cura Villa Igea, 60127 Ancona, Italy;
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
- Urology Unit, ASST Fatebenefratelli Sacco, 20131 Milano, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Kemal Sarica
- Department of Urology, Biruni University, 34015 Istanbul, Turkey;
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK;
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore 126817, Singapore
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7
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Cruz JACS, Danilovic A, Vicentini FC, Brito AH, Batagello CA, Marchini GS, Torricelli FCM, Nahas WC, Mazzucchi E. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review. Int Braz J Urol 2024; 50:346-358. [PMID: 38498688 PMCID: PMC11152322 DOI: 10.1590/s1677-5538.ibju.2024.9907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- José Agustin Cabrera Santa Cruz
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Artur Henrique Brito
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Carlos Alfredo Batagello
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Giovanni Scalla Marchini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio César Miranda Torricelli
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
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8
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Wanderling C, Saxton A, Phan D, Doersch KM, Shepard L, Schuler N, Hassig S, Quarrier S, Osinski T, Ghazi A. Getting hot in here! Comparison of Holmium vs. thulium laser in an anatomic hydrogel kidney model. Urolithiasis 2024; 52:49. [PMID: 38520506 DOI: 10.1007/s00240-024-01541-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: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024]
Abstract
As laser technology has advanced, high-power lasers have become increasingly common. The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has long been accepted as the standard for laser lithotripsy. The thulium fiber laser (TFL) has recently been established as a viable option. The aim of this study is to evaluate thermal dose and temperature for the Ho:YAG laser to the TFL at four different laser settings while varying energy, frequency, operator duty cycle (ODC). Utilizing high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system (PCS) with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Ho:YAG laser or TFL. At a standard power (40W) and irrigation (17.9 ml/min), we evaluated four different laser settings with ODC variations with different time-on intervals. Temperature was measured at two separate locations. In general, the TFL yielded greater cumulative thermal doses than the Ho:YAG laser. Thermal dose and temperature were typically greater at the stone when compared away from the stone. Regarding the TFL, there was no general trend if fragmentation or dusting settings yielded greater thermal doses or temperatures. The TFL generated greater temperatures and thermal doses in general than the Ho:YAG laser with Moses technology. Temperatures and thermal doses were greater closer to the laser fiber tip. It is inconclusive as to whether fragmentation or dusting settings elicit greater thermal loads for the TFL. Energy, frequency, ODC, and laser-on time significantly impact thermal loads during ureteroscopic laser lithotripsy, independent of power.
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Affiliation(s)
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Dennis Phan
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen M Doersch
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren Shepard
- Johns Hopkins Brady Institute of Urologic Surgery, Baltimore, MD, USA
| | - Nathan Schuler
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen Hassig
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Osinski
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Johns Hopkins Brady Institute of Urologic Surgery, Baltimore, MD, USA
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Corrales M, Panthier F, Solano C, Candela L, Traxer O. Laser safety, warnings, and limits in retrograde intrarenal surgery. Actas Urol Esp 2024; 48:19-24. [PMID: 37356576 DOI: 10.1016/j.acuroe.2023.06.009] [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: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the thulium fiber laser (TFL). METHODS Narrative overview of the most relevant articles published in MEDLINE and Scopus databases about this subject. RESULTS TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions. CONCLUSION The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy. In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL.
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Affiliation(s)
- M Corrales
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France.
| | - F Panthier
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - C Solano
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - L Candela
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France; Division de Oncología Experimental/Unidad de Urología, URI, IRCCS Hospital San Raffaele, Milán, Italy
| | - O Traxer
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
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10
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Pauchard F, Bhojani N, Chew B, Ventimiglia E. How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives. Actas Urol Esp 2024; 48:42-51. [PMID: 37832846 DOI: 10.1016/j.acuroe.2023.10.007] [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: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
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Affiliation(s)
- F Pauchard
- Servicio de Urología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - N Bhojani
- División de Urología, Universidad de Montreal, Montreal, QC, Canada
| | - B Chew
- Departamento de Ciencias Urológicas, Universidad de British Columbia, Vancouver, BC, Canada
| | - E Ventimiglia
- División de Oncología Experimental/Unidad de Urología, Instituto de Investigación Urológica (URI), IRCCS Hospital San Raffaele, Milán, Italy.
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11
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Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. A systematic review. Curr Opin Urol 2023; 33:308-317. [PMID: 37140545 DOI: 10.1097/mou.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years. RECENT FINDINGS We conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5-10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation. SUMMARY Recent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.
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Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
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Emiliani E, Kanashiro A, Angerri O. Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 2023; 33:302-307. [PMID: 36927702 DOI: 10.1097/mou.0000000000001092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. RECENT FINDINGS New Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points.TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SUMMARY Several new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.
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Affiliation(s)
- Esteban Emiliani
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona, Spain
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Balawender K. A Prospective Study of Renal Blood Flow during Retrograde Intrarenal Surgery. J Clin Med 2023; 12:jcm12083030. [PMID: 37109366 PMCID: PMC10146614 DOI: 10.3390/jcm12083030] [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: 02/08/2023] [Revised: 04/01/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
(I) Introduction: The use of Doppler ultrasound allows us to indirectly assess the effect of increased intrarenal pressure on renal blood flow during retrograde intrarenal surgery (RIRS). On the basis of vascular flow spectra from selected blood vessels in the kidney, it is possible to determine Doppler parameters that reflect the renal perfusion status, which indirectly shows the degree of vasoconstriction and reflects the resistance of kidney tissue. (II) Materials and methods: A total of 56 patients were included in the study. The study assessed the changes of three Doppler parameters of intrarenal blood flow: resistive index-RI, pulsatility index-PI, and acceleration time-AT in the ipsilateral and contralateral kidneys during RIRS. The effects of mean stone volume, energy used, and pre-stenting were examined as predictors and calculated at two time intervals. (III) Results: The mean value of RI and PI was significantly higher in the ipsilateral kidney than in the contralateral kidney just after RIRS. The mean value of the acceleration time was not significantly different before and after RIRS. The values of all three parameters 24 h after the procedure were comparable to their values immediately after the RIRS. The size of the stone exposed to laser lithotripsy, the value of the energy used, and pre-stenting are not factors that significantly influence Doppler parameters during RIRS. (IV) Conclusions: The significant increase in RI and PI after RIRS in the ipsilateral kidney suggests a vasoconstriction of the interlobar arteries generated by increased intrarenal pressure during the procedure.
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Affiliation(s)
- Krzysztof Balawender
- Clinical Department of Urology and Urological Oncology, Municipal Hospital in Rzeszow, 35-241 Rzeszow, Poland
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Medical College, Rzeszow University, 35-301 Rzeszow, Poland
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Emiliani E, Kanashiro AK, Balaña J, Fontanet S, Aumatell J, Calderón-Cortez J, Iregui-Parra J, Sanchez-Pui A, Sanchez-Martin F, Millan F, Angerri O. Use of Moses 2.0 with extended frequency and optimized Moses vs. high-power laser in MiniPCNL: a randomized controlled trial. Urolithiasis 2023; 51:75. [PMID: 37074477 DOI: 10.1007/s00240-023-01443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
The aim of the study was to compare standard high-power laser (with < 80 Hz) to extended frequency (> 100 Hz) lithotripsy during miniPCNL. 40 patients were randomized in to two groups undergoing MiniPCNL. For both groups, the Holmium Pulse laser Moses 2.0 (Lumenis) was used. For group A, standard high-power laser with < 80 Hz, with Moses distance was set using up to 3 J. For Group B, extended frequency (100-120 Hz) was used allowing up to 0.6 J. All patients underwent MiniPCNL using an 18 Fr balloon access. Demographics were comparable between groups. Mean stone diameter was 19 mm (14-23) with no differences between groups (p = 0.14). Mean operative time was 91 and 87 min for group A and B (p = 0.71), mean laser time was similar in both groups, 6.5 min and 7.5 min, respectively (p = 0.52) as well as the number of laser activations during the surgery (p = 0.43). Mean Watts used was 18 and 16 respectively being similar in both groups (p = 0.54) as well as the total KJoules (p = 0.29). Endoscopic vision was good in all surgeries. The endoscopic and radiologic stone free rate was achieved in all patients expect for two in both groups (p = 0.72). Two Clavien I complications were seen, a small bleeding for group A and a small pelvic perforation in group B. The use of high-power holmium laser with extended frequency and optimized Moses was effective and safe being comparable to standard high-power laser for MiniPCNL allowing more versatility with the setting range.
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Affiliation(s)
- Esteban Emiliani
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain.
| | - Andres Koey Kanashiro
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Josep Balaña
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Sofía Fontanet
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Julio Calderón-Cortez
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Juan Iregui-Parra
- Department of Urology, Clinica nueva de Cali. Department of Epidemiology, Interdisciplinary Group of Research in Epidemiology and Public Health (GIESP), Libre University, Cali, Colombia
| | - Antoni Sanchez-Pui
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Francisco Sanchez-Martin
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Felix Millan
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Oriol Angerri
- Department of Urology, Fundación Puigvert. Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
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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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Kwok JL, De Coninck V, Pietropaolo A, Juliebø-Jones P, Ventimiglia E, Tailly T, Alexander Schmid F, Hunziker M, Poyet C, Traxer O, Eberli D, Keller EX. Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept. Ther Adv Urol 2023; 15:17562872231179332. [PMID: 37377944 PMCID: PMC10291398 DOI: 10.1177/17562872231179332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Objective The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector (p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS (R2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton, Southampton, UK
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | | | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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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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