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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Panthier F, Kutchukian S, Ducousso H, Doizi S, Solano C, Candela L, Corrales M, Chicaud M, Traxer O, Hautekeete S, Tailly T. How to estimate stone volume and its use in stone surgery: a comprehensive review. Actas Urol Esp 2024; 48:71-78. [PMID: 37657708 DOI: 10.1016/j.acuroe.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy [URS], extracorporeal shockwave lithotripsy [ESWL] and percutaneous nephrolithotomy [PCNL]). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis treatment. MATERIAL AND METHODS A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. RESULTS In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20 mm. This was not the case for PCNL and SWL. CONCLUSIONS Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume.
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Affiliation(s)
- F Panthier
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France.
| | - S Kutchukian
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France; Servicio de Urología, Hospital Universitario de Poitiers, Poitiers, France
| | - H Ducousso
- Servicio de Urología, Hospital Universitario de Poitiers, Poitiers, France
| | - S Doizi
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France
| | - C Solano
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Universidad de La Sorbona, París, Francia; Servicio de Endourología, Uroclin SAS Medellín, Colombia
| | - L Candela
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France; Divisiónde Oncología Experimental, Unidad de Urología, URI. IRCCS Hospital San Raffaele, Universidad Vita-Salute San Raffaele, Milán, Italy
| | - M Corrales
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France
| | - M Chicaud
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France; Servicio de Urología, CHU Limoges, Limoges, France
| | - O Traxer
- Grupo de Investigación Clínica en Litiasis Urinaria, Hospital Tenon, Paris, France; Servicio de Urología, Asistencia Pública Hospitales de París, Hospital Tenon, Universidad de La Sorbona, Paris, France
| | - S Hautekeete
- Servicio de Radiología, Hospital Universitario de Gante, Gante, Belgium
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
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Raynal G, Malval B, Panthier F, Roustan FR, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy. Prog Urol 2023; 33:843-853. [PMID: 37918983 DOI: 10.1016/j.purol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- G Raynal
- Department of urology, clinique Métivet, 48, rue d'Alsace Lorraine, 94100 Saint-Maur-des-Fossés, France
| | - B Malval
- Clinique Saint-Hilaire, Rouen, France
| | - F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | | | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Panthier F, Abid N, Hoznek A, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Laser - utilization and settings. Prog Urol 2023; 33:825-842. [PMID: 37918982 DOI: 10.1016/j.purol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and "pop-corning". These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated. METHODOLOGY: These recommendations have been developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - N Abid
- Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Edouard-Herriot Hospital, Lyon, France
| | - A Hoznek
- Service d'urologie, hôpital Henri-Mondor, AP-HP, université Paris Est Créteil, Paris, France
| | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Fourniol C, Dariane C, Correas J, Audenet F, Pinar U, Anract J, Hostettler A, Panthier F, Timsit MO, Mejean A. Volumetric and functional outcomes at 1-year between percutaneous-ablation and partial-nephrectomy for T1b renal tumors. Prog Urol 2023; 33:509-518. [PMID: 37633733 DOI: 10.1016/j.purol.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population. METHODS Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA). RESULTS 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59 years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm3; P=0.0007) compared to PN group. At 1 year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm3; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh. CONCLUSION For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR.
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Affiliation(s)
- C Fourniol
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - C Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Correas
- Service de radiologie adulte, hôpital Necker-Enfants-Malades, AP-HP, centre, université de Paris, 245, rue de Sèvres, 75015 Paris, France
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - U Pinar
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP-centre, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Anract
- Service d'urologie, hôpital Cochin, AP-HP-centre, université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Hostettler
- Département de recherche et développement, IRCAD France, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F Panthier
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
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Kutchukian S, Doizi S, Lapouge P, Germain T, Dragos L, Berthe L, Solano C, Candela L, Corrales M, Chicaud M, Traxer O, Panthier F. Ablation rates with Holmium:YAG and Thulium Fiber Laser: Influence of the stone phantom homogeneity. An in vitro study. Prog Urol 2023:S1166-7087(23)00126-4. [PMID: 37442755 DOI: 10.1016/j.purol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES The lithotripsy efficiency (LE) in vitro study requires artificial or human stone samples (AS, HS). With the development of dusting lithotripsy, less ex vivo HS are available. We aimed to compare Thulium Fiber Laser (TFL) and Holmium:YAG (Ho:YAG)'s LE and define the most accurate LE parameter. METHODS Hard and soft homogenous- and heterogenous-AS (Ho-AS, He-AS) were made to reproduce calcium-oxalate monohydrate and uric acid stones, respectively by a rapid or slow brewing of BegostonePlus (Bego) and distilled water. One hundred and fifty and 272μm-laser fibers, connected to 50W-TFL and 30W-HoYAG generators, compared three settings for TFL (FD: 0.15J/100Hz; D: 0.5J/30Hz; Fr: 1J/15Hz) and two for Ho:YAG (D-Fr). An experimental setup consisted in immerged 10mm cubic stone phantoms with a 20 seconds' lasing spiral, in contact mode, repeated four times. Stones were dried, weighted and μ-scanned (ablation weight and volume [AW and AV]). RESULTS With He-AS, dusting AV were four- and three-fold higher with TFL compared to Ho:YAG against hard and soft (P<0.05). In fragmentation, AV were two-fold higher with TFL compared to Ho:YAG against hard (P<0.05) and soft (P<0.05). Experiments with Ho-AS were associated with non-significant differences when comparing TFL-150μm and TFL-272μm. The ablation weight-volume correlation coefficients was higher with Ho-AS than with He-AS (P<0.0001), and with hard than soft AS. If the LE can be estimated by the AW with hard AS, this approximation is not consistent for soft AS. CONCLUSION TFL presented higher ablation rates than Ho:YAG, significant with He-AS. If the AW is acceptable and less expensive for hard Ho-AS, AV are more accurate for He-AS, which are suggested to imitate closely HS.
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Affiliation(s)
- S Kutchukian
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Service d'urologie, CHU de Poitiers, Poitiers, France
| | - S Doizi
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - P Lapouge
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - T Germain
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - L Dragos
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - C Solano
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Department of Endourology, Uroclin S.A.S., Medellin, Colombia
| | - L Candela
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vital-Salute San Raffaele University, Milan, Italy
| | - M Corrales
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - M Chicaud
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, CHU de Limoges, Limoges, France
| | - O Traxer
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - F Panthier
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France.
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Thillou D, Timsit MO, Panthier F, Hurel S, Amrouche L, Anglicheau D, Méjean A, Audenet F. End-to-side versus end-to-end uretero-ureteral anastomosis in preemptive kidney transplantation from living donors: A monocentric experience. Prog Urol 2023; 33:118-124. [PMID: 36774268 DOI: 10.1016/j.purol.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE End-to-end (ETE) pyeloureterostomy is an alternative to ureteroneocystostomy for urinary anastomosis during kidney transplantation (KT). In preemptive KT from living donors (PKT-LD), end-to-side (ETS) uretero-ureteral anastomosis could have the benefits of pyeloureterostomy without ligation of the native kidney ureter. This study aimed to compare ETS to ETE uretero-ureteral anastomosis in PKT-LD. METHODS A monocentric retrospective 8-year study included all consecutive cases of PKT-LD, excluding ureteroneocystomy anastomosis and homolateral nephrectomy. Two groups were compared: ETS and ETE. Perioperative data on graft function and urological complications were collected. RESULTS One hundred and six patients were included: 48 patients in the ETS group and 58 patients in the ETE group. Median follow-up was 37.5 months [17.3; 57.5]. The estimated glomerular filtration rate at postoperative day ten and 3 months was similar in both groups. The overall complication rate was 16%, with no significant difference between the 2 groups. There was one ureteral stenosis in each group. None of the patients in the ETS group presented urinary fistula, whereas it occurred in one (1.7%) in the ETE group. Back pain due to native kidney obstruction occurred in 5 patients in the ETE group (8.6%), but not in the ETS group. CONCLUSION In preemptive kidney transplantation from living donors, urinary anastomosis can safely be performed as an end-to-side uretero-ureteral anastomosis, with low urological complications. It could prevent symptoms and complications due to native kidney obstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D Thillou
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Panthier
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - S Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - L Amrouche
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - D Anglicheau
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - A Méjean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France.
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Timsit MO, Terrier N, Toinet T, Dariane C, Debedde E, Panthier F, Thiounn N, Audenet F, Méjean A. Posterior transperitoneal robot-assisted partial nephrectomy in the treatment of renal tumors: Feasibility of a hybrid approach. Prog Urol 2022; 32:217-225. [DOI: 10.1016/j.purol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Doizi S, Germain T, Panthier F, Comperat E, Traxer O, Berthe L. Comparaison des effets des lasers Holmium:YAG et Thulium Fibré sur les tissus mous : résultats d’une étude ex vivo. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Germain T, Uzan A, Panthier F, Chiron P, Gorny C, Berthe L, Traxer O, Doizi S. Comparaison des lasers Holmium:YAG et Thulium fibré sur le risque de fracture des fibres laser et étude des facteurs impliqués dans leur dégradation. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Panthier F, Doizi S, Corrales M, Traxer O. Pulsed lasers and endocorporeal laser lithotripsy. Prog Urol 2021; 31:451-457. [PMID: 33516610 DOI: 10.1016/j.purol.2020.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023]
Abstract
Endocorporeal laser lithotripsy (ELL) is currently the gold standard for the treatment of renal stones during retrograde intra-renal surgery (RIRS). The newly-authorised thulium fibre laser (Tm-Fibre) in now evaluated as a holmium:yttrium-aluminium-garnet (Ho:YAG) laser alternative, which is the most well-known laser source for ELL. This update aimed to present the fundamentals of pulsed lasers for EEL [technology, period, pulse characteristic (rate, duration, energy, shape), peak power, average power], and the available lithotripsy modes for both Tm-Fibre and Ho:YAG lasers.
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Affiliation(s)
- F Panthier
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - S Doizi
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
| | - M Corrales
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
| | - O Traxer
- GRC n(o)20, groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 4, rue de la Chine, 75020 Paris, France.
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Panthier F, Lapouge P, Doizi S, Dragos L, Berthe L, Traxer O. Analyse in vitro de l’efficacité de la lithotritie laser : quel modèle utiliser ? Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Panthier F, Traxer O, Yonneau L, Lebret T, Berthe L, Timsit M, Méjean A, Doizi S, Audenet F. Évaluation préclinique et clinique d’un outil développé pour la planification opératoire des chirurgies lithiasiques : « Kidney Stone Calculator ». Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Panthier F, Doizi S, Berthe L, Traxer O. Developing a free three-dimensional tool for kidney stones’ surgical planning: Calculator. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Panthier F, Doizi S, Berthe L, Traxer O. Comparison of the fissures and fragments produced with 150µm and 272µm laser fibers with superpulsed thulium fiber laser: An in vitro study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32788-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Panthier F, Doizi S, Berthe L, Traxer O. In vitro comparison of the induced vapor bubbles between saline solution, iodinated contrast agent, urine and deionized water with 150µm-core-diameter laser fiber with superpulsed thulium fiber laser. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Panthier F, Doizi S, Berthe L, Traxer O. In vitro comparison of the induced vapor bubbles between 150µm and 272µm-core-diameter laser fibers with superpulsed thulium fiber laser. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Panthier F, Doizi S, Berthe L, Traxer O. Développement d’un outil tri-dimensionnel gratuit pour la planification opératoire des chirurgies lithiasiques. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Panthier F, Doizi S, Berthe L, Traxer O. Perte de puissance en fonction du diamètre de la fibre laser, des paramètres et de l’interface. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Panthier F, Doizi S, Berthe L, Traxer O. Comparaison in vitro des flux de bulles avec le Laser Thulium Fibré Superpulsé selon le diamètre de fibre laser (150 μm vs 272 μm) et le milieu d’activation (sérum physiologique, produit de contraste iodé, eau pour préparation injectable, urine). Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gasman D, Panthier F, Bruel S, Azancot V, Taille ADL. Experience monocentrique prospective de l’énucléation greenlep monobloc : 100 premiers cas. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lang T, Nicaud V, Slama K, Hirsch A, Imbernon E, Goldberg M, Calvel L, Desobry P, Favre-Trosson JP, Lhopital C, Mathevon P, Miara D, Miliani A, Panthier F, Pons G, Roitg C, Thoores M. Smoking cessation at the workplace. Results of a randomised controlled intervention study. Worksite physicians from the AIREL group. J Epidemiol Community Health 2000; 54:349-54. [PMID: 10814655 PMCID: PMC1731676 DOI: 10.1136/jech.54.5.349] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the effects of a worksite intervention by the occupational physician offering simple advice of smoking cessation with a more active strategy of advice including a "quit date" and extra support. POPULATION Employees of an electrical and gas company seen at the annual visit by their occupational physicians. CRITERIA END POINTS: Smoking point prevalence defined as the percentage of smokers who were non-smokers at one year. Secondary criteria were the percentage of smokers who stopped smoking for more than six months and the difference in prevalence of smoking in both groups. METHODS Randomised controlled trial. The unit of randomisation was the work site physician and a random sample of the employees of whom he or she was in charge. The length of the follow up was one year. Each of 30 work site physicians included in the study 100 to 150 employees. RESULTS Among 504 subjects classified as smokers at baseline receiving simple advice (group A) and 591 the more active programme (group B), 68 (13.5%) in group A and 109 (18. 4%) were non-smokers one year later (p=0.03; p=0.01 taking the occupational physician as the statistical unit and using a non-parametric test). Twenty three subjects (4.6%) in group A and 36 (6.1%) in group B (p=0.26) declared abstinence of six months or more. Among non-smokers at baseline, 3.4% in both groups were smokers after one year follow up. The prevalence of smokers did not differ significantly at baseline (32.9% and 32.4%, p=0.75). After the intervention the prevalence of smoking was 30.8% in group A and 28. 7% in group B (p=0.19). An increase of the mean symptoms score for depression in those who quit was observed during this period. CONCLUSIONS A simple cessation intervention strategy during a mandatory annual examination, targeting a population of smokers independently of their motivation to stop smoking or their health status, showed a 36% relative increase of the proportion of smokers who quit smoking as compared with what can be achieved through simple advice.
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Affiliation(s)
- T Lang
- INSERM U258, Villejuif, France
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