Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review

OBJECTIVE

To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones.

BASIC PROCEDURES

A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded.

MAIN FINDINGS

Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure.

CONCLUSION

Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

[Histomorphometric analysis of the bone tissue in patients with non-insulin-dependent diabetes (DMNID)]

The effects of long-term diabetes mellitus on mineral metabolism and bone integrity remain ill defined. Several studies have shown that patients with insulin-dependent diabetes mellitus (IDDM) have reduced bone mass. However, the effect of non-insulin-dependent diabetes mellitus (NIDDM) on bone mass has been controversial. Quantitative histologic assessments were completed in iliac crest bone samples obtained from 26 patients (13 male and 13 female) with non-insulin-dependent diabetes mellitus (NIDDM) and normal renal function (serum creatinine 1.00 +/- 0.04 mg/dl). The mean age was 67.42 +/- 2.74 yrs, range 50-89 yrs. For the control group the bone samples were taken from 20 non-diabetic subjects (11 male and 9 female) with a mean age of 57.95 +/- 3.96 yrs, range 33-91 yrs, n.s, that had suffered sudden or violent death. Significant lower values were present in the diabetic group for bone volume (p < 0.0001), osteoid volume (p < 0.005), osteoid thickness (p < 0.0001), cortical thickness (p < 0.05) and osteoblast surface (p < 0.05). Linear regression analysis revealed significant positive correlations of osteoid volume with osteoid thickness and osteoid surface in both groups. Our results suggest that the mechanism(s) underlying diabetic osteopenia may involve decreased bone turnover as reflected in a paucity of osteoblasts and diminished quantities of osteoid. A proeminent additional feature was a reduction in the cortical thickness.