1
|
Tefik T, Ergül RB, Osther P, Giusti G, Preminger GM, Straub M, Rassweiler JJ, Montanari E, Brehmer M, Seitz C, Grasso M, Pearle M, Proietti S, Cloutier J, Gunver MG, Nane I, Ozcan F, Traxer O. The relationship between the force applied and perceived by the surgeon during ureteral access sheath placement: ex-vivo experimental model. World J Urol 2024; 42:329. [PMID: 38753120 PMCID: PMC11098873 DOI: 10.1007/s00345-024-04982-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To define a peak force of insertion (PFOI) threshold for ureteral damage during ureteral access sheath (UAS) placement on an experimental ureteral orifice model. METHODS A specially designed water tank using 2 laparoscopic 5 mm ports and 2 different size (10 Fr and 8 Fr) sealing cap adaptors (SCA) as ureteral orifices was used to perform the test. A 10-12 Fr UAS was fixed to a load cell and the force of insertion (FOI) was continuously recorded with a digital force gauge.13 experts in the field of endourology who participated performed 3 UAS insertions. The FOI was recorded initially with 10 Fr followed by 8 Fr SCA. On the final insertion, the orifice was obstructed, leaving a 5 cm length to insert the UAS. The experts were asked to "Stop at the point they anticipate ureteral damage, and they would not proceed in real life". RESULTS Using 10 Fr SCA the PFOI was 2.12 ± 0.58 Newton (N) (range:1.48-3.48) while 8 Fr SCA showed a PFOI 5.76 ± 0.96 N (range:4.05-7.35). Six of the experts, said they would stop proceeding when they reached above 5.1 N. Three experts had PFOI < 5.1 N and the other 4 stated they would go with PFOIs of 5.88, 6.16, 6.69 and 7.35 N when using SCA of 8 Fr.The highest load they would stop proceeding had a PFOI of 6.09 ± 1.87 N (range: 2.53-10.74). CONCLUSION The PFOI threshold for ureteral damage inserting UAS of the experts is variable. Although FOI is a subjective perception, experience suggests that ureteral injury may occur at an average of 6.05 N perceived by surgeons' tactile feedback. In-vivo measurement of UAS PFOI may confirm a threshold.
Collapse
Affiliation(s)
- Tzevat Tefik
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France.
| | - Rifat Burak Ergül
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Palle Osther
- Department of Urology, Urological Research Center, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | | | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marianne Brehmer
- Department of Urology, Stockholm South General Hospital Stockholm, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Stockholm South General Hospital Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Grasso
- Department of Urology, Phelps Hospital/Northwell Health, New York, USA
| | | | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jonathan Cloutier
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - MGuven Gunver
- Department of Medical Statistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismet Nane
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Olivier Traxer
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| |
Collapse
|
2
|
Mishra A, Medairos R, Chen J, Soto-Palou F, Antonelli J, Preminger GM, Lipkin ME, Zhong P. Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model. BJU Int 2024; 133:223-230. [PMID: 37942684 PMCID: PMC10947524 DOI: 10.1111/bju.16218] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. MATERIALS AND METHODS An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. RESULTS High EP /low F settings demonstrated superior treatment efficiency compared to low EP /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. CONCLUSIONS Our findings suggest that high EP /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.
Collapse
Affiliation(s)
- Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Robert Medairos
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Francois Soto-Palou
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jodi Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| |
Collapse
|
3
|
Chen J, Mishra A, Medairos R, Antonelli J, Preminger GM, Lipkin ME, Zhong P. In vitro investigation of stone ablation efficiency, char formation, spark generation, and damage mechanism produced by thulium fiber laser. Urolithiasis 2023; 51:124. [PMID: 37917225 PMCID: PMC10880548 DOI: 10.1007/s00240-023-01501-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
To investigate stone ablation characteristics of thulium fiber laser (TFL), BegoStone phantoms were spot-treated in water at various fiber tip-to-stone standoff distances (SDs, 0.5 ~ 2 mm) over a broad range of pulse energy (Ep, 0.2 ~ 2 J), frequency (F, 5 ~ 150 Hz), and power (P, 10 ~ 30 W) settings. In general, the ablation speed (mm3/s) in BegoStone decreased with SD and increased with Ep, reaching a peak around 0.8 ~ 1.0 J. Additional experiments with calcium phosphate (CaP), uric acid (UA), and calcium oxalate monohydrate (COM) stones were conducted under two distinctly different settings: 0.2 J/100 Hz and 0.8 J/12 Hz. The concomitant bubble dynamics, spark generation and pressure transients were analyzed. Higher ablation speeds were consistently produced at 0.8 J/12 Hz than at 0.2 J/100 Hz, with CaP stones most difficult yet COM and UA stones easier to ablate. Charring was mostly observed in CaP stones at 0.2 J/100 Hz, accompanied by strong spark-generation, explosive combustion, and diminished pressure transients, but not at 0.8 J/12 Hz. By treating stones in parallel fiber orientation and leveraging the proximity effect of a ureteroscope, the contribution of bubble collapse to stone ablation was found to be substantial (16% ~ 59%) at 0.8 J/12 Hz, but not at 0.2 J/100 Hz. Overall, TFL ablation efficiency is significantly better at high Ep/low F setting, attributable to increased cavitation damage with less char formation.
Collapse
Affiliation(s)
- Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Robert Medairos
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Jodi Antonelli
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Michael E Lipkin
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA.
| |
Collapse
|
4
|
Soto-Palou F, Chen J, Medairos R, Zhong P, Antonelli J, Preminger GM, Lipkin ME. In Pursuit of the Optimal Dusting Settings with the Thulium Fiber Laser: An In Vitro Assessment. J Endourol 2023; 37:914-920. [PMID: 37300481 PMCID: PMC10494908 DOI: 10.1089/end.2023.0168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Objective: Low energy and high frequency settings are used in stone dusting for holmium lasers. Such settings may not be optimal for thulium fiber laser (TFL). With the seemingly endless combination of settings, we aim to provide guidance to the practicing urologists and assess the efficiency of the TFL platform in an automated in vitro "dusting model." Materials/Methods: Three experimental setups were designed to investigate stone dusting produced by an IPG Photonics TLR-50 W TFL system using 200 μm fiber and soft BegoStone phantoms. The most popular 10 and 20 W dusting settings among endourologist familiar with TFL were evaluated. We directly compared short pulse (SP) vs long pulse (LP) mode using various combinations of pulse energy (Ep) and pulse frequency (F). Thereafter, we tested the 10 and 20 W settings and compared them among each other to elucidate the most efficient settings at each power. Treatments were performed under the same total laser energy delivered to the stone at four different standoff distances (SDs) with a clinically relevant scanning speed of either 1 or 2 mm/sec. Ablation volumes were quantified by optical coherence tomography to assess stone dusting efficiency. Fragment size after ablation at different pulse energies was evaluated by sieving and evaluating under a microscope after treatment. Results: Overall, SP provided greater ablation volume when compared with LP. Our dusting efficiency model demonstrated that the maximum stone ablation was achieved at the combination of high energy/low frequency settings (p < 0.005) and at a SD of 0.2 mm. At all tested pulse energies, no stone phantoms were broken into fragments >1 mm. Conclusions: During stone dusting with TFL, SP offers superior ablation to LP settings. Optimal dusting at clinically relevant scanning speeds of 1 and 2 mm/sec occurs at high energy/low frequency settings. Thulium lithotripsy with high Ep does not result in increased fragment size.
Collapse
Affiliation(s)
- Francois Soto-Palou
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Robert Medairos
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Jodi Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
5
|
Tran S, Chen J, Kozel G, Chang E, Phung T, Peng Y, Dionise Z, Wu Y, Simmons WN, Lipkin ME, Preminger GM, Zhong P. Development of an optically transparent kidney model for laser lithotripsy research. BJU Int 2023; 132:36-39. [PMID: 36987835 PMCID: PMC10761083 DOI: 10.1111/bju.16015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Sabrina Tran
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Gunnar Kozel
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Eric Chang
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Trina Phung
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Yanxi Peng
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Zachary Dionise
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Yuan Wu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - W. Neal Simmons
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| |
Collapse
|
6
|
Zeng G, Zhong W, Chaussy CG, Tiselius HG, Xu C, Turney B, Turk C, Tailly GG, Preminger GM, Akpinar H, Petrik A, Bernardo N, Wiseman O, Farahat Y, Budia A, Jones DK, Beltran Suarez E, De Marco F, Mazzon G, Lv J, Natchagande G, Guven S, Ibrahim TAA, Xu H, Xie L, Ye Z, Sarica K. International Alliance of Urolithiasis Guideline on Shockwave Lithotripsy. Eur Urol Focus 2023; 9:513-523. [PMID: 36435718 DOI: 10.1016/j.euf.2022.11.013] [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: 06/21/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Wen Zhong
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Christian G Chaussy
- University of Munich, Munich, Germany; University of Regensburg, Regensburg, Germany
| | - Hans Göran Tiselius
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Changbao Xu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ben Turney
- Department of Urology, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christian Turk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Haluk Akpinar
- Department of Urology, Florence Nightingale Hospitals Group, Istanbul, Turkey
| | - Ales Petrik
- Department of Urology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Oliver Wiseman
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alberto Budia
- Department of Urology, La Fe Polytechnic University Hospital, Valencia, Spain
| | - David K Jones
- Department of Pharmacology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Edgar Beltran Suarez
- Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Ferdinando De Marco
- Urology Division, Istituto Neurotraumatologico Italiano-Grottaferrata, Rome, Italy
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Jianlin Lv
- Department of Urology, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | | | - Selcuk Guven
- Urology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Hanfeng Xu
- Department of Urology, First Affiliated Hospital of University of South China, Henyang, China
| | - Lei Xie
- Department of Urology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey.
| |
Collapse
|
7
|
Zeng G, Traxer O, Zhong W, Osther P, Pearle MS, Preminger GM, Mazzon G, Seitz C, Geavlete P, Fiori C, Ghani KR, Chew BH, Git KA, Vicentini FC, Papatsoris A, Brehmer M, Martinez JL, Cheng J, Cheng F, Gao X, Gadzhiev N, Pietropaolo A, Proietti S, Ye Z, Sarica K. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU Int 2023; 131:153-164. [PMID: 35733358 PMCID: PMC10084014 DOI: 10.1111/bju.15836] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Olivier Traxer
- GRC Urolithiasis No. 20, Sorbonne University, Tenon Hospital, Paris, France
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Palle Osther
- Department of Urology, Vejle Hospital-a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Petrisor Geavlete
- Sanador Hospital, Bucharest, Romania.,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kah Ann Git
- Department of Urology, Pantai Hospital, Penang, Malaysia
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, Hospital das Clínicas, São Paulo, Brazil
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Juan Lopez Martinez
- Department of Urology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | | | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Zhangqun Ye
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
| |
Collapse
|
8
|
Zeng G, Zhao Z, Mazzon G, Pearle M, Choong S, Skolarikos A, Denstedt J, Seitz C, Olvera Pasada D, Fiori C, Bosio A, Papatsoris A, Méndez Probst CE, Perez Fentes D, Ann Git K, Wu Q, Wiseman O, Emiliani E, Farahat Y, Ilker Gökce M, Giannakopoulos S, Goumas Kartalas I, Somani B, Knoll T, de la Rosette J, Zhong J, Vinicius Maroccolo M, Saltirov L, Chew B, Wang K, Lahme S, Giusti G, Ferretti S, Yong Cho S, Geavlete P, Cansino R, Kamphuis GM, Smith D, Matlaga BR, Ghani KD, Bernardo N, Silva AD, Ng ACF, Yang S, Gao X, Traxer O, Miernik A, Liatsikos E, Priyakant Parikh K, Duvdevani M, Celia A, Yasui T, Aquino A, Alomar M, Choonhaklai V, Erkurt B, Glass J, Sriprasad S, Osther PJ, Keeley FX, Preminger GM, Cepeda Delgado M, Beltran Suarez E, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Retrograde Intrarenal Surgery for the Management of Renal Stones. Eur Urol Focus 2022; 8:1461-1468. [PMID: 34836838 DOI: 10.1016/j.euf.2021.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. OBJECTIVE To develop recommendations for RIRS on the basis of existing data and expert consensus. DESIGN, SETTING, AND PARTICIPANTS A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. RESULTS AND LIMITATIONS The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. CONCLUSIONS The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. PATIENT SUMMARY An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Zhijian Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital London, London, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio General Hospital, Athens, Greece
| | - John Denstedt
- Division of Urology, Western University, London, ON, Canada
| | - Christian Seitz
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Daniel Olvera Pasada
- Department of Urology, Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Mexico
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea Bosio
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | | | - Daniel Perez Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Kah Ann Git
- Department of Urology, Pantai Hospital, Penang, Malaysia
| | - Qinghui Wu
- Urology Center, National University Hospital, Singapore
| | - Oliver Wiseman
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | | | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Thomas Knoll
- Department of Urology, Mannheim University Hospital, Mannheim, Germany
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Jiehui Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Lliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kunjie Wang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Petrisor Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Ramon Cansino
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Brian R Matlaga
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khurshid D Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Andres D Silva
- Department of Urology, Hospital del Salvador, Salvador, Chile
| | - Anthony C F Ng
- SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | - Kandarp Priyakant Parikh
- Department of Genitourinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Takahiro Yasui
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Albert Aquino
- Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Mohammad Alomar
- Department of Urology, King Khalid University Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Jonathan Glass
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Seshadri Sriprasad
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Palle J Osther
- Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Francis X Keeley
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | | | - Edgar Beltran Suarez
- Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
| |
Collapse
|
9
|
Michael ZD, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, Armstrong AJ, Gupta RT, Patierno S, Barrett NJ, George DJ, Preminger GM, Moul JW, Oeffinger KC, Shah K, Polascik TJ. Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health 2022:40.e60. [PMID: 36047079 DOI: 10.5534/wjmh.220068] [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: 04/25/2022] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network. MATERIALS AND METHODS We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017-2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL. RESULTS The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 vs. 1.98, p=0.001). CONCLUSIONS Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.
Collapse
Affiliation(s)
- Zoe D Michael
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Srinath Kotamarti
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Rohith Arcot
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kostantinos Morris
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Anand Shah
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John Anderson
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Andrew J Armstrong
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Rajan T Gupta
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Steven Patierno
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Nadine J Barrett
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Daniel J George
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Judd W Moul
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin C Oeffinger
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kevin Shah
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | |
Collapse
|
10
|
Tabib C, Whelan P, Kim C, Dionise Z, Soto-Palou F, Terry RS, Antonelli JA, Preminger GM, Lipkin ME. Benchtop Evaluation of Miniature Percutaneous Nephrolithotomy Lithotrites. J Endourol 2022; 36:1483-1488. [PMID: 35904417 DOI: 10.1089/end.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the preferred treatment for kidney stones >2cm. While PCNL has traditionally been performed using 24-30Fr access sheaths, there is a trend toward smaller sheaths and scopes to perform mini-PCNL (mPCNL). We performed benchtop assessment of multiple mPCNL lithotrites. METHODS One 1cm3, hard Begostone phantom was placed in a cylinder with four 5.5mm cylindrical openings to simulate the size of a 16.5Fr mPCNL sheath. Lithotripsy was performed with the 1.5mm and 1.9mm Trilogy, 1.83mm ShockPulse, or a 200m Holmium:YAG laser. Suction was used for the mechanical lithotrites. The Trilogy probes were set at 50% impact, 6Hz, 80% ultrasound and 10% suction. The ShockPulse was used at high-power setting with low suction. The 1.9mm Trilogy probe was used with a 15Fr mini-nephroscope. The 1.83mm ShockPulse, 1.5mm Trilogy and laser fiber were used with a 12Fr mini-nephroscope. The 120 W holmium laser was set at 0.5J/70Hz Moses-Distance. Ten independent runs were performed with modality. Time to complete stone clearance was recorded and mass stone clearance rates were calculated. RESULTS The Trilogy 1.9mm showed superior stone clearance rate (11.69 ± 3.68 mg/s) vs the SP 1.83mm (6.29 ± 1.37 mg/s, p=0.003), the laser fiber (4.73 ± 0.61 mg/s, p<0.0005), and the Trilogy 1.5mm (6.84± 1.21 mg/s). The 200m laser fiber was inferior to all mechanical lithotrites. There was no difference between the 1.5mm Trilogy and the 1.83mm ShockPulse (p=0.772). This translates to 3.9, 4.8 and 8.1 minutes less treatment time vs the 1.5mm Trilogy, SP, and laser, respectively, for a spherical 1.5cm diameter calcium oxalate monohydrate stone. CONCLUSION Among these four commonly used mPCNL lithotripters, the Trilogy 1.9 mm demonstrated superior stone clearance rates in this benchtop model versus the Ho:YAG laser, 1.83mm SP, and Trilogy 1.5mm. Future clinical testing is warranted to evaluate the optimal lithotrite for mPCNL.
Collapse
Affiliation(s)
- Christian Tabib
- Duke University Medical Center, Surgery, Urology, 40 Medicine Circle, Clinic 1G, Durham, North Carolina, United States, 27710;
| | - Patrick Whelan
- Chesapeake Urology Associates LLC, Hanover, Maryland, United States;
| | - Christopher Kim
- Duke University Medical Center, Surgery, Urology, Durham, North Carolina, United States;
| | - Zachary Dionise
- Duke University Medical Center, Surgery, Urology, Durham, North Carolina, United States;
| | - Francois Soto-Palou
- Duke University Medical Center, Surgery, Urology, Durham, North Carolina, United States;
| | - Russell Stevens Terry
- University of Florida, Department of Urology, 1600 SW Archer Rd., Box 100247, Gainesville, Florida, United States, 32610-0247;
| | - Jodi A Antonelli
- Duke University Medical Center, Urology, Durham, North Carolina, United States;
| | - Glenn M Preminger
- Duke University Medical Center, Urology, DUMC 3167, Durham, North Carolina, United States, 27710;
| | - Michael Eric Lipkin
- Duke University Medical Center, Surgery, Urology, DUMC 3167, Durham, North Carolina, United States, 27710;
| |
Collapse
|
11
|
Zhong P, Lipkin ME, Preminger GM. Editorial Comment:Elucidating the Mechanism of Stone Dusting Requires a Fresh and Rigorous Approach in the New Era of Laser Lithotripsy. J Endourol 2022; 36:686-687. [PMID: 35369728 DOI: 10.1089/end.2022.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
12
|
Chen J, Ho DS, Xiang G, Sankin G, Preminger GM, Lipkin ME, Zhong P. Cavitation Plays a Vital Role in Stone Dusting During Short Pulse Holmium:YAG Laser Lithotripsy. J Endourol 2022; 36:674-683. [PMID: 34806899 PMCID: PMC9145256 DOI: 10.1089/end.2021.0526] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the mechanism of stone dusting in Holmium (Ho): YAG laser lithotripsy (LL). Materials and Methods: Cylindrical BegoStone samples (6 × 6 mm, H × D) were treated in water using a clinical Ho:YAG laser lithotripter in dusting mode (0.2-0.4 J with 70-78 μs in pulse duration, 20 Hz) at various fiber tip to stone standoff distances (SD = 0, 0.5, and 1 mm). Stone damage craters were quantified by optical coherence tomography and bubble dynamics were captured by high-speed video imaging. To differentiate the contribution of cavitation vs thermal ablation to stone damage, three additional experiments were performed. First, presoaked wet stones were treated in air to assess stone damage without cavitation. Second, the laser fiber was advanced at various offset distances (OSD = 0.25, 1, 2, 3, and 10 mm) from the tip of a flexible ureteroscope to alter the dynamics of bubble collapse. Third, stones were treated with parallel fiber to minimize photothermal damage while isolating the contribution of cavitation to stone damage. Results: Treatment in water resulted in 2.5- to 90-fold increase in stone damage compared with those produced in air where thermal ablation dominates. With the fiber tip placed at OSD = 0.25 mm, the collapse of the bubble was distracted away from the stone surface by the ureteroscope tip, leading to significantly reduced stone damage compared with treatment without the scope or with scope at large OSD of 3-10 mm. The average crater volume produced by parallel fiber orientation at 0.2 J after 100 pulses, where cavitation is the dominant mechanism of stone damage, was comparable with those produced by using perpendicular fiber orientation within SD = 0.25-1 mm. Conclusion: Cavitation plays a dominant role over photothermal ablation in stone dusting during short pulse Ho:YAG LL when 10 or more pulses are delivered to the same location.
Collapse
Affiliation(s)
- Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Derek S. Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Gaoming Xiang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Georgy Sankin
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Glenn M. Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E. Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Address correspondence to: Pei Zhong, PhD, Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC 27708, USA
| |
Collapse
|
13
|
Sur RL, Agrawal S, Eisner BH, Haleblian GE, Ganpule A, Sabnis RB, Desai M, Preminger GM. Initial Safety and Feasibility of Steerable Ureteroscopic Renal Evacuation (SURE), A Novel Approach for the Treatment of Urolithiasis. J Endourol 2022; 36:1161-1167. [PMID: 35331002 PMCID: PMC9422793 DOI: 10.1089/end.2021.0759] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is a need to reliably render urolithiasis patients completely stone free with minimal morbidity. We report on the initial safety and feasibility with steerable ureteroscopic renal evacuation (SURE) in a prospective study using basket extraction as a comparison. Materials and Methods: A pilot randomized controlled study was conducted comparing SURE with basket extraction postlaser lithotripsy. SURE is performed using the CVAC™ Aspiration System, a steerable catheter (with introducer). The safety and feasibility of steering CVAC throughout the collecting system under fluoroscopy and aspirating stone fragments as it was designed to do were evaluated. Fluoroscopy time, change in hemoglobin, adverse events through 30 days, total and proportion of stone volume removed at 1 day, intraoperative stone removal rate, and stone-free rate (SFR) at 30 days through CT were compared. Results: Seventeen patients were treated (n = 9 SURE, n = 8 Basket). Baseline demographics and stone parameters were not significantly different between groups. One adverse event occurred in each group (self-limiting ileus for SURE and urinary tract infection for Basket). No mucosal injury and no contrast extravasation were observed in either group. The CVAC catheter was steered throughout the collecting system and aspirated fragments. There was no significant difference in fluoroscopy time, procedure time, change in hemoglobin, or stone removal rate between groups. SURE removed more and a greater proportion of stone volume at day 1 vs baskets (202 mm3vs 91 mm3, p < 0.01 and 84% vs 56%, p = 0.022). SURE achieved 100% SFR at 30 days vs 75% for baskets, although this difference was not statistically significant (p = 0.20). Conclusions: This initial study suggests SURE is safe, feasible, and may be more effective in stone removal postlaser lithotripsy compared to basketing. More development is needed, and larger clinical studies are underway.
Collapse
Affiliation(s)
- Roger L Sur
- University of California San Diego, 8784, Urology, Department of Urology, 200 Arbor Drive #8897, San Diego, California, United States, 92103.,Sur Roger, Department of Urology, 200 Arbor Drive #8897, United States;
| | - Shashank Agrawal
- Muljibhai Patel Urological Hospital, 29025, V V desai road, Nadiad, Gujarat, India, 387001;
| | - Brian H Eisner
- Massachusetts General Hospital, Harvard Medical School, Urology, 55 Fruit Street, Dept. of Urology, GRB 1102, Boston, Massachusetts, United States, 02114;
| | - George E Haleblian
- Brigham and Women's Hospital, 1861, Urology, 45 Francis St, Boston, Massachusetts, United States, 02115;
| | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Department of Urology, Dr Virendra Desai Road,Nadiad,India, Nadiad, Gujarat, India, 387001;
| | - R B Sabnis
- MPUH, Urology, VV Desai road, Nadiad, Gujarat, India, 387001;
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Urology, Dr Virendra Desai Road, Nadiad, Nadiad, Gujarat, India, 387001;
| | - Glenn M Preminger
- Duke University Medical Center, Urology, DUMC 3167, Durham, North Carolina, United States, 27710;
| |
Collapse
|
14
|
Terry RS, Ho DS, Scialabba DM, Whelan PS, Qi R, Ketterman BT, Preminger GM, Zhong P, Lipkin ME. Comparison of Different Pulse Modulation Modes for Holmium:Yttrium-Aluminum-Garnet Laser Lithotripsy Ablation in a Benchtop Model. J Endourol 2022; 36:29-37. [PMID: 34269626 PMCID: PMC8785761 DOI: 10.1089/end.2021.0113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Manipulation of Holmium:Yttrium-Aluminum-Garnet laser parameters such as pulse energy (PE), frequency, and duration can impact laser lithotripsy ablation efficiency. In 2017, Lumenis introduced Moses™ Technology, which uses pulse modulation to enhance the delivery of energy from fiber to stone as well as to minimize stone retropulsion. Since the introduction of Moses Technology, other companies have brought additional pulse modulation concepts to market. The purpose of this in vitro study is to compare the pulse characteristics and stone ablation efficiency of Lumenis Moses Technology with Quanta's Vapor Tunnel™. Materials and Methods: Submerged BegoStone phantoms were systematically ablated using either the Lumenis Moses Pulse 120H or the Quanta Litho 100 clinical laser system. Two PEs (0.4 and 1 J), three fiber-stone standoff distances (SDs) (0.5, 1, 2 mm), and all available pulse duration and modulation modes for each laser were tested in combination. Fiber speed was adjusted to scan across the stone surface at either 1 or 10 pulses/mm to form single pulse craters or an ablation trough, respectively. Volumes of single craters and 1 mm trough segments were imaged and quantified using optical coherence tomography. Results: Ablation volumes decreased with decreasing PE and increasing SD. Statistically significant variability was seen between pulse types (PT) at every tested parameter set. Among pulse modulation modes, Moses Distance (MD) was superior at 0.5 mm in all testing and at 2 mm in trough testing. Vapor Tunnel (VT) was superior in 2 mm single crater testing. All modulated pulses performed similarly at 1 mm. Conclusions: In this benchtop model of laser lithotripsy, stone ablation was significantly impacted by PT. MD demonstrated superior or noninferior stone ablation at most tested parameters. VT maintained its efficacy the best as SD increased. Future work should focus on the mechanistic differences of these modes relative to other traditional laser pulse modes.
Collapse
Affiliation(s)
- Russell S. Terry
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA.,Address correspondence to: Russell S. Terry, MD, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Box 100247, Gainesville, FL 32610, USA
| | - Derek S. Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Dominick M. Scialabba
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Patrick S. Whelan
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert Qi
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Michael E. Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
15
|
Whelan P, Kim C, Tabib C, Preminger GM, Lipkin ME. Evolution of Single-Use Urologic Endoscopy: Benchtop and Initial Clinical Assessment of a New Single-Use Flexible Cystoscope. J Endourol 2021; 36:13-21. [PMID: 34235971 DOI: 10.1089/end.2021.0219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Office cystoscopy is one of the most frequently performed procedures by a urologist. However, single-use cystoscopes remain quite undeveloped. Ambu® has developed single-use broncoscopes, rhinolaryngoscopes and duodenoscopes. Recently, they released a single-use cystoscope. In this study, we performed a benchtop and initial clinical assessment of the Ambu® aScope™ (4) Cysto single-use cystoscope. Methods Ten new, never-used Ambu® aScope™ (4) Cysto single-use cystoscopes were assessed for optical performance, maximal tip flexion and irrigation flow rate with empty working channel, 365μm laser fiber, 0.035in hydrophilic-tipped wire, 1.9Fr nitinol basket and a 1.8mm flexible stent grasper. All cystoscopes were then fully flexed 25 times in each direction, and maximal flexion angles were re-measured with and without instruments. Optical resolution, distortion, and depth of field was measured and compared to our reusable digital flexible cystoscopes. Assessment of clinical use was performed for inpatient bedside procedures using a Likert feedback survey and the NASA Task-Load-Index. Results Maximal upward flexion exceeded 200○ and 160○ for all working instruments in upward and downward flexion. Downward flexion demonstrated different flexion between instrument groups in pre- and post-cycling (p<0.001). There was no clinical difference between the pre- or post-cycling flexion. Flow rate decreased with increasing working instrument size (p<0.001). The Olympus HD cystoscope resolution was superior at 3mm and 5mm distance, but not at other distances. The Ambu® scope was superior to the Olympus SD scope at all distances except 3mm. The aScope™ (4) Cysto had higher Likert scale survey scores for clinical use. Conclusions The new Ambu® single-use cystoscope demonstrates good flexion across instruments and comparable optics to reusable cystoscopes. Additionally, initial inpatient bedside use of the aScope™ (4) Cysto and Monitor system compares favorably to the Olympus reusable cystoscope. Further testing in clinical scenarios such as hematuria, urothelial carcinoma and operative endoscopy is warranted.
Collapse
Affiliation(s)
- Patrick Whelan
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Christopher Kim
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Christian Tabib
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Glenn M Preminger
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| | - Michael Eric Lipkin
- Duke University Medical Center, 22957, Surgery, Urology, Durham, North Carolina, United States;
| |
Collapse
|
16
|
Whelan P, Preminger GM. Case of the Month from Duke University Medical Centre: a complete renal staghorn stone. BJU Int 2021; 128:25-28. [PMID: 34160133 DOI: 10.1111/bju.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick Whelan
- Division of Urological Surgery, Duke University Medical Centre, Durham, NC, USA
| | - Glenn M Preminger
- Division of Urological Surgery, Duke University Medical Centre, Durham, NC, USA
| |
Collapse
|
17
|
Ho DS, Scialabba D, Terry RS, Ma X, Chen J, Sankin GN, Xiang G, Qi R, Preminger GM, Lipkin ME, Zhong P. The Role of Cavitation in Energy Delivery and Stone Damage During Laser Lithotripsy. J Endourol 2021; 35:860-870. [PMID: 33514285 DOI: 10.1089/end.2020.0349] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Although cavitation during laser lithotripsy (LL) contributes to the Moses effect, the impact of cavitation on stone damage is less clear. Using different laser settings, we investigate the role of cavitation bubbles in energy delivery and stone damage. Materials and Methods: The role of cavitation in laser energy delivery was characterized by using photodetector measurements synced with high-speed imaging for laser pulses of varying durations. BegoStone samples were treated with the laser fiber oriented perpendicularly in contact with the stone in water or in air to assess the impact of cavitation on crater formation. Crater volume and geometry were quantified by using optical coherence tomography. Further, the role of cavitation in stone damage was elucidated by treatment in water with the fiber oriented parallel to the stone surface and by photoelastic imaging. Results: Longer pulse durations resulted in higher energy delivery but smaller craters. Stones treated in water resulted in greater volume, wider yet shallower craters compared with those treated in air. Stones treated with the parallel fiber showed crater formation after 15 pulses, confirmed by high-speed imaging of the bubble collapse with the resultant stress field captured by photoelastic imaging. Conclusions: Despite improved energy delivery, the longer pulse mode produced smaller crater volume, suggesting additional processes secondary to photothermal ablation are involved in stone damage. Our critical observations of the difference in stone damage treated in water vs in air, combined with the crater formation by parallel fiber, suggest that cavitation is a contributor to stone damage during LL.
Collapse
Affiliation(s)
- Derek S Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Dominick Scialabba
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Russell S Terry
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Xiaojian Ma
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Department of Research and Development, China Academy of Launch Vehicle Technology, Beijing, China
| | - Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Georgy N Sankin
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Gaoming Xiang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Robert Qi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| |
Collapse
|
18
|
Shah A, Polascik TJ, George DJ, Anderson J, Hyslop T, Ellis AM, Armstrong AJ, Ferrandino M, Preminger GM, Gupta RT, Lee WR, Barrett NJ, Ragsdale J, Mills C, Check DK, Aminsharifi A, Schulman A, Sze C, Tsivian E, Tay KJ, Patierno S, Oeffinger KC, Shah K. Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network. J Gen Intern Med 2021; 36:92-99. [PMID: 32875501 PMCID: PMC7858708 DOI: 10.1007/s11606-020-06124-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs. post-implementation (2/2/2017-2/21/2018). PARTICIPANTS Men, aged 40-75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and post-implementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS During the pre- and post-implementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the pre-implementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ariel Schulman
- Duke University, Durham, NC, USA.,Maimonides Medical Center, New York, NY, USA
| | - Christina Sze
- Duke University, Durham, NC, USA.,Weill Cornell Medical College, New York, NY, USA
| | | | - Kae Jack Tay
- Duke University, Durham, NC, USA.,SingHealth, Duke-NUS, Singapore, Singapore
| | | | | | | |
Collapse
|
19
|
Abstract
Introduction: Single-use flexible ureteroscopes are an increasingly popular alternative to reusable ureteroscopes. In this study, we performed a benchtop examination of the physical and optical properties of the new Dornier Axis™ (Webling, Germany) single-use ureteroscope. Methods: Ten new, never-used Dornier Axis ureteroscopes were assessed for optical performance, maximal tip deflection, and irrigation flow rate with an empty working channel and with insertion of 200 and 365 μm laser fibers, and a 1.9F nitinol basket. All ureteroscopes were then fully deflected 100 times in each direction, and maximal deflection angles were re-measured with and without instruments in the working channel. All measurements were performed in duplicate. In vitro optical testing for resolution, image distortion, and depth of field was performed and compared vs the LithoVue™ (Boston Scientific, Marlborough, MA) single-use ureteroscope. Statistical analyses using paired Wilcoxon rank-sum tests and Kruskal-Wallis multiple-group comparison tests were performed in R. Results: Median maximal deflection angles exceeded 300° in both directions before and after 100 full deflection cycles for all groups except the 365 μm laser fiber group. After 100 deflection cycles, there was no change in the majority of working instruments, except a decrease in upward flexion with an empty channel and 200 μm Moses™ laser fiber, and downward flexion with 200 μm Flexiva™ laser fiber (all <10°). After excluding the 365 μm fiber, there was no difference in multi-group comparison for upward and downward flexion pre- and post-cycling. Median flow rate through an empty channel was 48.0 mL/min, and it decreased significantly with all used instruments (p < 0.001). Compared with the LithoVue, the Axis demonstrated superior resolution at all tested distances and less distortion. Conclusions: The new Dornier Axis single-use ureteroscope demonstrates excellent tip deflection, which remains unchanged after 100 manual flexions in each direction. The Axis also demonstrates superior optical performance compared with the LithoVue in benchtop testing.
Collapse
Affiliation(s)
- Patrick Whelan
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Russell S Terry
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert Qi
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Ketterman
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
20
|
Terry R, Boydston K, Lipkin M, Preminger GM. Letter to the Editor—Reply. Urology 2020; 143:270. [DOI: 10.1016/j.urology.2020.06.012] [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: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
|
21
|
Youssef RF, Martin JW, Sakhaee K, Poindexter J, Dianatnejad S, Scales CD, Preminger GM, Lipkin ME. Rising occurrence of hypocitraturia and hyperoxaluria associated with increasing prevalence of stone disease in calcium kidney stone formers. Scand J Urol 2020; 54:426-430. [PMID: 32715836 DOI: 10.1080/21681805.2020.1794955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate metabolic risk factors in calcium kidney stone formers from two different decades, comparing changes in metabolic profiles over time. METHODS A retrospective analysis was performed of calcium kidney stone formers who underwent metabolic evaluation of urolithiasis with 24-hour urine collections at a single institution. There were 309 patients evaluated from 1988 to 1994 (Group A), and 229 patients from 2007 to 2010 (Group B). A comparison between both groups was performed to assess changes in demographics and in metabolic stone profiles. RESULTS Comparing Group A to Group B, the percentage of females increased from 43 to 56%, obese patients (BMI ≥ 30) increased from 22 to 35%, and patients ≥ 50 years increased from 29 to 47% (all p < 0.005). A greater percentage of patients had hypocitraturia in the recent cohort (46-60%, p = 0.001), with hypocitraturia significantly more frequent in obese patients (p = 0.005). Hyperoxaluria was also increased in Group B compared to Group A (23-30% p = 0.07), a finding that was significant in males (32-53%, p = 0.001). CONCLUSIONS Urolithiasis has increased in females, obese, and older patients, consistent with population-based studies. We report a rising incidence of hypocitraturia and hyperoxaluria in the contemporary cohort, particularly in obese patients and in males, respectively. Further studies are needed to better characterize the metabolic changes corresponding to the increase in stone disease.
Collapse
Affiliation(s)
- Ramy F Youssef
- Department of Urology, University of California, Irvine, CA, USA
| | - Jeremy W Martin
- Department of Urology, University of California, Irvine, CA, USA
| | - Khashayar Sakhaee
- Department of Internal Medicine, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern, Dallas, TX, USA
| | - John Poindexter
- Department of Internal Medicine, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern, Dallas, TX, USA
| | | | - Charles D Scales
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Michael E Lipkin
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
22
|
Eisner BH, Goldfarb DS, Baum MA, Langman CB, Curhan GC, Preminger GM, Lieske JC, Pareek G, Thomas K, Zisman AL, Papagiannopoulos D, Sur RL. Evaluation and Medical Management of Patients with Cystine Nephrolithiasis: A Consensus Statement. J Endourol 2020; 34:1103-1110. [PMID: 32066273 DOI: 10.1089/end.2019.0703] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder with both autosomal recessive and incompletely dominant inheritance. The disorder disrupts cystine and other dibasic amino acid transport in proximal tubules of the kidney, resulting in recurrent kidney stone formation. Currently, there are no consensus guidelines on evaluation and management of this disease. This article represents the consensus of the author panel and will provide clinicians with a stepwise framework for evaluation and clinical management of patients with cystinuria based on evidence in the existing literature. Materials and Methods: A search of MEDLINE®/PubMed® and Cochrane databases was performed using the following key words: "cystine nephrolithiasis," "cystinuria," "penicillamine, cystine," and "tiopronin, cystine." In total, as of May 2018, these searches yielded 2335 articles, which were then evaluated for their relevance to the topic of evaluation and management of cystinuria. Evidence was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-five articles on the topic of cystinuria or cystine nephrolithiasis were deemed suitable for inclusion in this study. The literature supports a logical evaluation process and step-wise treatment approach beginning with conservative measures: fluid intake and dietary modification. If stone formation recurs, proceed to pharmacotherapeutic options by first alkalinizing the urine and then using cystine-binding thiol drugs. Conclusions: The proposed clinical pathways provide a framework for efficient evaluation and treatment of patients with cystinuria, which should improve overall outcomes of this rare, but highly recurrent, form of nephrolithiasis.
Collapse
Affiliation(s)
- Brian H Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David S Goldfarb
- NYU Langone Health, New York, New York, USA.,NYU School of Medicine, New York, New York, USA
| | - Michelle A Baum
- Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - John C Lieske
- Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Gyan Pareek
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, and King's College, London, United Kingdom
| | - Anna L Zisman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Roger L Sur
- UC San Diego Health, San Diego, California, USA
| |
Collapse
|
23
|
Terry RS, Preminger GM. Metabolic evaluation and medical management of staghorn calculi. Asian J Urol 2019; 7:122-129. [PMID: 32257805 PMCID: PMC7096691 DOI: 10.1016/j.ajur.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/10/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
Abstract
Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system. They may be composed of metabolic or infection stone types. They are often associated with specific metabolic defects. Infection stones are associated with urease-producing bacterial urinary tract infections. The ideal treatment for staghorn calculi is maximal surgical removal. However, some patients are either unwilling or unable to proceed with that modality of treatment, and therefore other management must be used. One such technique is the metabolic evaluation with directed medical management. Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology, and furthermore that even infection stones are usually associated with metabolic abnormalities, metabolic evaluation with directed medical management is recommended for all staghorn stone formers. The scientific basis of this recommendation is reviewed in the present work.
Collapse
Affiliation(s)
- Russell S Terry
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
24
|
Winship B, Wollin D, Carlos E, Peters C, Li J, Terry R, Boydston K, Preminger GM, Lipkin ME. The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy. J Endourol 2019; 33:794-799. [PMID: 31016991 DOI: 10.1089/end.2019.0084] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Temperatures over 43°C-the threshold for cellular injury-may be achieved during ureteroscopic holmium laser lithotripsy. The time to reach and subsequently clear high temperatures at variable laser power settings and irrigation pressures has not been studied. Methods: A flexible or semirigid ureteroscope was placed within an 11/13 F ureteral access sheath inserted into a 250-mL saline bag simulating a normal-caliber ureter, renal pelvis reservoir, and antegrade irrigation flow. A thermocouple was placed adjacent to a 365 μm fiber fired for 45 seconds at 0.6 J/6 Hz, 0.8 J/8 Hz, 1 J/10 Hz, 1 J/20 Hz, and 0.2 J/80 Hz. Irrigation pressures of 200, 100, and 0 mm Hg were tested. Mean temperature changes were recorded with 6°C increase as a threshold for injury (as body temperature is 6°C below 43°C). Results: Semirigid scope: At 200 mm Hg no temperature changes >6°C were observed. At 100 mm Hg, changes >6°C occurred with 1 J/20 Hz within 1 second of activation and returned to ≤6°C within 1 second of cessation. At 0 mm Hg, changes >6°C occurred with all settings; within 1 second at power ≥10 W. Temperatures returned to ≤6°C within 5-10 seconds. Flexible scope: At 200 mm Hg, changes >6°C occurred at 1 J/10 Hz (15 seconds), 0.2 J/80 Hz (3 seconds), and 1 J/20 Hz (2 seconds). Temperatures returned within 6°C of baseline within 2 seconds. At 100 mm Hg, changes >6°C occurred in all but 0.6 J/6 Hz. Temperatures returned to ≤6°C in 5-10 seconds. At 0 mm Hg, all settings produced changes >6°C within 3 seconds, except 0.6 J/6 Hz (35 seconds). Temperatures returned to ≤6°C in under 10 seconds. Conclusions: High temperatures were achieved in our in vitro model in as little as 1 second at common irrigation pressures and laser settings, particularly with a flexible ureteroscope and power ≥10 W. However, with laser cessation, temperatures quickly returned to a safe level at each irrigation pressure.
Collapse
Affiliation(s)
- Brenton Winship
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel Wollin
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Evan Carlos
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chloe Peters
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jingqiu Li
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Russell Terry
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kohldon Boydston
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
25
|
Winship B, Wollin D, Carlos E, Li J, Preminger GM, Lipkin ME. Avoiding a Lemon: Performance Consistency of Single-Use Ureteroscopes. J Endourol 2019; 33:127-131. [DOI: 10.1089/end.2018.0805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brenton Winship
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Evan Carlos
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jingqiu Li
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
26
|
Winship B, Wollin D, Carlos E, Li J, Peters C, Simmons WN, Preminger GM, Lipkin M. Dusting Efficiency of the Moses Holmium Laser: An AutomatedIn VitroAssessment. J Endourol 2018; 32:1131-1135. [DOI: 10.1089/end.2018.0660] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Brenton Winship
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Evan Carlos
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Chloe Peters
- Duke University, School of Medicine, Durham, North Carolina
| | - W. Neal Simmons
- Department of Mechanical Engineering, Duke University, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
27
|
Carlos EC, Peters CE, Wollin DA, Winship BB, Davis LG, Li J, Scales CD, Eaton SH, Preminger GM, Lipkin ME. Psychiatric Diagnoses and Other Factors Associated with Emergency Department Return within 30 Days of Ureteroscopy. J Urol 2018; 201:556-562. [PMID: 30316894 DOI: 10.1016/j.juro.2018.09.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Emergency department visits after ureteroscopy are costly and inconvenient. To better understand those at risk we aimed to identify patient demographic, medical and surgical factors associated with 30-day emergency department presentation following ureteroscopy for urolithiasis with particular attention to those with a history of a psychiatric diagnosis. MATERIALS AND METHODS We retrospectively reviewed 1,576 cases (1,395 adults) who underwent stone related ureteroscopy during 3 years at a total of 2 hospitals. We collected patient demographics, medical history and operative details. The primary outcome was return to the emergency department within 30 days of ureteroscopy. Logistic regression was performed to examine factors associated with emergency department presentation. RESULTS Of the patients 613 (43.9%) had a history of psychiatric diagnosis. Of those with ureteroscopy encounters 12.6% returned to the emergency department within 30 days of ureteroscopy, including 58.8% with a history of psychiatric diagnosis. On multivariable analysis variables associated with emergency department return included a history of psychiatric diagnosis (OR 1.57, p = 0.012), uninsured status (OR 2.46, p = 0.001) and a stone only in the kidney (OR 1.76, p = 0.022). Patients who returned to the emergency department had had more emergency department visits in the year prior to surgery (OR 1.40, p <0.001). On univariable analysis older patients and those with longer operative time were more frequently admitted from the emergency department (OR 1.03, p = 0.002 and OR 1.96, p = 0.03. respectively) while uninsured patients were admitted less frequently (OR 0.19, p = 0.013). No difference was noted in admissions between those with a psychiatric diagnosis and all others (60.7% vs 55.8%, p = 0.48). CONCLUSIONS We identified factors associated with emergency department return after ureteroscopy, including a history of psychiatric diagnosis, uninsured status and emergency department visits in the year before surgery. These patients may benefit from targeted interventions to help avoid unnecessary emergency department visits.
Collapse
Affiliation(s)
- Evan C Carlos
- Division of Urologic Surgery, Durham, North Carolina
| | - Chloe E Peters
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Leah G Davis
- Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - Jingqiu Li
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Charles D Scales
- Division of Urologic Surgery, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | |
Collapse
|
28
|
Wollin DA, Kaplan AG, Preminger GM, Ferraro PM, Nouvenne A, Tasca A, Croppi E, Gambaro G, Heilberg IP. Defining metabolic activity of nephrolithiasis - Appropriate evaluation and follow-up of stone formers. Asian J Urol 2018; 5:235-242. [PMID: 30364613 PMCID: PMC6197397 DOI: 10.1016/j.ajur.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Considering the variation in metabolic evaluation and medical management of kidney stone disease, this consensus review was created to discuss the metabolic activity of nephrolithiasis, define the difference between single and recurrent stone formers, and develop a schema for metabolic and radiologic follow-up. A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis. Both single and recurrent stone formers share many similarities in metabolic profiles. The study group determined that based on an assessment of risk for stone recurrence and metabolic activity, single and recurrent stone formers should be evaluated comprehensively, including two 24 h urine studies on a random diet. Targeted medication and dietary recommendations are effective for many patients in reducing the risk of stone recurrence. Follow-up of those with stone disease should be obtained depending on the level of metabolic activity of the patient, the risk of chronic kidney disease and the risk of osteoporosis/osteopenia. A standard scheme includes a baseline metabolic profile, a repeat study 3-6 months after initiation of treatment, and then yearly when stable, with abdominal imaging obtained every 1-2 years.
Collapse
Affiliation(s)
- Daniel A. Wollin
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Adam G. Kaplan
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Glenn M. Preminger
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Pietro Manuel Ferraro
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Antonio Nouvenne
- University of Parma, Department of Clinical and Experimental Medicine, Parma, Italy
| | - Andrea Tasca
- S. Bortolo Hospital, Department of Urology, Vicenza, Italy
| | - Emanuele Croppi
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Giovanni Gambaro
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Ita P. Heilberg
- Universidade Federal de São Paulo, Nephrology Division, São Paulo, Brazil
| |
Collapse
|
29
|
Aksenov LI, Wietsma AC, Lipkin ME, Routh JC, Preminger GM, Scales CD. Analgesic Prescribing Patterns for Acute Symptomatic Kidney Stones in Emergency Departments. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.425] [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]
|
30
|
Cone EB, Hammill BG, Routh JC, Lipkin ME, Preminger GM, Schmader KE, Scales CD. Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones. Urology 2018; 120:103-108. [PMID: 29940233 PMCID: PMC6689223 DOI: 10.1016/j.urology.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe variation in utilization and costs of inpatient care for patients with kidney stones, examining associations with older age. MATERIALS AND METHODS Using the Nationwide Inpatient Sample we examined inpatient discharges with stone diagnoses from 2007 to 2011. We examined length of stay, hospitalization cost, and postdischarge care utilization using multivariable regression to identify associations between patient/hospital characteristics and resource. RESULTS An estimated 1.7 million hospital discharges for stone disease occurred during the study period. Median length of stay was 2.1 days with a median cost of $6300. Hospital use was substantially higher among persons ≥65 years old (older adults) as compared to those aged 18-64 (younger adults): median length of stay was 3.1 days, with 25% staying more than 5.9 days. Older adults were significantly more likely to utilize home health (odds ratio [OR] 3.6) or skilled nursing (OR 5.0) after discharge. Older adults accounted for 1 in 3 hospital discharges, 40% of costs, and half of postdischarge care utilization. They were more likely to be septic during hospitalization (OR 1.8) which doubled costs per episode, but less likely to receive surgery (OR 0.93). CONCLUSION While historically at lower risk for kidney stones compared to younger adults, older adults utilizing inpatient care account for a disproportionate share of the economic burden of disease. Utilization is higher for older adults across multiple dimensions, including hospital costs, length of stay, and postdischarge care. These findings suggest that efforts to understand and mitigate the impact of kidney stones on this vulnerable population are required.
Collapse
Affiliation(s)
- Eugene B Cone
- Duke Clinical Research Institute, Durham, NC; Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC.
| | - Bradley G Hammill
- Duke Clinical Research Institute, Durham, NC; Duke University Medical Center, Department of Medicine, Durham, NC
| | - Jonathan C Routh
- Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC; Duke University Medical Center, Department of Pediatrics, Durham, NC
| | - Michael E Lipkin
- Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC
| | - Glenn M Preminger
- Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC
| | - Kenneth E Schmader
- Duke University Medical Center, Department of Medicine, Durham, NC; Duke University School of Medicine, Durham, NC; Durham VA Medical Center, Geriatric Research Education and Clinical Center, Durham, NC
| | - Charles D Scales
- Duke Clinical Research Institute, Durham, NC; Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC
| |
Collapse
|
31
|
Carlos EC, Youssef RF, Kaplan AG, Wollin DA, Winship BB, Eisner BH, Sur RL, Preminger GM, Lipkin ME. Antibiotic Utilization Before Endourological Surgery for Urolithiasis: Endourological Society Survey Results. J Endourol 2018; 32:978-985. [DOI: 10.1089/end.2018.0494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan C. Carlos
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| | - Ramy F. Youssef
- Department of Urology, University of California, Irvine, California
| | - Adam G. Kaplan
- Department of Urology, St. Joseph Health Medical Group, Santa Rosa, California
| | - Daniel A. Wollin
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| | - Brent B. Winship
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Roger L. Sur
- Department of Urology, UC San Diego Health System, San Diego, California
| | - Glenn M. Preminger
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
32
|
Carlos EC, Li J, Young BJ, Radvak D, Wollin DA, Winship BB, Simmons WN, Preminger GM, Lipkin ME. Let's Get to the Point: Comparing Insertion Characteristics and Scope Damage of Flat-Tip and Ball-Tip Holmium Laser Fibers. J Endourol 2018; 33:22-26. [PMID: 29943662 DOI: 10.1089/end.2018.0229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A ball-tip holmium laser fiber (TracTip; Boston Scientific) has been developed to theoretically reduce damaging friction forces generated within a ureteroscope working channel. We compared the insertional forces and damage with a ureteroscope inner lining when inserting standard flat-tip and ball-tip laser fibers. MATERIALS AND METHODS A standard ureteroscope channel liner was placed in a 3D-printed plastic mold. Molds were created at four angles of deflection (30°, 45°, 90°, and 180°) with a 1 cm radius of curvature. New 200 μm ball-tip (TracTip; Boston Scientific) and 200 μm flat-tip (Flexiva; Boston Scientific) laser fibers were advanced through the liner using a stage controller. A strain gauge was used to measure force required for insertion. Each fiber was passed 600 times at each angle of deflection. The ureteroscope liner was changed every 150 passes. Leak testing was performed every 50 passes or when the insertional force increased significantly to assess damage to the liner. RESULTS At all deflection angles, the average insertional force was significantly lower with the ball-tip laser fibers compared with flat-tip laser fibers (p < 0.001). All trials with the ball-tip lasers were completed at each angle without any leaks. Two of four trials using flat-tip fibers at 45° deflection caused liner leaks (at 91 and 114 passes). At 90° deflection, all flat-tip trials caused liner leaks on first pass. The 180° trials could not physically be completed with the flat-tip laser fiber. Within the flat- and ball-tip groups, an increasing amount of force was needed to pass the fiber as the degree of deflection increased (p < 0.001). CONCLUSIONS The ball-tip holmium laser fiber can be safely passed through a deflected ureteroscope without causing liner perforation. The standard flat-tip fiber requires greater insertion force at all angles and can cause the ureteroscope liner to leak if it is deflected 45° or more.
Collapse
Affiliation(s)
- Evan C Carlos
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Jingqiu Li
- 2 National University of Singapore, Duke-NUS Medical School , Singapore, Singapore
| | - Brian J Young
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniela Radvak
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Daniel A Wollin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Brenton B Winship
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Walter Neal Simmons
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
33
|
Wollin DA, Gupta RT, Young B, Cone E, Kaplan A, Marin D, Patel BN, Mazurowski MA, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi? Urology 2018; 120:56-61. [PMID: 30006268 DOI: 10.1016/j.urology.2018.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation. MATERIALS AND METHODS Seven fresh tissue cadavers were implanted with stones of known size and/or composition and imaged with KUB, DT, and NCCT. Four blinded readers (2 urologists, 2 radiologists) evaluated KUBs for presence and/or location of calculi. They then re-evaluated with addition of tomograms to assess additional value. After a memory extinction period, readers evaluated NCCT images. Accuracy of detection was determined using nearest-neighbor match with generalized linear mixed modeling. RESULTS Total of 59 stones were identified on reference read. Overall, NCCT and DT were both superior to KUB alone (P < .001) while the difference between DT and NCCT was not significant (P = .06). When evaluating uric acid stones, NCCT and DT outperformed KUB (P < .01 and P < .05, respectively) while DT and NCCT were similar (P = .16). Intrarenal stones were better evaluated on DT and NCCT (P < .001 compared to KUB), while DT and NCCT were similar (P = 1.00). Accuracy was lower than anticipated across modalities due to use of the cadaver model. CONCLUSION Our study demonstrates DT is superior to KUB for identification of intrarenal calculi and could replace routine use of KUB or NCCT for detecting renal stones, even those composed of uric acid.
Collapse
Affiliation(s)
- Daniel A Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Rajan T Gupta
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC; Department of Radiology, Duke University Medical Center, Durham, NC
| | - Brian Young
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Eugene Cone
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Adam Kaplan
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Bhavik N Patel
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiology, Stanford University, Palo Alto, CA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| |
Collapse
|
34
|
Wollin DA, Tom WR, Jiang R, Simmons WN, Preminger GM, Lipkin ME. An in vitro evaluation of laser settings and location in the efficiency of the popcorn effect. Urolithiasis 2018; 47:377-382. [PMID: 29947996 DOI: 10.1007/s00240-018-1066-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
To examine different locations and laser settings' effects on the efficiency of the "popcorn" method of laser lithotripsy, which consists of placing the laser in a group of small stones and firing continuously to break them into smaller particles. Pre-fragmented BegoStones were created between 2 and 4 mm to mimic typical popcorning conditions. A 0.5 g collection of fragments was placed into 3D-printed models (a spherical calyx and ellipsoid pelvis model) and a 200-µm laser fiber was positioned above the stones. The laser was fired for 2 min with irrigation, with 5 trials at each setting: 0.2 J/50 Hz, 0.5 J/20 Hz, 0.5 J/40 Hz, 1 J/20 Hz, 0.2 J/80 Hz, 0.5 J/80 Hz. After drying, fragmentation efficiency was determined by calculating the mass of stones reduced to sub-2 mm particles. Statistical analysis was performed with ANOVA and Student's t test. The trials within the calyx model were significantly more efficient compared to the pelvis (0.19 vs 0.15 g, p = 0.01). When comparing laser settings, there was a difference between groups by one-way ANOVA [F(5,54) = 8.503, p = 5.47 × 10-6]. Post hoc tests showed a power setting of 0.5 J/80 Hz was significantly more efficient than low-power settings 0.2 J/50 Hz and 0.5 J/20 Hz (p < 0.05). Additionally, 0.2 J/50 Hz was significantly less efficient than 0.5 J/40 Hz, 1 J/20 Hz, and 0.2 J/80 Hz. Popcorning is most efficient in smaller spaces; we recommend displacement of stones into a calyx before popcorning. No difference was seen between high-power settings, although 0.5 J/40 Hz and 0.5 J/80 Hz performed best, suggesting that moderate energy popcorning methods with at least 0.5 J per pulse are most efficient.
Collapse
Affiliation(s)
- Daniel A Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Westin R Tom
- Duke University School of Medicine, Durham, NC, USA
| | - Ruiyang Jiang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - W Neal Simmons
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
35
|
Carlos EC, Wollin DA, Winship BB, Jiang R, Radvak D, Chew BH, Gustafson MR, Simmons WN, Zhong P, Preminger GM, Lipkin ME. In Vitro Comparison of a Novel Single Probe Dual-Energy Lithotripter to Current Devices. J Endourol 2018; 32:534-540. [PMID: 29649900 DOI: 10.1089/end.2018.0143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The LithoClast Trilogy is a novel single probe, dual-energy lithotripter with ultrasonic (US) vibration and electromagnetic impact forces. ShockPulse and LithoClast Select are existing lithotripters that also use a combination of US and mechanical impact energies. We compared the efficacy and tip motion of these devices in an in vitro setting. MATERIALS AND METHODS Begostones, in the ratio 15:3, were used in all trials. Test groups were Trilogy, ShockPulse, Select ultrasound (US) only, and Select ultrasound with pneumatic (USP). For clearance testing, a single investigator facile with each lithotripter fragmented 10 stones per device. For drill testing, a hands-free apparatus with a submerged balance was used to apply 1 or 2 lbs of pressure on a stone in contact with the device tip. High-speed photography was used to assess Trilogy and ShockPulse's probe tip motion. RESULTS Select-USP was slowest and Trilogy fastest on clearance testing (p < 0.01). On 1 lbs drill testing, Select-US was slowest (p = 0.001). At 2 lbs, ShockPulse was faster than Select US (p = 0.027), but did not significantly outpace Trilogy nor Select-USP. At either weight, there was no significant difference between Trilogy and ShockPulse. During its US function, Trilogy's maximum downward tip displacement was 0.041 mm relative to 0.0025 mm with ShockPulse. Trilogy had 0.25 mm of maximum downward displacement during its impactor function while ShockPulse had 0.01 mm. CONCLUSIONS Single probe dual-energy devices, such as Trilogy and ShockPulse, represent the next generation of lithotripters. Trilogy more efficiently cleared stone than currently available devices, which could be explained by its larger probe diameter and greater downward tip displacement during both US and impactor functions.
Collapse
Affiliation(s)
- Evan C Carlos
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniel A Wollin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Brenton B Winship
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Ruiyang Jiang
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniela Radvak
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Ben H Chew
- 3 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
- 4 Endourology Disease Group for Excellence (EDGE) Research Consortium
| | - Michael R Gustafson
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - W Neal Simmons
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Pei Zhong
- 2 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
- 4 Endourology Disease Group for Excellence (EDGE) Research Consortium
| |
Collapse
|
36
|
Taffel MT, Nikolaidis P, Beland MD, Blaufox MD, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Preminger GM, Purysko AS, Smith AD, Wang ZJ, Weinfeld RM, Wong-You-Cheong JJ, Remer EM, Lockhart ME. ACR Appropriateness Criteria ® Renal Transplant Dysfunction. J Am Coll Radiol 2018; 14:S272-S281. [PMID: 28473084 DOI: 10.1016/j.jacr.2017.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Myles T Taffel
- Principal Author, George Washington University Hospital, Washington, District of Columbia.
| | - Paul Nikolaidis
- Panel Vice-chair, Northwestern University, Chicago, Illinois
| | | | - M Donald Blaufox
- Albert Einstein College of Medicine, Bronx, New York; Society of Nuclear Medicine and Molecular Imaging
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia; Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | - Glenn M Preminger
- Duke University Medical Center, Durham, North Carolina; American Urological Association
| | | | - Andrew D Smith
- The University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
| | | | | | - Mark E Lockhart
- Panel Chair, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
37
|
Winship BB, Preminger GM. Editorial Comment on: Outpatient Percutaneous Nephrolithotomy: The UC San Diego Health Experience by Bechis et al. J Endourol 2018; 32:402. [PMID: 29571267 DOI: 10.1089/end.2018.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brenton B Winship
- Department of Urology, Duke University Medical Center , Durham, North Carolina
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
38
|
Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME. Effect of Laser Settings and Irrigation Rates on Ureteral Temperature During Holmium Laser Lithotripsy, anIn VitroModel. J Endourol 2018; 32:59-63. [DOI: 10.1089/end.2017.0658] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Daniel A. Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Evan C. Carlos
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Westin R. Tom
- Duke University School of Medicine, Durham, North Carolina
| | - W. Neal Simmons
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
39
|
Abstract
Percutaneous nephrolithotomy is a common surgical treatment for large and complex stones within the intrarenal collecting system. A wide variety of complications can result from this procedure, including bleeding, injury to surrounding structures, infection, positioning-related injuries, thromboembolic disease, and even death. Knowledge of the different types of complications can be useful in order to prevent, diagnose, and treat these problems if they occur. This review describes the diversity of complications with the goal of improving their avoidance and treatment.
Collapse
Affiliation(s)
- Daniel A Wollin
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA.
| | - Glenn M Preminger
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA
| |
Collapse
|
40
|
Cone EB, Jibara G, Wollin D, Preminger GM. Subcapsular Splenic Urinoma and Splenorenal Fistula: A New Complication of Percutaneous Nephrolithotomy. J Endourol Case Rep 2017; 3:134-137. [PMID: 29098195 PMCID: PMC5655835 DOI: 10.1089/cren.2017.0085] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Splenic urinoma has not been previously reported as a complication of percutaneous nephrolithotomy (PNL). Case Presentation: A 46-year-old Caucasian male underwent PNL for two large left renal stones. Surgery was performed in prone split-leg position, with access obtained through combined fluoroscopic guidance and direct ureteroscopic observation of the targeted calix. The tract was dilated to 30F using a pressure balloon, and complete clearance of stones was obtained through a combination of rigid and flexible nephroscopy, as well as antegrade ureteroscopy. The patient was left with a Double-J ureteral stent on a string for removal in 1 week. After overnight observation, his hemoglobin, white blood cell count, and renal function were normal and thus he was discharged home. The day after stent removal, he presented to the emergency department with abdominal pain, was found to have mild left hydronephrosis on CT, and was discharged on 1 week of antibiotics. One week later he re-presented with worsening abdominal pain and was found to have an elevated creatinine and a white blood cell count of 21 × 109/L. On contrasted CT with delayed images, an 18 cm splenic fluid collection was seen with a fistulous connection to the left kidney collecting system. He underwent emergent stent placement and improved clinically without drainage of the urinoma. A renal ultrasonography 1 month after stent placement confirmed resolution of the splenic urinoma, so the stent was removed at 1 month. Follow-up CT 1 month after stent removal was normal without any evidence of fistula or urinoma recurrence. Conclusion: This is the first report of a subcapsular splenic urinoma and splenorenal fistula post-PNL. Ureteral stent placement was sufficient for drainage and to resolve the complication.
Collapse
Affiliation(s)
- Eugene B Cone
- Division of Urology, Duke Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Ghalib Jibara
- Division of Urology, Duke Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Daniel Wollin
- Division of Urology, Duke Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Glenn M Preminger
- Division of Urology, Duke Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
41
|
York NE, Borofsky MS, Chew BH, Dauw CA, Paterson RF, Denstedt JD, Razvi H, Nadler RB, Humphreys MR, Preminger GM, Nakada SY, Krambeck AE, Miller NL, Terry C, Rawlings LD, Lingeman JE. Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy. J Endourol 2017; 31:1145-1151. [PMID: 28859485 DOI: 10.1089/end.2017.0436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Prospective, randomized controlled trial at nine centers in North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual-probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO2 cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS-II ultrasonic lithotripter to allow fair comparison with combination devices. RESULTS Two hundred seventy patients were enrolled, 69 were excluded after randomization. Two hundred one patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select group, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8 mm2 vs 577.5 mm2 (Lithoclast Select) and 627.9 mm2 (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm2/min vs 28.9 mm2/min and 32.3 mm2/min in the Lithoclast Select and Cyberwand groups, respectively. After statistically adjusting for the smaller mean stone in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p = 0.249). Secondary outcomes, including complications and stone-free rates, were similar between the groups. CONCLUSIONS The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones >2 cm. The safety and efficacy of these devices are comparable.
Collapse
Affiliation(s)
- Nadya E York
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael S Borofsky
- 2 Department of Urology, University of Minnesota , Minneapolis, Minnesota
| | - Ben H Chew
- 3 Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, Canada
| | - Casey A Dauw
- 4 Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - Ryan F Paterson
- 3 Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, Canada
| | - John D Denstedt
- 5 Division of Urology, Western University , London, Ontario, Canada
| | - Hassan Razvi
- 5 Division of Urology, Western University , London, Ontario, Canada
| | - Robert B Nadler
- 6 Department of Urology, Northwestern University , Chicago, Illinois
| | | | | | - Stephen Y Nakada
- 9 Department of Urology, University of Wisconsin , Madison, Wisconsin
| | - Amy E Krambeck
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.,10 Mayo Clinic , Rochester, Minnesota
| | - Nicole L Miller
- 11 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Colin Terry
- 12 Methodist Research Institute , Indianapolis, Indiana
| | - Lori D Rawlings
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James E Lingeman
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| |
Collapse
|
42
|
Tom WR, Wollin DA, Jiang R, Radvak D, Simmons WN, Preminger GM, Lipkin ME. Next-Generation Single-Use Ureteroscopes: An In Vitro Comparison. J Endourol 2017; 31:1301-1306. [PMID: 28978227 DOI: 10.1089/end.2017.0447] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Single-use ureteroscopes have been gaining popularity in recent years. We compare the optics, deflection, and irrigation flow of two novel single-use flexible ureteroscopes-the YC-FR-A and the NeoFlex-with contemporary reusable and single-use flexible ureteroscopes. METHODS Five flexible ureteroscopes, YC-FR-A (YouCare Tech, China), NeoFlex (Neoscope, Inc., USA), LithoVue (Boston Scientific, USA), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany), were assessed in vitro for image resolution, distortion, field of view, depth of field, color representation, and grayscale imaging. Ureteroscope deflection and irrigation were also compared. RESULTS The YC-FR-A showed a resolution of 5.04 lines/mm and 4.3% image distortion. NeoFlex showed a resolution of 17.9 lines/mm and 14.0% image distortion. No substantial difference was demonstrated regarding the other optic characteristics between the two. Across all tested ureteroscopes, single-use or reusable, the digital scopes performed best with regard to optics. The YC-FR-A had the greatest deflection at baseline, but lacks two-way deflection. The NeoFlex had comparable deflection at baseline to reusable devices. Both ureteroscopes had substantial loss of deflection with instruments in the working channel. The YC-FR-A had the greatest irrigation rate. The NeoFlex has comparable irrigation to contemporary ureteroscopes. CONCLUSIONS The YouCare single-use fiberoptic flexible ureteroscope and NeoFlex single-use digital flexible ureteroscope perform comparably to current reusable ureteroscopes, possibly making each a viable alternative in the future. Newer YouCare single-use flexible ureteroscopes with a digital platform and two-way deflection may be more competitive, while the NeoFlex devices are undergoing rapid improvement as well. Further testing is necessary to validate the clinical performance and utility of these ureteroscopes, given the wide variety of single-use devices under development.
Collapse
Affiliation(s)
- Westin R Tom
- 1 Duke University School of Medicine , Durham, North Carolina
| | - Daniel A Wollin
- 2 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Ruiyang Jiang
- 2 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Daniela Radvak
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Walter Neal Simmons
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 2 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 2 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
43
|
Cabrera FJ, Shin RH, Waisanen KM, Nguyen G, Wang C, Scales CD, Ferrandino MN, Preminger GM, Yoshizumi TT, Lipkin ME. Comparison of Radiation Exposure from Fixed Table Fluoroscopy to a Portable C-Arm During Ureteroscopy. J Endourol 2017. [PMID: 28622024 DOI: 10.1089/end.2017.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Current treatment practices within the field of endourology require the routine use of radiation exposure to provide adequate imaging during urologic procedures. One such procedure requiring repeated radiation exposure during treatment is ureteroscopy. We set out to compare estimated fluoroscopic radiation exposures employing fixed table and portable C-arm fluoroscopy. MATERIALS AND METHODS A cross-sectional dosimetry phantom model was placed supine on both fixed fluoroscopy and standard operating room tables. The models were then exposed to three separate 5-minute runs of fluoroscopic exposure. Metal oxide semiconductor field effect transistor dosimeters were utilized in organ-specific locations to determine specific radiation exposure dosages. Absorbed radiation was determined for each organ location for both fluoroscopy units. Organ dose volumetric corrections were performed for skin and red bone marrow, to correct for the nonirradiated portion. Organ dose rate (ODR, mGy/s) and effective dose rate (EDR, mSv/s) were calculated, with values reported as mean ± standard deviation. RESULTS There were found to be statistically significant elevations for both total EDR and organ-specific dose rates with the use of fixed table fluoroscopy compared with C-arm fluoroscopy. EDR was found to be 0.0240 ± 0.0019 mSv/s for the fixed table unit and 0.0029 ± 0.0005 mSv/s for the C-arm unit (p = 0.0024). Internal organs exposed to the most radiation during fixed table fluoroscopy included the gall bladder and stomach in comparison to C-arm fluoroscopy, which found elevated exposure in the kidneys, pancreas, and spleen. CONCLUSION The routine use of fixed table fluoroscopy results in significantly elevated estimated organ doses and EDR when directly compared with C-arm fluoroscopy in model trials. This difference should be taken into consideration by practicing urologists when patient treatment requires the use of fluoroscopy to maintain radiation exposure as low as reasonably achievable.
Collapse
Affiliation(s)
| | - Richard H Shin
- 2 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina
| | - Kyle M Waisanen
- 1 Department of Urology, Cleveland Clinic Florida , Weston, Florida
| | - Giao Nguyen
- 3 Radiation Safety Division, Duke University Medical Center , Durham, North Carolina.,4 Department of Radiology, Duke University Medical Center , Durham, North Carolina
| | - Chu Wang
- 5 Radiation Safety Office, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Charles D Scales
- 2 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina.,6 Duke Clinical Research Institute, Duke University , Durham, North Carolina
| | - Michael N Ferrandino
- 2 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina
| | - Glenn M Preminger
- 2 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina
| | - Terry T Yoshizumi
- 3 Radiation Safety Division, Duke University Medical Center , Durham, North Carolina.,4 Department of Radiology, Duke University Medical Center , Durham, North Carolina.,7 Department of Radiation Oncology, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 2 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
44
|
Xing Y, Chen TT, Simmons WN, Sankin G, Cocks FH, Lipkin ME, Preminger GM, Zhong P. Comparison of Broad vs Narrow Focal Width Lithotripter Fields. J Endourol 2017; 31:502-509. [PMID: 28340536 DOI: 10.1089/end.2016.0560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the impact of lithotripter focal width on stone fragmentation. MATERIALS AND METHODS A modified reflector was used to reduce -6 dB beam size of the HM3 lithotripter, while increasing concomitantly peak pressure. Fragmentation in vitro was assessed with modified and original reflectors using BegoStone phantoms. A membrane holder was used to mimic lithotripsy in vivo, and a matrix holder was used to assess variations of fragmentation power in the focal plane of the lithotripter field. Stone fragmentation in vivo produced by the two reflectors was further compared in a swine model. RESULTS Stone fragmentation in vitro after 500 (or 2000) shocks was ∼60% (or ∼82%) vs ∼40% (or ∼75%) with original and modified reflector, respectively (p ≤ 0.0016). Fragmentation power with the modified reflector was the highest on the lithotripter axis, but dropped rapidly in the lateral direction and became insignificant at radial distances >6.0 mm. Stone fragmentation with the original reflector was lower along the lithotripter axis, but fragmentation power decayed slowly in lateral direction, with appreciable fragmentation produced at 6.0 mm. Stone fragmentation efficiency in vivo after 500 (or 2000) shocks was ∼70% (or ∼90%) vs ∼45% (or ∼80%) with original and modified reflector, respectively (p ≤ 0.04). CONCLUSIONS A lithotripter field with broad beam size yields superior stone comminution when compared with narrow beam size under comparable effective acoustic pulse energy both in vivo and in vitro. These findings may facilitate future improvements in lithotripter design to maximize comminution efficiency while minimizing tissue injury.
Collapse
Affiliation(s)
- Yifei Xing
- 1 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Tony T Chen
- 2 School of Medicine, Duke University , Durham, North Carolina
| | - Walter N Simmons
- 1 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Georgy Sankin
- 1 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Franklin H Cocks
- 1 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Michael E Lipkin
- 3 Comprehensive Kidney Stone Center/Urologic Surgery, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 3 Comprehensive Kidney Stone Center/Urologic Surgery, Duke University , Durham, North Carolina
| | - Pei Zhong
- 1 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina.,3 Comprehensive Kidney Stone Center/Urologic Surgery, Duke University , Durham, North Carolina
| |
Collapse
|
45
|
Youssef RF, Martin JW, Sakhaee K, Poindexter J, Vernez SL, Dutta R, Scales CD, Preminger GM, Lipkin ME. MP01-19 RECENT EPIDEMIOLOGICAL AND METABOLIC TRENDS IN STONE DISEASE: RISING HYPOCITRATURIA AND HYPEROXALURIA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Hobbs KT, Hammill B, Wollin D, Preminger GM, Lipkin ME, Schmader KE, Scales, Jr. CD. MP95-05 INCREASING UTILIZATION OF CARE FOR URINARY STONE DISEASE IN OLDER ADULTS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
47
|
Dale J, Kaplan AG, Radvak D, Shin R, Ackerman A, Chen T, Scales CD, Ferrandino MN, Simmons WN, Preminger GM, Lipkin ME. Evaluation of a Novel Single-Use Flexible Ureteroscope. J Endourol 2017; 35:903-907. [PMID: 27981862 DOI: 10.1089/end.2016.0237] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: A novel single-use flexible ureteroscope promises the optical characteristics and maneuverability of a reusable fourth-generation flexible ureteroscope. In this study, the LithoVue Single-Use Digital flexible ureteroscope was directly compared with contemporary reusable flexible ureteroscopes, with regard to optics, deflection, and irrigation flow. Methods: Three flexible ureteroscopes such as the LithoVue (Single Use; Boston Scientific), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany) were assessed in vitro for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field. Ureteroscope deflection was tested with an empty channel followed by placement of a 200 μm laser fiber and a 1.9F wire basket, a 2.0F nanoelectric pulse lithotripsy (NPL) probe, and a 2.4F NPL probe. Ureteroscope irrigation flow was measured using normal saline at 100 cm, with an empty channel followed by a 200 μm laser fiber, a 1.9F wire basket and a 2.0F NPL probe. Results: The LithoVue showed the largest field of view, with excellent resolution, image distortion, and depth of field. No substantial difference was demonstrated in color reproducibility or in the discernment of grayscales between ureteroscopes. The LithoVue maintained full deflection ability with all instruments in the working channel, although the Flex-Xc and Cobra ureteroscopes showed loss of deflection ranging from 2° to 27°, depending on the instrument placed. With an empty channel, the LithoVue showed an absolute flow rate similar to the Flex-Xc ureteroscope (p = 0.003). It maintained better flow with instruments in the channel than the Flex-Xc ureteroscope. The Cobra ureteroscope has a separate 3.3F instrument channel, keeping flow rates the same with instrument insertion. Conclusion: The LithoVue Single-Use Digital ureteroscope has comparable optical capabilities, deflection, and flow, making it a viable alternative to standard reusable fourth-generation flexible digital and fiberoptic ureteroscopes.
Collapse
Affiliation(s)
- Joanne Dale
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Adam G Kaplan
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Daniela Radvak
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Richard Shin
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Anika Ackerman
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Tony Chen
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Charles D Scales
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | | | - Walter Neal Simmons
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Glenn M Preminger
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University, Durham, North Carolina
| |
Collapse
|
48
|
Kaplan AG, Chen TT, Sankin G, Yang C, Dale JA, Simmons WN, Zhong P, Preminger GM, Lipkin ME. Comparison of the Nanopulse Lithotripter to the Holmium Laser: Stone Fragmentation Efficiency and Impact on Flexible Ureteroscope Deflection and Flow. J Endourol 2016; 30:1150-1154. [PMID: 27736195 DOI: 10.1089/end.2016.0228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The Nanopulse Lithotripter (NPL; Lithotech Medical, Israel) is a novel intracorporeal device that uses a nanosecond duration electrical discharge through a reusable flexible coaxial probe to endoscopically fragment urinary stones. This device was compared with a holmium laser lithotripsy (HoL) with regard to stone fragmentation efficiency (SFE) and its impact on flexible ureteroscope (URS) deflection and flow of irrigation. METHODS Using a custom bench model, a 6 mm BegoStone cylindrical phantom (mixture 5:2) was confined under 0.9% saline atop sequential mesh sieves. The SFE of two NPL probe sizes (2.0F, 3.6F) and two HoL fibers (200, 365 μm) was evaluated using concordant settings of 1 J and 5 Hz. URS deflection and irrigation flow with NPL probes in the working channel were tested in five new fourth generation flexible URS and compared with other adjunct endourologic instruments. RESULTS The 2.0F NPL showed improved SFE compared with the 200 μm laser (86 mg/min vs 52 mg/min, p = 0.014) as did the 3.6F NPL vs the 365 μm laser (173 mg/min vs 80 mg/min, p = 0.05). The NPL created more 1 to 2 mm fragments; the laser created more dust. URS deflection reduced by 3.75° with the 2.0 NPL probe. URS irrigation flow reduced from 36.5 to 6.3 mL/min with the 2.0F NPL probe. CONCLUSION NPL shows improved SFE compared with HoL. Flow with the 2.0F probe is akin to a stone basket. NPL offers an effective alternative to HoL.
Collapse
Affiliation(s)
- Adam G Kaplan
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Tony T Chen
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Georgy Sankin
- 2 Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Chen Yang
- 2 Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Joanne A Dale
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - W Neal Simmons
- 2 Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Pei Zhong
- 2 Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Michael Eric Lipkin
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
49
|
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 2016; 196:1153-60. [DOI: 10.1016/j.juro.2016.05.090] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Dean Assimos
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Amy Krambeck
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Nicole L. Miller
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Manoj Monga
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - M. Hassan Murad
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Caleb P. Nelson
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Kenneth T. Pace
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Vernon M. Pais
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Margaret S. Pearle
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Glenn M. Preminger
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Hassan Razvi
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Ojas Shah
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Brian R. Matlaga
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| |
Collapse
|
50
|
Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, Preminger GM, de la Rosette J. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol 2016; 70:382-96. [DOI: 10.1016/j.eururo.2016.01.047] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022]
|