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Galeano-Lovera SF, Pollak P, Phillips S, Gonzalez C, Cabalka AK, Bravo-Jaimes K. Intravascular Lithotripsy in an Adult With Fontan Pathway Obstruction. JACC Case Rep 2024; 29:102296. [PMID: 38708431 PMCID: PMC11068967 DOI: 10.1016/j.jaccas.2024.102296] [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] [Received: 01/02/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 05/07/2024]
Abstract
Fontan pathway obstruction is a potentially serious complication characterized by an anatomical or functional narrowing anywhere in the cavo-pulmonary pathways. Here, we report the first case in the literature where an innovative Fontan conduit rehabilitation procedure with intravascular lithotripsy was used achieving a dramatic increase in the pathway size.
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Affiliation(s)
| | - Peter Pollak
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Sabrina Phillips
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Carolyn Gonzalez
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Allison K. Cabalka
- Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota, USA
- Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
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Chen X, He L, Yu X, Bo Y, Yu L, Chen Q, Zhao Z. Effects of Thermal Insulation on Recovery and Comfort of Patients Undergoing Holmium Laser Lithotripsy. Med Sci Monit 2024; 30:e942836. [PMID: 38632864 PMCID: PMC11036894 DOI: 10.12659/msm.942836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Patients with urolithiasis often undergo transurethral ureteroscopic holmium laser lithotripsy, a procedure that can be affected by perioperative thermal management. This study examines the impact of compound thermal insulation management on patient recovery and comfort during transurethral ureteroscopic holmium laser lithotripsy. MATERIAL AND METHODS In this study, 551 patients who underwent transurethral ureteroscopic holmium laser lithotripsy from April 2019 to December 2022 were randomly assigned to either an observation group (n=276) or control group (n=275). Both groups received routine surgical care, with the observation group additionally receiving compound thermal insulation management. We recorded and compared perioperative body temperature changes, anesthetic resuscitation indicators (bispectral index recovery time, extubation time, fully awake time, Postanesthesia Care Unit retention time), comfort level (General Comfort Questionnaire), and quality of life (Nottingham Health Profile). We also compared the incidence of complications. RESULTS There was no significant difference in body temperature between groups at the start surgery. However, the observation group showed significantly higher temperatures during and at the end of surgery. Anesthetic resuscitation indicators were significantly better in the observation group. Both groups showed improved comfort and quality of life after surgery, with more significant improvements in the observation group. The observation group also had a lower incidence of complications, such as hypothermia and rigor. CONCLUSIONS Compound thermal insulation management during transurethral ureteroscopic holmium laser lithotripsy improved perioperative temperature maintenance, accelerated postoperative recovery, reduced complication rates, and enhanced patient comfort and quality of life.
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Paramythiotis D, Karlafti E, Kollatou AS, Simou T, Mavropoulou X, Psoma E, Rafailidis V, Papachristodoulou A, Pyrrou N, Ioannidis A, Panidis S, Michalopoulos A. Pancreatolithiasis: Does Management Depend on Clinical Manifestations? Am J Case Rep 2024; 25:e942725. [PMID: 38615191 PMCID: PMC11025692 DOI: 10.12659/ajcr.942725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/29/2024] [Accepted: 02/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. CASE REPORT We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. CONCLUSIONS The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated.
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Affiliation(s)
- Daniel Paramythiotis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Department of Emergency, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Sevasti Kollatou
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Simou
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xanthippi Mavropoulou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Psoma
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Papachristodoulou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoletta Pyrrou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristeidis Ioannidis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Panidis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hakamifard A, Khorvash F, Hajiahmadi S, Eskandari Y. Candida endophthalmitis and Candida pneumonia after trans-urethral lithotripsy: A case report. Clin Case Rep 2024; 12:e8746. [PMID: 38601170 PMCID: PMC11004260 DOI: 10.1002/ccr3.8746] [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] [Received: 04/24/2023] [Revised: 12/18/2023] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
Key Clinical Message Invasive candidiasis may be one of the serious complications of transurethral lithotripsy. Candiduria before this procedure should be assessed, and antifungals should be prescribed. Abstract This case is about a 44-year-old diabetic female patient who, after trans-urethral lithotripsy with double-J stent insertion, was diagnosed with Candida pneumonia and Candida endophthalmitis.
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Affiliation(s)
- Atousa Hakamifard
- Department of Infectious Diseases, School of MedicineIsfahan University of Medical SciencesIsfahanIran
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Farzin Khorvash
- Nosocomial Infection Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Somayeh Hajiahmadi
- Department of Radiology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Yasaman Eskandari
- Department of Infectious Diseases, School of MedicineIsfahan University of Medical SciencesIsfahanIran
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Johnson J, Lee J, Movassaghi M, Han D, Pingle SR, Williams J, Schulster M, Gorroochurn P, Shao Y, Shah O. Comparative Analyses and Ablation Efficiency of Thulium Fiber Laser by Stone Composition. J Urol 2024; 211:445-454. [PMID: 38134235 DOI: 10.1097/ju.0000000000003833] [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: 07/29/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE There are limited data on ablation effects of thulium fiber laser (TFL) settings with varying stone composition. Similarly, little is known surrounding the photothermal effects of TFL lithotripsy regarding the chemical and structural changes after visible char formation. We aim to understand the TFL's ablative efficiency across various stone types and laser settings, while simultaneously investigating the photothermal effects of TFL lithotripsy. MATERIALS AND METHODS Human specimens of calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, struvite, cystine, carbonate apatite, and brushite stones were ablated using 13 prespecified settings with the Coloplast TFL Drive. Pre- and postablation mass, ablation time, and total energy were recorded. Qualitative ablative observations were recorded at 1-minute intervals with photographs and gross description. Samples were analyzed with Fourier-transform infrared spectroscopy pre- and postablation and electron microscopy postablation to assess the photothermal effects of TFL. RESULTS Across all settings and stone types, 0.05 J × 1000 Hz was the best numerically efficient ablation setting. When selected for more clinically relevant laser settings (ie, 10-20 W), 0.2 J × 100 Hz, short pulse was the most numerically efficient setting for calcium oxalate dihydrate, cystine, and struvite stones. Calcium oxalate monohydrate ablated with the best numerical efficiency at 0.4 J × 40 Hz, short pulse. Uric acid and carbonate apatite stones ablated with the best numerical efficiency at 0.3 J × 60 Hz, short pulse. Brushite stones ablated with the best numerical efficiency at 0.5 J × 30 Hz, short pulse. Pulse duration impacted ablation effectiveness greatly with 6/8 (75%) of inadequate ablations occurring in medium or long pulse settings. The average percent of mass lost during ablation was 57%; cystine stones averaged the highest percent mass lost at 71%. Charring was observed in 36/91 (40%) specimens. Charring was most often seen in uric acid, cystine, and brushite stones across all laser settings. Electron microscopy of char demonstrated a porous melting effect different to that of brittle fracture. Fourier-transform infrared spectroscopy of brushite char demonstrated a chemical composition change to amorphous calcium phosphate. CONCLUSIONS We describe the optimal ablation settings based on stone composition, which may guide urologists towards more stone-specific care when using thulium laser for treating renal stones (lower energy settings would be safer for ureteral stones). For patients with unknown stone composition, lasers can be preset to target common stone types or adjusted based on visual cues. We recommend using short pulse for all TFL lithotripsy of calculi and altering the settings based on visual cues and efficiency to minimize the charring, an effect which can make the stone refractory to further dusting and fragmentation.
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Affiliation(s)
- Jeffrey Johnson
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Justin Lee
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Miyad Movassaghi
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - David Han
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Srinath-Reddi Pingle
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - James Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Schulster
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | | | - Yinming Shao
- Department of Physics, Columbia University, New York, New York
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center, New York, New York
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Ostergar A, Alkazemi MH, Hill H, Awad MM, Ushinsky A, Darcy M, Desai AC, Figenshau RS. Successful Percutaneous Ultrasonic Lithotripsy of Gallstones. Ochsner J 2024; 24:84-86. [PMID: 38510219 PMCID: PMC10949052 DOI: 10.31486/toj.23.0071] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. Case Series: We present the cases of 2 patients with acute calculous cholecystitis who were deemed ineligible candidates for cholecystectomy because of their complicating medical histories. Both patients initially underwent cholecystostomy and drain placement with interventional radiology for management of acute calculous cholecystitis. Their large gallstones remained refractory to attempts at removal by electrohydraulic lithotripsy via the cholecystostomy access. The patients' gallstones were successfully removed via percutaneous ultrasonic lithotripsy during a collaborative procedure with interventional radiology and urology. Conclusion: An interdisciplinary approach using percutaneous cholecystolithotomy with rigid ultrasonic lithotripsy is an effective method for removing challenging gallstones in patients for whom traditional approaches fail.
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Affiliation(s)
- Adam Ostergar
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Muhammad Hassan Alkazemi
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Hayden Hill
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael M. Awad
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alexander Ushinsky
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael Darcy
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alana C. Desai
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Bhojani N, Koo KC, Bensaadi K, Halawani A, Wong VK, Chew BH. Retrospective first-in-human use of the LithoVue™ Elite ureteroscope to measure intrarenal pressure. BJU Int 2023; 132:678-685. [PMID: 37667553 DOI: 10.1111/bju.16173] [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: 09/06/2023]
Abstract
OBJECTIVE To report on our first-in-human experience using the LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) to measure intrarenal pressure (IRP) during flexible ureteroscopy. PATIENTS AND METHODS A single-arm retrospective observational analysis was performed in 50 consecutive patients undergoing ureteroscopic lithotripsy using the LithoVue Elite™ system with pressure sensing capability between April 2022 and February 2023 at two centres. A pressure bag set at 150 mmHg or hand irrigation with a 60-mL syringe was used for irrigation and a ureteric access sheath (UAS) was placed at the physician's discretion. Median and maximum IRPs, and relative cumulative time exceeding 20, 40, 60, 80, 100, 120, 140, 160, and 200 mmHg per total procedure time were analysed. The two-sample Mann-Whitney U-test was used, with statistical significance set at P < 0.05. RESULTS The median (interquartile range [IQR]) patient age and body mass index (BMI) was 62.5 (46.7-68.2) years and 27.6 (23.3-32.1) kg/m2 , respectively. During the median (IQR) total procedure time of 31.9 (17.4-44.9) min, the median and maximum IRPs were 28.5 (20.0-47.5) and 174.0 (133.5-266.0) mmHg, respectively. IRP remained at <60 mmHg during 92% of the procedure times. Patients with Asian ethnicity, and those without pre-stenting or UAS use exhibited longer cumulative/total durations exceeding pre-defined IRP cut-off values. The smaller 10/12-F UAS did not lower pressures as much as the 11/13-F or 12/14-F UAS (P < 0.001). Age, diabetes, hypertension, preoperative α-blockade, stone size, and BMI did not show any statistically significant associations with IRP. CONCLUSIONS The IRP can now be routinely measured during ureteroscopy. Patients had a median IRP of 28.5 mmHg and a maximum of 174 mmHg. Using a smaller UAS (10/12 F), Asian ethnicity, and tight ureters were found to have higher IRPs.
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Affiliation(s)
- Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Montreal, Canada
| | - Kyo Chul Koo
- Department of Urological Sciences, Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kahina Bensaadi
- Division of Urology, University of Montreal Hospital Center, Montreal, Canada
| | - Abdulghafour Halawani
- Department of Urological Sciences, Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Victor Kf Wong
- Department of Urological Sciences, Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben H Chew
- Department of Urological Sciences, Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Zhai Q, Zhang J, Wei Q, Zeng M, Song L, Zhang Y, Maheremu M, Luo M, Xu Z, Fan D. Clinical application of novel integrated suctioning semi-rigid ureteroscopic lithotripsy. MINIM INVASIV THER 2023; 32:314-322. [PMID: 37366228 DOI: 10.1080/13645706.2023.2225599] [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: 10/20/2022] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Urinary calculi are frequently encountered in urology. Traditionally, the lack of a perfect water injection and drainage system means the observation field is affected during ureteroscopy. Here, we explored the effect and clinical value of a new integrated suctioning semi-rigid ureteroscopic lithotripsy (URSL) for treating ureteral calculi. MATERIAL AND METHODS A total of 180 patients were successfully enrolled in this study (60 in each group). Group A included patients who underwent a traditional semi-rigid URSL, group B included patients who underwent a suctioning semi-rigid URSL with a sheath being connected to a vacuum device, and group C included patients who underwent a new type of suctioning integrated rigid URSL with a novel designed ureteroscope. RESULTS In total, 164 cases of URSL were completed in one stage. Compared with group A, group C had a higher stone-clearance rate at 30 days postoperatively, shorter operation time, and fewer hospitalization days (p < .05); compared with group B, group C had a higher one-stage operation success rate, shorter operation time, and fewer hospitalization days (p < .05). CONCLUSIONS Comparatively, the new suctioning integrated semi-rigid URSL is advantageous for treating upper urinary calculi, considering the reduced operation time, length of hospital stay, and low invasiveness.
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Affiliation(s)
- Qiliang Zhai
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Jianqiang Zhang
- Department of Urology, Ruikang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
- Integrated Chinese and Western Medicine Clinical Research Center for Kidney Disease, Nanning, Guangxi, China
| | - Qiang Wei
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Min Zeng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Yifan Zhang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Maierhaba Maheremu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Mayao Luo
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Zhuofan Xu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Difu Fan
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
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Soderberg L, Ergun O, Ding M, Parker R, Borofsky MS, Pais V, Dahm P. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults. Cochrane Database Syst Rev 2023; 11:CD013445. [PMID: 37955353 PMCID: PMC10642177 DOI: 10.1002/14651858.cd013445.pub2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Kidney stones (also called renal stones) can be a source of pain, obstruction, and infection. Depending on size, location, composition, and other patient factors, the treatment of kidney stones can involve observation, shock wave lithotripsy, retrograde intrarenal surgery (RIRS; i.e. ureteroscopic approaches), percutaneous nephrolithotomy (PCNL), or a combination of these approaches. OBJECTIVES To assess the effects of percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults. SEARCH METHODS We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, Scopus, and two trials registries up to 23 March 2023. We applied no restrictions on publication language or status. SELECTION CRITERIA We included randomized controlled trials that evaluated PCNL (grouped by access size in French gauge [Fr] into three groups: ≥ 24 Fr [standard PCNL], 15-23 Fr [mini-PCNL and minimally invasive PCNL], and < 15 Fr [ultra-mini-, mini-micro-, super-mini-, and micro-PCNL]) versus RIRS. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data from the included studies. Our primary outcomes were stone-free rate, major complications, and need for secondary interventions. Our main secondary outcomes were unplanned medical visits to emergency/urgent care or outpatient clinic, length of hospital stay, ureteral stricture or injury, and quality of life. We performed statistical analyses using a random-effects model. We rated the certainty of evidence using GRADE criteria. We adopted a minimally contextualized approach with predefined thresholds for minimal clinically important differences (MCIDs). MAIN RESULTS We included 42 trials assessing the effects of PCNL versus RIRS in 4571 randomized participants. Twenty-two studies were published as full-text articles, and 20 were published as abstract proceedings. The average size of stones ranged from 10.1 mm to 39.1 mm. Most studies did not report sources of funding or conflicts of interest. The main results for the most important outcomes are summarized below. Stone-free rate PCNL compared with RIRS may improve stone-free rates (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08 to 1.18; I2 = 71%; 39 studies, 4088 participants; low-certainty evidence). Based on 770 participants per 1000 being stone-free with RIRS, this corresponds to 100 more (62 more to 139 more) stone-free participants per 1000 with PCNL (an absolute difference of 10%, where the predefined MCID was 5%). Major complications PCNL compared with RIRS probably has little or no effect on major complications (RR 0.86, 95% CI 0.59 to 1.25; I2 = 15%; 34 studies, 3649 participants; moderate-certainty evidence). Based on 31 complications in the RIRS group, this corresponds to six fewer (13 fewer to six more) major complications per 1000 with PCNL (an absolute difference of 0.6%, where the predefined MCID was 2%). Need for secondary interventions PCNL compared with RIRS may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17 to 0.55; I2 = 61%; 21 studies, 2005 participants; low-certainty evidence). Based on 222 secondary interventions in the RIRS group, this corresponds to 153 fewer (185 fewer to 100 fewer) secondary interventions per 1000 with PCNL (an absolute difference of 15.3%, where the predefined MCID was 5%). Unplanned medical visits No studies reported unplanned medical visits. Length of hospital stay PCNL compared with RIRS may extend length of hospital stay (mean difference 1.04 days more, 95% CI 0.27 more to 1.81 more; I2 = 100%; 26 studies, 2804 participants; low-certainty evidence). This effect size is greater than the predefined MCID of one day. Ureteral stricture or injury PCNL compared with RIRS may have little or no effect on the occurrence of ureteral strictures (RR 0.93, 95% CI 0.39 to 2.21; I2 = 0%; 13 studies, 1574 participants; low-certainty evidence). Based on 14 ureteral strictures in the RIRS group, this corresponds to one fewer (nine fewer to 17 more) ureteral strictures per 1000 with PCNL (an absolute difference of 0.1%, where the predefined MCID was 2%). Quality of life No studies reported quality of life. AUTHORS' CONCLUSIONS Based on a large body of evidence from 42 trials, we found that PCNL compared with RIRS may improve stone-free rates and may reduce the need for secondary interventions, but probably has little or no effect on major complications. PCNL compared with RIRS may have little or no effect on ureteral stricture rates and may increase length of hospital stay. We found no evidence on unplanned medical visits or participant quality of life. Because of the considerable shortcomings of the included trials, the evidence for most outcomes was of low certainty. Access size for PCNL was less than 24 Fr in most studies that provided this information. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.
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Affiliation(s)
- Leah Soderberg
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Onuralp Ergun
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maylynn Ding
- School of Medicine, McMaster University, Hamilton, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vernon Pais
- Department of Surgery, Dartmouth Medical School, Lebanon, NH, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Moon YJ, Cho KS, Jung DC, Chung DY, Lee JY. The Consecutive 200 Cases of Endoscopic-Combined Intrarenal Surgery: Comparison between Standard and Miniature Surgeries. Medicina (Kaunas) 2023; 59:1971. [PMID: 38004020 PMCID: PMC10673269 DOI: 10.3390/medicina59111971] [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] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Percutaneous nephrolithotomy (PCNL) is still the gold-standard treatment for large and/or complex renal stones. Endoscopic combined intrarenal surgery (ECIRS) was developed with the goal of minimizing the number of access tracts of PCNL while simultaneously improving the one-step stone-free rate (SFR). The aim of this study was to share the experience of the consecutive 200 cases of ECIRS in one institute and analyze surgical outcomes of mini-ECIRS and standard ECIRS. Materials and Methods: We performed ECIRS for 200 adult patients between July 2017 and January 2020. An ECIRS was performed with the patient under general anesthesia in the intermediate-supine position. Surgeries were finished using a tubeless technique with a simple ureteral stent insertion. Results: There were significant differences in the mean maximal stone length (MSL), the variation coefficient of stone density (VCSD), the linear calculus density (LCD), the Seoul National University Renal Stone Complexity (S-ReSC), and the modified S-ReSC scores in stone characteristics, and estimated blood loss (EBL) and operation time in peri-operative outcomes between conventional and mini-ECIRS. After propensity-score matching, there was only a difference in EBL between the two groups. In logistic regression models, MSL [odds ratio (OR) 0.953; 95% confidence interval (CI) 0.926-0.979; p < 0.001], LCD (OR 4.702; 95% CI 1.613-18.655; p = 0.013) were significant factors for the success rate after ECIRS. Conclusions: In patients who underwent a mini-ECIRS, the stones were relatively smaller and less complex, and the operation time was shorter. However, if the size of stones was similar, there was no difference in the success rate, but EBL was lower in mini-ECIRS than in standard surgery.
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Affiliation(s)
- Young Joon Moon
- Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41944, Republic of Korea;
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Doo Yong Chung
- Department of Urology, Inha University College of Medicine, Incheon 22212, Republic of Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
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11
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Sharma S, Sabale V, Satav V, Mulay A. To Evaluate the Impact of Ho:YAG Laser Lithotripsy for Ureteroscopic Removal of Proximal and Distal Ureter Calculi. Cureus 2023; 15:e47498. [PMID: 38022108 PMCID: PMC10663642 DOI: 10.7759/cureus.47498] [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] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Urinary calculus illness is a prevalent clinical issue encountered by the medical community, particularly urologists, in contemporary society. Laser technologies have been widely accepted as standard modalities for lithotripsy applications. Using the Ho:YAG laser has expanded the range of applications for ureteroscopic stone management (URS), enabling the treatment of bigger stones in all regions of the upper urinary tract. It is noteworthy that ureteroscopy (URS) demonstrates superior rates of stone clearance for distal stones, regardless of their size, with a success rate of 94.5% compared to 74% for other treatment modalities. Significant variation exists in the reported results and problems associated with Ho:YAG laser lithotripsy across different trials, as documented in the literature. The procedure's outcome might vary based on factors such as the size of the stone, the length of impaction, the presence of ureteral damage and granulation, the kind and size of endoscopes used, and the specific energy settings employed by various operators. The present study aimed to evaluate the impact of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureter calculi. Methods This prospective observational study was carried out in the Department of Urology at DY Patil Medical College and Hospital, Pune, from March 2021 to March 2023. Patients diagnosed with a case of ureteric stone who opted for URSL during the study period were included. A total of 50 patients who underwent URSL in the urology department were included in this study. These were then grouped into those with proximal ureteral stones and distal ureteral stones. (25 each) Results The study observed that patients diagnosed with proximal ureteral stones had bigger calculi, with a mean stone size of 15mm, in comparison to patients with distal ureteral stones, with a mean stone size of 10mm (P=0.010). The stone burden was significantly higher for proximal ureteral stone patients than those with distal ureteric stones (P=0.010). The average duration of the operating procedure for upper ureter stones was 70 minutes, but for lower stones, the mean operative time was 45 minutes (P<0.001). No statistical significance was seen in the median age of patients between the two groups (P=0.89). The maximum number of cases in the upper stone group were in the age group of 16-30 years, and in the lower stone group was in the age group of 31-45 years. The prevalence of DJ stents at the time of presentation was higher among patients diagnosed with proximal ureteric stones than those with distal ureteric stones, with rates of 28% and 20%, respectively (P=0.508). Full fragmentation was successfully accomplished in all patients within the distal calculus group, accounting for 100% of the cases. At the same time, for proximal ureteric stones, a single laser lithotripsy session resulted in 92% (23 patients) achieving a stone-free status after two weeks. Conclusion The study observed that stone size, burden, and procedure duration were statistically significant among other criteria. Mean age, stone HU, prior DJ stent, and stone-free rate were statistically insignificant. The procedure indicated that Ho:YAG laser lithotripsy has efficacy in treating both proximal and distal ureteral stones, with minimal intraoperative and postoperative complications. None of the complications were due to laser energy.
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Affiliation(s)
- Supran Sharma
- Urology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Vilas Sabale
- Urology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Vikram Satav
- Urology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Abhirudra Mulay
- Urology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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12
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Ali ZA, Kereiakes DJ, Hill JM, Saito S, Di Mario C, Honton B, Gonzalo N, Riley RF, Maehara A, Matsumura M, Shin D, Stone GW, Shlofmitz RA. Impact of Calcium Eccentricity on the Safety and Effectiveness of Coronary Intravascular Lithotripsy: Pooled Analysis From the Disrupt CAD Studies. Circ Cardiovasc Interv 2023; 16:e012898. [PMID: 37847770 PMCID: PMC10573097 DOI: 10.1161/circinterventions.123.012898] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/27/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Coronary intravascular lithotripsy (IVL) safely facilitates successful stent implantation in severely calcified lesions. This analysis sought to determine the relative impact of lesion calcium eccentricity on the safety and effectiveness of IVL using high-resolution optical coherence tomography imaging. METHODS Individual patient-level data (n=262) were pooled from 4 distinct international prospective studies (Disrupt CAD I, II, III, and IV) and analyzed by an independent optical coherence tomography core laboratory. IVL performance in eccentric versus concentric calcification was analyzed by dividing calcified lesions into quartiles (≤180° [most eccentric], 181°-270°, 271°-359°, and 360° [concentric]) by maximum continuous calcium arc. RESULTS In the 230 patients with clear imaging field on optical coherence tomography, there were no differences in preprocedure minimum lumen area, diameter stenosis, or maximum calcium thickness. The calcium length and volume index increased progressively with increasing mean and maximum continuous calcium arc (ie, concentricity). Conversely, the minimum calcium thickness decreased progressively with increasing concentricity. Post-procedure, the number of calcium fractures, fracture depth, and fracture width increased with increasing concentricity, with a 4-fold increase in the number of fractures in lesions with 360° of calcium arc compared with ≤180°. This increase in IVL-induced calcium fracture with increasing calcium burden and concentricity facilitated stent expansion and luminal gain such that there were no significant differences across quartiles. CONCLUSIONS IVL induced calcium fractures proportional to the magnitude of coronary artery calcium, including in eccentric calcium, leading to consistent improvements in stent expansion and luminal gain in both eccentric and concentric calcified coronary lesions.
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Affiliation(s)
- Ziad A. Ali
- St. Francis Hospital, Roslyn, NY (Z.A.A., A.M., D.S., R.A.S.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., M.M., R.A.S.)
| | - Dean J. Kereiakes
- The Christ Hospital and Lindner Research Center, Cincinnati, OH (D.J.K.)
| | | | - Shigeru Saito
- Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan (S.S.)
| | | | | | | | - Robert F. Riley
- Overlake Medical Center and Clinics, Bellevue, Washington (R.F.R.)
| | - Akiko Maehara
- St. Francis Hospital, Roslyn, NY (Z.A.A., A.M., D.S., R.A.S.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., M.M., R.A.S.)
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., M.M., R.A.S.)
| | - Doosup Shin
- St. Francis Hospital, Roslyn, NY (Z.A.A., A.M., D.S., R.A.S.)
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | - Richard A. Shlofmitz
- St. Francis Hospital, Roslyn, NY (Z.A.A., A.M., D.S., R.A.S.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., M.M., R.A.S.)
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Juliebø-Jones P, Keller EX, De Coninck V, Uguzova S, Tzelves L, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond. Front Surg 2023; 10:1274583. [PMID: 37780913 PMCID: PMC10533910 DOI: 10.3389/fsurg.2023.1274583] [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: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Ureteroscopy has become an increasingly popular surgical intervention for conditions such as urinary stone disease. As new technologies and techniques become available, debate regarding their proper use has risen. This includes the role of single use ureteroscopes, optimal laser for stone lithotripsy, basketing versus dusting, the impact of ureteral access sheath, the need for safety guidewire, fluoroscopy free URS, imaging and follow up practices are all areas which have generated a lot of debate. This review serves to evaluate each of these issues and provide a balanced conclusion to guide the clinician in their practice.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
| | - Etienne Xavier Keller
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Sabine Uguzova
- Department of Urology, Royal Preston Hospital, Preston, United Kingdom
| | - Lazaros Tzelves
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- 2nd Department of Urology, Sismanogleion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mathias Sørstrand Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar K. Somani
- Department of Urology, Southampton General Hospital, Southampton, United Kingdom
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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14
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Ghani KR, Olumolade OO, Daignault-Newton S, Cole A, Yang P, Linsell S, Seifman B, Wenzler D, Dauw C. What Is the Optimal Stenting Duration After Ureteroscopy and Stone Intervention? Impact of Dwell Time on Postoperative Emergency Department Visits. J Urol 2023; 210:472-480. [PMID: 37285234 DOI: 10.1097/ju.0000000000003555] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE AUA stone management guidelines recommend stenting duration following ureteroscopy be minimized to reduce morbidity; stents with extraction strings may be used for this purpose. However, an animal study demonstrated that short dwell time results in suboptimal ureteral dilation, and a pilot clinical study showed this increases postprocedure events. Using real-world practice data we examined stent dwell time after ureteroscopy and its association with postoperative emergency department visits. MATERIALS AND METHODS We used the Michigan Urological Surgery Improvement Collaborative registry to identify ureteroscopy and stenting procedures (2016-2019). Pre-stented cases were excluded. Stenting cohorts with and without strings were analyzed. Using multivariable logistic regression we evaluated the risk of an emergency department visit occurring on the day of, or day after, stent removal based on dwell time and string status. RESULTS We identified 4,437 procedures; 1,690 (38%) had a string. Median dwell time was lower in patients with a string (5 vs 9 days). Ureteroscopy in younger patients, smaller stones, or renal stone location had a higher frequency of string use. The predicted probability of an emergency department visit was significantly greater in procedures with string, compared to without string, when dwell times were less than 5 days (P < .01) but were not statistically significant after. CONCLUSIONS Patients who had ureteroscopy and stenting with a string have short dwell times. Patients are at increased risk of a postoperative emergency department visit around the time of stent removal if dwell time is ≤4 days. We recommended stenting duration of at least 5 days in nonpre-stented patients.
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Affiliation(s)
- Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Adam Cole
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York
| | - Patrick Yang
- Michigan State University College of Human Medicine; Michigan Health Care Professionals, Farmington Hills, Michigan
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Brian Seifman
- Michigan Institute of Urology, Beaumont Hospital, Royal Oak, Michigan
| | - Dave Wenzler
- Michigan State University College of Human Medicine; Michigan Health Care Professionals, Farmington Hills, Michigan
| | - Casey Dauw
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Iwashita T, Iwasa Y, Senju A, Tezuka R, Uemura S, Okuno M, Iwata K, Mukai T, Yasuda I, Shimizu M. Comparing endoscopic ultrasound-guided antegrade treatment and balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography in the management of bile duct stones in patients with surgically altered anatomy: A retrospective cohort study. J Hepatobiliary Pancreat Sci 2023; 30:1078-1087. [PMID: 36862054 DOI: 10.1002/jhbp.1321] [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] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided antegrade treatment (EUS-AG) and balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) have emerged as useful procedures for managing bile duct stones (BDS) in patients with surgically altered anatomy. However, the comparison between these two procedures has not been well studied. The aim of our study was to compare the clinical outcomes of EUS-AG and BE-ERCP for managing BDS in patients with surgically altered anatomy. METHODS The database was retrospectively evaluated at two tertiary care centers to identify patients with surgically altered anatomy who underwent either EUS-AG or BE-ERCP for BDS. Clinical outcomes were compared between the procedures. The success rate of each procedure was evaluated in three steps: endoscopic approach, biliary access, and stone extraction. RESULTS Among the 119 identified patients, 23 had EUS-AG, and 96 had BE-ERCP. The overall technical success rates of EUS-AG and BE-ERCP were 65.2% (15/23) and 69.8% (67/96), respectively (P = .80). The comparison of each step between the procedures EUS-AG versus BE-ERCP was as follows: endoscopic approach, 100% (23/23) versus 88.5% (85/96) (P = .11); biliary access, 73.9% (17/23) versus 80.0% (68/85) (P = .57); stone extraction, 88.2% (15/17) versus 98.5% (67/68) (P = .10). The overall adverse event rate was 17.4% (4/23) versus 7.3% (7/96) (P = .22). CONCLUSIONS Both EUS-AG and BE-ERCP are effective and relatively safe procedures in the management of BDS in patients with surgically altered anatomy. The challenging steps of each procedure might be different, which could help decide which one to use to manage BDS in patients with surgically altered anatomy.
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Yuhei Iwasa
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Akihiko Senju
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Ryuichi Tezuka
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Mitsuru Okuno
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Kanazawa, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama Hospital, Toyama, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
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Castellani D, Fong KY, Lim EJ, Chew BH, Tailly T, Emiliani E, Teoh JYC, Chai CA, Heng CT, Ong Lay Keat W, Tanidir Y, Ragoori D, Galosi AB, Singh A, Bin Hamri S, Traxer O, Somani BK, Gauhar V. Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. J Urol 2023; 210:323-330. [PMID: 37126223 DOI: 10.1097/ju.0000000000003504] [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: 11/04/2022] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. MATERIALS AND METHODS Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free. RESULTS Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. CONCLUSIONS This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
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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.
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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
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Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2023; 8:CD007044. [PMID: 37526261 PMCID: PMC10392035 DOI: 10.1002/14651858.cd007044.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nephrolithiasis is a common urological disease worldwide. Extracorporeal shock wave lithotripsy (ESWL) has been used for the treatment of renal stones since the 1980s, while retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are newer, more invasive treatment modalities that may have higher stone-free rates. The complications of RIRS and PCNL have decreased owing to improvement in surgical techniques and instruments. We re-evaluated the best evidence on this topic in an update of a Cochrane Review first published in 2014. OBJECTIVES To assess the effects of extracorporeal shock wave lithotripsy compared with percutaneous nephrolithotomy or retrograde intrarenal surgery for treating kidney stones. SEARCH METHODS We performed a comprehensive search in CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov with no restrictions on language or publication status. The latest search date was 6 December 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs that compared ESWL with PCNL or RIRS for kidney stone treatment. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies, extracted data, and assessed risk of bias. Our primary outcomes were treatment success rate at three months (defined as residual fragments smaller than 4 mm, or as defined by the study authors), quality of life (QoL), and complications. Our secondary outcomes were retreatment rate, auxiliary procedures rate, and duration of hospital stay. We performed statistical analyses using a random-effects model and independently rated the certainty of evidence using the GRADE approach. MAIN RESULTS We included 31 trials involving 3361 participants (3060 participants completed follow-up). Four trials were only available as an abstract. Overall mean age was 46.6 years and overall mean stone size was 13.4 mm. Most participants (93.8%) had kidney stones measuring 20 mm or less, and 68.9% had lower pole stones. ESWL versus PCNL ESWL may have a lower three-month treatment success rate than PCNL (risk ratio [RR] 0.67, 95% confidence interval [CI] 0.57 to 0.79; I2 = 87%; 12 studies, 1303 participants; low-certainty evidence). This corresponds to 304 fewer participants per 1000 (397 fewer to 194 fewer) reporting treatment success with ESWL. ESWL may have little or no effect on QoL after treatment compared with PCNL (1 study, 78 participants; low-certainty evidence). ESWL probably leads to fewer complications than PCNL (RR 0.62, 95% CI 0.47 to 0.82; I2 = 18%; 13 studies, 1385 participants; moderate-certainty evidence). This corresponds to 82 fewer participants per 1000 (115 fewer to 39 fewer) having complications after ESWL. ESWL versus RIRS ESWL may have a lower three-month treatment success rate than RIRS (RR 0.85, 95% CI 0.78 to 0.93; I2 = 63%; 13 studies, 1349 participants; low-certainty evidence). This corresponds to 127 fewer participants per 1000 (186 fewer to 59 fewer) reporting treatment success with ESWL. We are very uncertain about QoL after treatment; the evidence is based on three studies (214 participants) that we were unable to pool. We are very uncertain about the difference in complication rates between ESWL and RIRS (RR 0.93, 95% CI 0.63 to 1.36; I2 = 32%; 13 studies, 1305 participants; very low-certainty evidence). This corresponds to nine fewer participants per 1000 (49 fewer to 48 more) having complications after ESWL. AUTHORS' CONCLUSIONS ESWL compared with PCNL may have lower three-month success rates, may have a similar effect on QoL, and probably leads to fewer complications. ESWL compared with RIRS may have lower three-month success rates, but the evidence on QoL outcomes and complication rates is very uncertain. These findings should provide valuable information to aid shared decision-making between clinicians and people with kidney stones who are undecided about these three options.
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Affiliation(s)
- Vasun Setthawong
- Department of Surgery, Lerdsin Hospital, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
- Department of Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Attasit Srisubat
- Institute of Medical Research and Technology Assessment, Dept of Medical Services, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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19
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Houlihan I, Kang B, De S, Krishna V. Photonic Lithotripsy: Near-Infrared Laser Activated Nanomaterials for Kidney Stone Comminution. Nano Lett 2023; 23:5981-5988. [PMID: 37358929 PMCID: PMC10348310 DOI: 10.1021/acs.nanolett.3c01166] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Near-infrared activated nanomaterials have been reported for biomedical applications ranging from photothermal tumor destruction to biofilm eradication and energy-gated drug delivery. However, the focus so far has been on soft tissues, and little is known about energy delivery to hard tissues, which have thousand-fold higher mechanical strength. We present photonic lithotripsy with carbon and gold nanomaterials for fragmenting human kidney stones. The efficacy of stone comminution is dependent on the size and photonic properties of the nanomaterials. Surface restructuring and decomposition of calcium oxalate to calcium carbonate support the contribution of photothermal energy to stone failure. Photonic lithotripsy has several advantages over current laser lithotripsy, including low operating power, noncontact laser operation (distances of at least 10 mm), and ability to break all common stones. Our observations can inspire the development of rapid, minimally invasive techniques for kidney stone treatment and extrapolate to other hard tissues such as enamel and bone.
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Affiliation(s)
- Ian Houlihan
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Benjamin Kang
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Smita De
- Urology, Glickman
Urology and Kidney Institute, Cleveland Clinic, Cleveland Ohio 44195, United States
- Urology,
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
| | - Vijay Krishna
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
- Biomedical
Engineering, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
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20
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Katibov MI, Bogdanov AB, Magomedov ZM, Mollaeva KE. [Giant prostate stones: case report]. Urologiia 2023:98-101. [PMID: 37417417] [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] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.
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Affiliation(s)
- M I Katibov
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- GBOU VPO Dagestan State Medical University of the Ministry of Health of the Russia, Republic of Dagestan, Makhachkala, Russia
- City clinical hospital named after S.P. Botkin, Moscow, Russia
- FGBOU DPO RMANPO of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - A B Bogdanov
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- GBOU VPO Dagestan State Medical University of the Ministry of Health of the Russia, Republic of Dagestan, Makhachkala, Russia
- City clinical hospital named after S.P. Botkin, Moscow, Russia
- FGBOU DPO RMANPO of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Z M Magomedov
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- GBOU VPO Dagestan State Medical University of the Ministry of Health of the Russia, Republic of Dagestan, Makhachkala, Russia
- City clinical hospital named after S.P. Botkin, Moscow, Russia
- FGBOU DPO RMANPO of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - K E Mollaeva
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- GBOU VPO Dagestan State Medical University of the Ministry of Health of the Russia, Republic of Dagestan, Makhachkala, Russia
- City clinical hospital named after S.P. Botkin, Moscow, Russia
- FGBOU DPO RMANPO of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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21
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Heinrich H, Bauerfeind P, Wiegand N. Stunned by a stone-A curious case of belly trouble. United European Gastroenterol J 2023; 11:576-577. [PMID: 37309092 PMCID: PMC10337736 DOI: 10.1002/ueg2.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/18/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Henriette Heinrich
- Universitäres Bauchzentrum Clarunis, Gastroenterologie und Hepatologie, UniversitätsSpital Basel, Basel, Switzerland
| | | | - Nico Wiegand
- St. Anna Spital Luzern, Gastroenterologie, Luzern, Switzerland
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22
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Montero-Cabezas JM, Al Amri I, van Oort MJH, Bingen BO, Scherptong RWC, van der Kley F. Retrograde Use of Intravascular Lithotripsy in Anterograde Uncrossable In-Stent Chronic Occlusion: "Retrotripsy Technique". JACC Cardiovasc Interv 2023:S1936-8798(23)00857-9. [PMID: 37354167 DOI: 10.1016/j.jcin.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023]
Affiliation(s)
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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23
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Dutta R, Mithal P, Klein I, Patel M, Gutierrez-Aceves J. Outcomes and Costs Following Mini-percutaneous Nephrolithotomy or Flexible Ureteroscopic Lithotripsy for 1-2-cm Renal Stones: Data From a Prospective, Randomized Clinical Trial. J Urol 2023; 209:1151-1158. [PMID: 37157794 DOI: 10.1097/ju.0000000000003397] [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] [Indexed: 05/10/2023]
Abstract
PURPOSE We evaluate the outcomes of ureteroscopy vs prone mini-percutaneous nephrolithotomy for 1-2-cm renal stones using a 2-group parallel randomized control trial. MATERIALS AND METHODS Adult patients presenting with renal stones between 1 and 2 cm were randomized. Exclusion criteria included solitary kidney, multiple stones, and comorbidities precluding prone positioning. Block randomization was performed and was opened to the surgeon the morning of the procedure. Stone-free rate was evaluated by computed tomography 1-30 days postoperatively. Complications, re-treatment rates, and costs were evaluated. RESULTS A total of 51 mini-percutaneous nephrolithotomy and 50 ureteroscopy patients were included. Baseline demographics were similar. Using a 2-mm cutoff, stone-free rate was higher in the mini-percutaneous nephrolithotomy group (76 vs 46%, P = .0023). The residual stone burden was significantly higher in the ureteroscopy group than the mini-percutaneous nephrolithotomy group (3.6 vs 1.4 mm, P = .0026). Fluoroscopy time was significantly higher in the mini-percutaneous nephrolithotomy group (273 vs 49 seconds, P < .0001). There were no differences in postoperative complications within 30 days, the necessity of a secondary procedure within 30 days, and pre- to postoperative creatinine change (P > .05). Surgical time did not vary significantly (P = .1788). Average length of stay was higher in the mini-percutaneous nephrolithotomy group (P < .0001). Both net revenue and direct costs were higher in mini-percutaneous nephrolithotomy procedures (P < .05), though they offset each other with a nonsignificant operating margin (P = .2541). CONCLUSIONS In a prospective, randomized, controlled clinical trial using a 2-mm residual stone burden cutoff, mini-percutaneous nephrolithotomy was more likely to render patients stone-free than flexible ureteroscopy. Complications, surgical times, and operating margins did not vary between the approaches.
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Affiliation(s)
- Rahul Dutta
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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24
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Malik A, Sato KT, Riaz A. Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy. Semin Intervent Radiol 2023; 40:294-297. [PMID: 37484449 PMCID: PMC10359116 DOI: 10.1055/s-0043-1769768] [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] [Indexed: 07/25/2023]
Abstract
The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.
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Affiliation(s)
- Asad Malik
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kent T. Sato
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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25
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Tasian GE, Maltenfort MG, Rove K, Ching CB, Ramachandra P, DeFoor B, Fernandez N, Forrest CB, Ellison JS. Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy. J Urol 2023; 209:1194-1201. [PMID: 36812398 DOI: 10.1097/ju.0000000000003389] [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: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Little is known about the impact of ureteral stents on youth having stone surgery. We evaluated the association of ureteral stent placement before or concurrent with ureteroscopy and shock wave lithotripsy with emergency department visits and opioid prescriptions among pediatric patients. MATERIALS AND METHODS We conducted a retrospective cohort study of individuals aged 0-24 years who underwent ureteroscopy or shock wave lithotripsy from 2009-2021 at 6 hospitals in PEDSnet, a research network that aggregates electronic health record data from children's health systems in the United States. The exposure, primary ureteral stent placement, was defined as a stent placed concurrent with or within 60 days before ureteroscopy or shock wave lithotripsy. Associations between primary stent placement and stone-related ED visits and opioid prescriptions within 120 days of the index procedure were evaluated with mixed-effects Poisson regression. RESULTS Two-thousand ninety-three patients (60% female; median age 15 years, IQR 11-17) had 2,477 surgical episodes; 2,144 were ureteroscopy and 333 were shock wave lithotripsy. Primary stents were placed in 1,698 (79%) ureteroscopy episodes and 33 (10%) shock wave lithotripsy episodes. Ureteral stents were associated with a 33% higher rate of emergency department visits (IRR 1.33; 95% CI 1.02-1.73) and a 30% higher rate of opioid prescriptions (IRR 1.30; 95% CI 1.10-1.53). The magnitudes of both associations were greater for shock wave lithotripsy. Results were similar for age <18 and were lost when restricted to concurrent stent placement. CONCLUSIONS Primary ureteral stent placement was associated with more frequent emergency department visits and opioid prescriptions, driven by pre-stenting. These results support elucidating situations where stents are not necessary for youth with nephrolithiasis.
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Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell G Maltenfort
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kyle Rove
- Department of Surgery, Division of Urology, Children's Hospital Colorado, Aurora, Colorado
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Puneeta Ramachandra
- Department of Surgery, Division of Urology, Nemours Children's Health, Wilmington, Delaware
| | - Bob DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Nicolas Fernandez
- Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Christopher B Forrest
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan S Ellison
- Department of Urology, Children's Wisconsin & Medical College of Wisconsin, Milwaukee, Wisconsin
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Kunkel G, Sorokin I, Oster M, Van Horn C, Movahedi B, Pang-Yen F, Martins PN. Ex-vivo ureteroscopy, laser lithotripsy, and stone basketing extraction of deceased donor kidney stones during machine perfusion preservation. Artif Organs 2023. [PMID: 37026524 DOI: 10.1111/aor.14528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
The incidence of nephrolithiasis in kidney donors is rare. The timing and treatment of nephrolithiasis in deceased donor kidneys are not well established. While some programs have proposed ex-situ rigid or flexible ureteroscopy treatment before transplantation, we report on two cases of kidney stones in the same deceased donor that we treated by flexible ureteroscopy and laser lithotripsy performed during the storage time on a hypothermic perfusion machine. Two deceased donor kidneys were found to have multiple kidney stones discovered on preprocurement CT imaging. The right kidney had less than five 2-3 mm stones, whereas the left had five to ten 1 mm stones with a single 7 mm stone. Both organs were placed on a hypothermic perfusion machine and maintained at a temperature of 4°C. An ex-vivo flexible ureteroscopy with laser lithotripsy and basket extraction was performed while the kidneys were maintained on Lifeport* perfusion machine. The cold ischemia time was 16.9 and 23.1 h. After 12 months of observational follow-up, neither recipient had nephrolithiasis, UTI, or other urologic complications. The creatinine values now are 1.17 and 2.44 mg/dL (103.4 and 215.7 μmol/L), respectively. Ex-vivo flexible ureteroscopy with laser lithotripsy and stone removal on machine-perfused kidneys appears to be safe and offers a good option to treat graft nephrolithiasis and prevent posttransplant complications. Ureteroscopy serves as a minimally invasive treatment option with direct stone removal. Performing this while on machine perfusion minimizes the ischemic time of the kidney and resultant complications or delays in graft function.
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Affiliation(s)
- Gregory Kunkel
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Igor Sorokin
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Michela Oster
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Christine Van Horn
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Babak Movahedi
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Fan Pang-Yen
- Division of Transplant Nephrology, Department of Medicine, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Paulo N Martins
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
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27
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Dowling RA, Chen Q, Goldfischer E, Albala DM. Surgical Stone Treatment: Patterns May Predict Performance on Episode Based Cost Measure in the Quality Payment Program. Urol Pract 2023:101097UPJ0000000000000407. [PMID: 37103884 DOI: 10.1097/upj.0000000000000407] [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] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The Renal or Ureteral Stone Surgical Treatment Episode based Measure in the Quality Payment Program (QPP) evaluates clinicians' cost to Medicare for beneficiaries who receive surgical treatment for stones.1 The measure score is calculated from Medicare claims according to a complex methodology.2 This paper seeks to describe the stone treatment patterns of urologists and establish benchmarks for 2 surrogate measures- preoperative stenting and postoperative infection-which may predict clinician performance on the episode cost based measure. METHODS The study data were drawn from the adjudicated claims of 960 providers who performed at least 30 surgical stone treatments between January 1, 2020 and June 30, 2022. To allow for the correlation of procedures performed by same providers, generalized estimating equations logistic regression models were used to evaluate the rate of preoperative stenting and postoperative infection. RESULTS 185,076 surgical episodes (113,799 [61.5%] ureteroscopy, 63,931 [34.5%] extracorporeal shock wave lithotripsy (ESWL), and 7,346 [4.0%] percutaneous nephrolithotripsy (PCNL)) were identified over the study period. Preoperative stenting was performed in 35,550 episodes (19.2%) and postoperative infection was documented in 13,114 episodes (7.1%). Preoperative stenting and postoperative infection were significantly more common in patients who were female (aOR 1.42, 1.38), in those undergoing ureteroscopy vs ESWL (aOR 3.24, 1.66), and in patients on Medicare vs Commercial insurance (aOR 1.19, 1.17). CONCLUSIONS This large study of surgical stone treatments documents rates of events and associated attributes of patients that may increase episode cost and be relevant to urologists participating in the QPP.
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Affiliation(s)
| | | | | | - David M Albala
- Chief of Urology, Crouse Hospital
- Physician, Associated Medical Professionals; Visiting Professor, Downstate Health Sciences University
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28
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Hufkens E, Struyve M, Bronswijk M, van der Merwe S. Endoscopic therapy for Bouveret syndrome, illustrated by a case report. Acta Gastroenterol Belg 2023; 86:360-362. [PMID: 37428171 DOI: 10.51821/86.2.10503] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Bouveret syndrome is an exceptionally rare form of gallstone ileus secondary to a bilioenteric fistula, through which a voluminous gallstone can migrate into the pylorus or duodenum, thereby causing gastric outlet obstruction. In order to increase awareness, we reviewed the clinical features, diagnostic tools and management options for this uncommon entity. We specifically focus on endoscopic therapeutic options, illustrated by a case of a 73 year old woman with Bouveret syndrome, where endoscopic electrohydraulic lithotripsy was successful in relieving gastroduodenal obstruction.
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Affiliation(s)
- E Hufkens
- Department of Gastroenterology and Hepatology, UZ Gasthuisberg, Leuven, Belgium
| | - M Struyve
- Department of Gastroenterology and Hepatology, Zuid-Oost-Limburg, Genk, Belgium
| | - M Bronswijk
- Department of Gastroenterology and Hepatology, Imelda, Bonheiden, Belgium
| | - S van der Merwe
- Department of Gastroenterology and Hepatology, Imelda, Bonheiden, Belgium
- Department of Gastroenterology and Hepatology, UZ Gasthuisberg, Leuven, Belgium
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29
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Kaneko J, Watahiki M, Jindo O, Matsumoto K, Kosugi T, Kusama D, Tamakoshi H, Niwa T, Takeshita Y, Takinami M, Kiuchi R, Tsuji A, Nishino M, Takahashi Y, Sasada Y, Kawata K, Yamada T, Sakaguchi T. Gallbladder perforation following peroral cholangioscopy-guided lithotripsy: A case report. DEN Open 2023; 3:e237. [PMID: 37091282 PMCID: PMC10117168 DOI: 10.1002/deo2.237] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Peroral cholangioscopy-guided lithotripsy is highly effective in clearing difficult bile duct stones. It can cause adverse events, such as cholangitis and pancreatitis; however, gallbladder perforation is extremely rare. Herein, we describe the case of a 77-year-old woman who developed gallbladder perforation following peroral cholangioscopy -guided lithotripsy. She was referred to our hospital to treat multiple large bile duct stones. She underwent peroral cholangioscopy-guided lithotripsy because of conventional lithotripsy failure. After a cholangioscope was advanced into the bile duct, saline irrigation was used for visualization. Electronic hydraulic lithotripsy was performed, but it took time for fragmentation because the calculus was hard. The 2-h endoscopic procedure did not completely remove the stone, and treatment was discontinued after placing a biliary plastic stent and nasobiliary tube. After the endoscopic procedure, she started experiencing right hypochondrial pain, which worsened the next day. Computed tomography showed a gallbladder wall defect in the gallbladder fundus with pericholecystic fluid. She was diagnosed with gallbladder perforation and underwent emergency surgery. A perforation site was found at the gallbladder fundus. Open cholecystectomy, choledochotomy, and extraction of residual bile duct stones were performed. The patient was discharged 9 days post-surgery without any complications. The saline irrigation used for visualization may have caused a surge in intra-gallbladder pressure, resulting in gallbladder perforation. Therefore, endoscopists may need to conserve irrigation water during peroral cholangioscopy-guided lithotripsy.
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Affiliation(s)
- Junichi Kaneko
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | - Moeka Watahiki
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | - Osamu Jindo
- Division of Gastrointestinal SurgeryIwata City HospitalShizuokaJapan
| | - Keigo Matsumoto
- Division of Gastrointestinal SurgeryIwata City HospitalShizuokaJapan
| | | | - Daisuke Kusama
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | | | - Tomoyuki Niwa
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | - Yu Takeshita
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | - Masaki Takinami
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | - Ryota Kiuchi
- Division of Gastrointestinal SurgeryIwata City HospitalShizuokaJapan
| | - Atsushi Tsuji
- Division of GastroenterologyIwata City HospitalShizuokaJapan
| | | | | | - Yuzo Sasada
- Division of HepatologyIwata City HospitalShizuokaJapan
| | - Kazuhito Kawata
- Department of Internal Medicine IIHamamatsu University School of MedicineShizuokaJapan
| | - Takanori Yamada
- Division of GastroenterologyIwata City HospitalShizuokaJapan
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30
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Taguchi M, Yasuda K, Kinoshita H. Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy. Int J Urol 2023. [PMID: 36964958 DOI: 10.1111/iju.15176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/17/2022] [Accepted: 02/26/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To evaluate ureteral injuries caused by insertion of a 13-Fr ureteral access sheath and identify factors (other than pre-stenting) that are predictive of ureteral injury. METHODS We enrolled 201 patients who underwent ureteroscopic lithotripsy (URSL). We excluded 80 patients who underwent ureteral stent insertion before URSL, 10 patients who did not use a ureteral access sheath, and 2 patients in whom a ureteral access sheath could not be inserted. In total, 109 patients were analyzed; all underwent insertion of a 13-Fr ureteral access sheath. We investigated ureteral injuries using the Traxer ureteral injury scale. RESULTS There were 21 (19.3%) cases of ureteral access sheath-related ureteral injury, including 11 (10.1%) grade 2 cases and 10 (9.2%) grade 3 cases. The ureteral injury location was the proximal ureter in 20 cases (18.3%), middle ureter in one case (0.9%), and distal ureter in zero cases. Multiple logistic regression analysis showed that male sex and smaller stone diameter were significant predictive factors for ureteral injury (p = 0.037, odds ratio [OR]: 5.19, 95% confidence interval [CI]: 1.11-24.3 and p = 0.02, OR: 0.83, 95% CI: 0.71-0.97, respectively). Postoperative ureteral stricture did not occur in any cases. CONCLUSIONS The rate of ureteral injury caused by a 13-Fr ureteral access sheath was considerable, and most ureteral injuries occurred in the proximal ureter. Male sex and smaller stone diameter were significant predictive factors for ureteral injury. The proximal ureter should be confirmed when using a 13-Fr ureteral access sheath, particularly in male patients and patients with small stones.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation Inc., Osaka, Japan
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Kaneki Yasuda
- Department of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation Inc., Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Stavroulakis K, Torsello G, Chlouverakis G, Bisdas T, Damerau S, Tsilimparis N, Argyriou A. Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Common Femoral Artery Atherosclerotic Disease. J Endovasc Ther 2023:15266028231158313. [PMID: 36896876 DOI: 10.1177/15266028231158313] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Intravascular lithotripsy (IVL) followed by drug-coated balloon (DCB) angioplasty might be a valuable alternative to surgery for calcified common femoral artery (CFA) atherosclerotic disease. Nonetheless, the 12 months performance of this treatment strategy remains unknown. This study reports on the 12 months outcomes of IVL with adjunctive DCB angioplasty for calcified CFA lesions. METHODS This is a retrospective single-center, single-arm study. Consecutive patients treated by IVL and DCB for calcified CFA disease between February 2017 and September 2020 were evaluated. The primary measure outcome of this analysis was primary patency. Procedural technical success (<30% stenosis), freedom from target lesion revascularization (TLR), secondary patency, and overall mortality were additionally analyzed. RESULTS Thirty-three (n=33) patients were included in this study. The majority presented with lifestyle limiting claudication (n=20, 61%), 52% (n=17) of the patients had chronic kidney disease (CKD) and 33% (n=11) had diabetes. The procedural technical success was 97% (n=32). A flow-limiting dissection post IVL was observed in 2 patients (6%) and a peripheral embolization in a single patient (3%), while the bail-out stenting rate amounted to 12% (n=4). No perforation was observed. The median length of hospital stay was 2 days (interquartile range 2-3). At 12 months, the primary patency was 72%. The freedom from TLR and the secondary patency rates were 94% and 88%, respectively. The 12-month survival amounted to 100% and 75% (n=25) of the patients were asymptomatic or presented with mild claudication. The presence of chronic limb-threatening ischemia (CLTI) (hazard ratio [HR], 0.92; confidence interval (CI); 0.18-4.8, p=0.7) or CKD (HR, 1.30; 95% CI, 0.29-5.8; p=0.72), as well as the use of a 7 mm IVL catheter (HR, 0.59; 95% CI, 0.13-2.63; p=0.49) or of high-dose DCB (HR, 0.68; 95% CI, 0.13-3.53; p=0.65) did not influence the primary patency. CONCLUSIONS In this study, the combination of IVL and DCB angioplasty for calcified CFA disease was associated with low risk for periprocedural complications, acceptable 12 months clinical outcomes, and low rates of reinterventions. CLINICAL IMPACT Intravascular lithotripsy in combination with DCB angioplasty can be an alternative to surgery in highly selected patients with CFA atherosclerotic disease. In this Cohort the combination therapy lead to acceptable clinical results and low reintervention rates at 12 months.
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Affiliation(s)
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany
| | - Gregory Chlouverakis
- Biostatistics Laboratory, Department of Social Medicine, School of Medicine, University of Crete, Rethymno, Greece
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Marousi, Greece
| | - Sarah Damerau
- Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, Marien Hospital Herne, Herne, Germany
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Yaghoubian AJ, Anastos H, Khusid JA, Shimonov R, Lundon DJ, Khargi R, Gallante B, Gassmann K, Bamberger JN, Chandhoke R, Zampini A, Atallah W, Gupta M. Displacement of Lower Pole Stones During Retrograde Intrarenal Surgery Improves Stone-free Status: A Prospective Randomized Controlled Trial. J Urol 2023;:101097JU0000000000003199. [PMID: 36753676 DOI: 10.1097/JU.0000000000003199] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE Lower pole renal stones are associated with the lowest stone-free status of any location in the urinary tract during retrograde intrarenal surgery. Prior work has suggested displacing lower pole stones to a more accessible part of the kidney to improve stone-free status. We sought to prospectively compare the efficacy of laser lithotripsy in situ vs after displacement during retrograde intrarenal surgery for lower pole stones. MATERIALS AND METHODS Between July 2017 and May 2022 patients undergoing retrograde intrarenal surgery for lower pole stones were randomized into an in situ or displacement group. Demographics, comorbidities, and operative parameters were documented. Primary outcome was stone-free status, determined by combination of abdominal x-ray and renal ultrasound at 30-day follow-up. Secondary outcomes included operative time, 30-day complications, emergency department visits, and readmissions. RESULTS A total of 138 patients (69 per group) were enrolled and analyzed. Baseline characteristics were similar between groups. Stone-free status significantly favored the displacement group over the in situ group (95% vs 74%, P = .003, n=62 in each group). Operative time, total laser energy usage, 30-day complications, and 30-day emergency department visits or hospital readmissions were similar between groups. On multivariate analysis only study group allocation was significantly associated with stone-free status (P = .024). CONCLUSIONS Basket displacement of lower pole stones results in a significantly higher stone-free status compared to in situ lithotripsy. The technique is simple, atraumatic, and requires no additional equipment costs and little additional operative time, making it a practical tool in the treatment of lower pole stones.
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Stavroulakis K, Bisdas T, Torsello G, Tsilimparis N, Damerau S, Argyriou A. Intravascular Lithotripsy and Drug-Coated Balloon Angioplasty for Severely Calcified Femoropopliteal Arterial Disease. J Endovasc Ther 2023; 30:106-113. [PMID: 35130782 PMCID: PMC9896408 DOI: 10.1177/15266028221075563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The combination of intravascular lithotripsy (IVL) and drug-coated balloon (DCB) angioplasty for calcified peripheral lesions is associated with promising short-term results. However, data regarding the 12 months performance of this treatment option is missing. This study reports on the outcomes of IVL and DCB angioplasty for calcified femoropopliteal disease. METHODS Patients treated with IVL and DCB for calcified femoropopliteal lesions between February 2017 and September 2020 were included into this study. The primary outcome measure of this analysis was primary patency. Secondary patency, freedom from target lesion revascularization (TLR) and overall mortality were additionally analyzed. RESULTS Fifty-five (n = 55) patients and 71 lesions were analyzed. Most patients presented with long-term limb-threatening ischemia (n = 31, 56%), 47% (n = 26) were diabetics, and 66% (n = 36) had long-term kidney disease. The median lesion length was 77 mm (interquartile range: 45-136), and 20% (n = 14) of the lesions were chronic total occlusions (CTOs). Eccentric calcification was found in 23% of the vessels (n = 16), and circumferential calcium (peripheral arterial calcium scoring system [PACSS] Class 3 and 4) was present in 78% (n = 55) of the treated lesions.The technical success after IVL amounted to 87% (n = 62) and the procedural success to 97% (n = 69). A flow-limiting dissection was observed in 2 cases (3%). Both the rates of target lesion perforation and distal embolization were 1% (n = 1). A bail-out scaffold was deployed in 5 lesions (7%). At 12 months the Kaplan-Meier estimate of primary patency was 81%, the freedom from TLR was 92% and the secondary patency 98%. The overall survival amounted to 89%, while the freedom from major amputation to 98%. The presence of eccentric disease, CTOs, or PACSS Class 4 did not increase the risk for loss of patency or TLR. CONCLUSIONS In this challenging cohort of patients, the use of IVL and DCB for calcified femoropopliteal lesions was associated with promising 12 months outcomes and an excellent safety profile.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular Surgery,
Ludwig-Maximilians-University Hospital Munich, Munchen, Germany,Konstantinos Stavroulakis, Department of
Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Marchioninistr.
15, Munich 81377, Germany.
| | - Theodosios Bisdas
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular and Endovascular
surgery, Athens Medical Center, Athens, Greece
| | - Giovanni Torsello
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery,
Ludwig-Maximilians-University Hospital Munich, Munchen, Germany
| | - Sarah Damerau
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St.
Franziskus-Hospital GmbH, Muenster, Germany,Department of Vascular and Endovascular
Surgery, Augusta Hospital, Duesseldorf, Germany
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Tagliaferri AR, Melki G, Cavanagh Y. Endoscopic Treatment of Acute Cholelithiasis Using AXIOS Stenting and Lithotripsy: A Case Series. Cureus 2023; 15:e34643. [PMID: 36895531 PMCID: PMC9990536 DOI: 10.7759/cureus.34643] [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] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
The management of gallbladder diseases, including acute cholecystitis and choledocholithiasis, puts a significant strain on healthcare. The first-line treatment for acute cholecystitis is cholecystectomy. Patients who have concomitant choledocholithiasis, large stones, and/or gallstone pancreatitis may also benefit from endoscopic interventions. Endoscopic treatments may also be utilized in patients who are not surgical candidates due to underlying comorbidities. Studies examining the role of endoscopic lithotripsy in concomitant cholecystitis are limited. Herein we present a case series in which an AXIOS stent (Boston Scientific, Marlborough, Massachusetts) was placed into the gallbladder for decompression and utilized to access the gallbladder lumen to perform electrohydraulic lithotripsy in two patients.
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Affiliation(s)
| | - Gabriel Melki
- Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Yana Cavanagh
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
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Fontanet S, Farré A, Angerri O, Kanashiro A, Suquilanda E, Bollo J, Gallego M, Sánchez-Martín FM, Millán F, Palou J, Bonnin D, Emiliani E. Bowel Perforation after Extracorporeal Wave Lithotripsy: A Review of the Literature. J Clin Med 2023; 12:jcm12031052. [PMID: 36769699 PMCID: PMC9917583 DOI: 10.3390/jcm12031052] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10-20 mm in diameter. Complications are uncommon, with a reported rate of 0-6% in the literature. Bowel perforation has only been described in a few case reports but requires rapid diagnosis and treatment. METHODS A review of the literature from PubMed/Medline, Embase, Cochrane, and Web of Science databases was performed including studies reporting bowel perforation secondary to ESWL between January 1990 and June 2022. RESULTS We found 16 case reports of intestinal perforation in the literature. Although some patients had previously undergone abdominal surgery or had inflammatory intestinal disease, others were without comorbidities that could lead to complications. Abdominal pain was the main symptom and imaging was required to confirm the diagnosis, which usually necessitated a surgical intervention. As regards the ESWL technique, it appears that the combination of a high energy level and the prone position constitutes a risk factor for these rare complications. At the authors' centre, only one case has been reported among 24,000 ESWL procedures over 20 years: A 59-year-old female who underwent ESWL for a distal right ureteral stone presented acute abdominal pain and free intraperitoneal pelvic fluid on ultrasound. A CT scan revealed a small bowel perforation requiring open laparotomy with primary closure. CONCLUSIONS In conclusion, although bowel perforation after ESWL is rare, progressive abdominal pain with tenderness at physical examination requires proper imaging evaluation to exclude bowel perforation and prompt intervention if required.
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Affiliation(s)
- Sofia Fontanet
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Alba Farré
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Oriol Angerri
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Andrés Kanashiro
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Edgar Suquilanda
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Jesús Bollo
- Department of General Surgery, Sant Pau Hospital, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Maria Gallego
- Department of General Surgery, Sant Pau Hospital, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | | | - Félix Millán
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Diana Bonnin
- Department of Radiology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
- Correspondence:
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Curini L, Pesce M. Shockwaves delivery for aortic valve therapy-Realistic perspective for clinical translation? Front Cardiovasc Med 2023; 10:1160833. [PMID: 37113704 PMCID: PMC10128859 DOI: 10.3389/fcvm.2023.1160833] [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: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Calcific aortic valve disease (CAVD) is the most frequent valvular heart disorder, and the one with the highest impact and burden in the elderly population. While the quality and standardization of the current aortic valve replacements has reached unprecedented levels with the commercialization of minimally-invasive implants and the design of procedures for valve repair, the need of supplementary therapies able to block or retard the course of the pathology before patients need the intervention is still awaited. In this contribution, we will discuss the emerging opportunity to set up devices to mechanically rupture the calcium deposits accumulating in the aortic valve and restore, at least in part, the pliability and the mechanical function of the calcified leaflets. Starting from the evidences gained by mechanical decalcification of coronary arteries in interventional cardiology procedures, a practice already in the clinical setting, we will discuss the advantages and the potential drawbacks of valve lithotripsy devices and their potential applicability in the clinical scenario.
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37
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Talyshinskii A, Bakhman G, Hameed BMZ, Pietropaolo A, Naik N, Somani BK. Current state of mobile health apps in endourology: a review of mobile platforms in marketplaces and literature. Ther Adv Urol 2023; 15:17562872231176368. [PMID: 37284592 PMCID: PMC10240556 DOI: 10.1177/17562872231176368] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
Several mobile healthcare (mHealth) apps are available in various marketplaces, but there is still concern about their accuracy, data safety, and regulation. The goal of this review was to critically analyze the mobile apps created for education, diagnosis, and medical and surgical treatment of patients with kidney stone disease (KSD), as well as to assess the level of data security, the contribution of physicians in their development and adherence to the Food and Drug Administration (FDA) and Medical Device Regulation (MDR) guidance. A comprehensive literature search was performed using PubMed (September 2022), in the Apple App Store and Google Play store using relevant keywords and inclusion criteria. Information was extracted for the name of the app, primary and additional functionalities, release and last update, number of downloads, number of marks and average rating, Android/iOS compatibility, initial and in-app payments, data safety statement, physician involvement statement, and FDA/MDR guidance. A total of 986 apps and 222 articles were reviewed, of which based on the inclusion, 83 apps were finally analyzed. The apps were allocated to six categories about their primary purpose: education (n = 8), fluid trackers (n = 54), food content description and calculators (n = 11), diagnosis (n = 3), pre- and intra-operative application (n = 4), and stent trackers (n = 2). Of these apps, the number of apps supported for Android, iOS, and both of them were 36, 23, and 23, respectively. Despite a wide range of apps available for KSD, the participation of doctors in their development, data security, and functionality remains insufficient. Further development of mHealth should be carried out properly under the supervision of urological associations involving patient support groups, and these apps must be regularly updated for their content and data security.
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Affiliation(s)
- Ali Talyshinskii
- Department of Urology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Urology Center with Robot-Assisted Surgery, Mariinsky Hospital, Saint Petersburg, Russia
| | - Guliev Bakhman
- Department of Urology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Urology Center with Robot-Assisted Surgery, Mariinsky Hospital, Saint Petersburg, Russia
| | - BM Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [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: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
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Miller CS, Whiles BB, Ito WE, Machen E, Thompson JA, Duchene DA, Neff DA, Molina WR. Image Distortion During Flexible Ureteroscopy: A Laboratory Model Comparing Super Pulsed Thulium Fiber Laser vs High-Power Ho:YAG Laser. J Endourol 2023; 37:99-104. [PMID: 36106599 PMCID: PMC10623464 DOI: 10.1089/end.2022.0195] [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] [Indexed: 01/11/2023] Open
Abstract
Purpose: Digital ureteroscopes employ "chip-on-the-tip" technology that allows for significant improvement in image resolution. However, image distortion often occurs during laser lithotripsy owing to acoustic wave production. We sought to compare image distortion using different laser power settings and distances from the laser fiber tip to the scope for the Super Pulsed Thulium Fiber (SPTF) laser and high-power Holmium:YAG (Ho:YAG) laser. Materials and Methods: Ureteroscopy was simulated using a silicon kidney-ureter-bladder model fitted with a 12F/14F access sheath and the Lithovue™ (Boston Scientific), disposable digital flexible ureteroscope. At defined laser parameters (10, 20, 30 and 40 W, short pulse), a 200-μm laser fiber was slowly retracted toward the tip of the ureteroscope during laser activation. Image distortion was identified, and distance from the laser tip to the scope tip was determined. Data from the two lasers were compared utilizing t-tests. Results: After controlling for frequency, power, and laser mode, utilizing 1.0 J of energy was significantly associated with less feedback than 0.5 J (-0.091 mm, p ≤ 0.05). Increased power was associated with larger feedback distance (0.016 mm, p ≤ 0.05); however, increase in frequency did not have a significant effect (-0.001 mm, p = 0.39). The SPFT laser had significantly less feedback when compared with all Holmium laser modes. Conclusions: Increased total power results in image distortion occurring at greater distances from the tip of the ureteroscope during laser activation. Image distortion occurs further from the ureteroscope with Ho:YAG laser than with SPTF fibers at the same laser settings. In clinical practice, the tip of the laser fiber should be kept further away from the tip of the scope during ureteroscopy as the power increases as well as when utilizing the Ho:YAG system compared with the SPTF laser platform. The SPTF laser may have a better safety profile in terms of potential scope damage.
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Affiliation(s)
- Caleb S. Miller
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Bristol B. Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Willian E. Ito
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Edward Machen
- University of Kansas, School of Medicine, Kansas City, Kansas, USA
| | - Jeffrey A. Thompson
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David A. Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Donald A. Neff
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Wilson R. Molina
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
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Sierra A, Corrales M, Somani B, Traxer O. Laser Efficiency and Laser Safety: Holmium YAG vs. Thulium Fiber Laser. J Clin Med 2022; 12. [PMID: 36614950 DOI: 10.3390/jcm12010149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Objective: To support the efficacy and safety of a range of thulium fiber laser (TFL) pre-set parameters for laser lithotripsy: the efficiency is compared against the Holmium:YAG (Ho:YAG) laser in the hands of juniors and experienced urologists using an in vitro ureteral model; the ureteral damage of both lasers is evaluated in an in vivo porcine model. (2) Materials and Methods: Ho:YAG laser technology and TFL technology, with a 200 µm core-diameter laser fibers in an in vitro saline ureteral model were used. Each participant performed 12 laser sessions. Each session included a 3-min lasering of stone phantoms (Begostone) with each laser technology in six different pre-settings retained from the Coloplast TFL Drive user interface pre-settings, for stone dusting: 0.5 J/10 Hz, 0.5 J/20 Hz, 0.7 J/10 Hz, 0.7 J/20 Hz, 1 J/12 Hz and 1 J/20 Hz. Both lasers were also used in three in vivo porcine models, lasering up to 20 W and 12 W in the renal pelvis and the ureter, respectively. Temperature was continuously recorded. After 3 weeks, a second look was done to verify the integrity of the ureters and kidney and an anatomopathological analysis was performed. (3) Results: Regarding laser lithotripsy efficiency, after 3 min of continuous lasering, the overall ablation rate (AR) percentage was 27% greater with the TFL technology (p < 0.0001). The energy per ablated mass [J/mg] was 24% lower when using the TFL (p < 0.0001). While junior urologists performed worse than seniors in all tests, they performed better when using the TFL than Ho:YAG technology (36% more AR and 36% fewer J/mg). In the in vivo porcine model, no urothelial damage was observed for both laser technologies, neither endoscopically during lasering, three weeks later, nor in the pathological test. (4) Conclusions: By using Coloplast TFL Drive GUI pre-set, TFL lithotripsy efficiency is higher than Ho:YAG laser, even in unexperienced hands. Concerning urothelial damage, both laser technologies with low power present no lesions.
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Chiou YE, Chung CH, Chien WC, Tsay PK, Kan HC, Weng WH. A Comparative Study of Stone Re-Treatment after Lithotripsy. Life (Basel) 2022; 12. [PMID: 36556495 DOI: 10.3390/life12122130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The high recurrence rate has always been a problem associated with urolithiasis. This study aimed to explore the effectiveness of single interventions, combined therapies, and surgical and nonsurgical interventions. Herein, three lithotripsy procedures—extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL)—were assessed and a retrospective cohort was selected in order to further analyze the association with several risk factors. Firstly, a population-based cohort from the Taiwan National Health Insurance Research Database (NHIRD) from 1997 to 2010 was selected. In this study, 350 lithotripsy patients who underwent re-treatment were followed up for at least six years to compare re-treatment rates, with 1400 patients without any lithotripsy treatment being used as the comparison cohort. A Cox proportional hazards regression model was applied. Our results indicate that the risk of repeat urolithiasis treatment was 1.71-fold higher in patients that received lithotripsy when compared to patients that were not treated with lithotripsy (hazard ratio (HR) 1.71; 95% confidence interval (CI) = 1.427−2.048; p < 0.001). Furthermore, a high percentage of repeated treatment was observed in the ESWL group (HR 1.60; 95% CI = 1.292−1.978; p < 0.001). Similarly, the PCNL group was also independently associated with a high chance of repeated treatment (HR 2.32; 95% CI = 1.616−3.329; p < 0.001). Furthermore, age, season, level of care, and Charlson comorbidities index (CCI) should always be taken into consideration as effect factors that are highly correlated with repeated treatment rates.
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Li S, Wu J, Li Q, Zhang J. Reverse Trendelenburg Lithotomy with Certain Inclination Angles Reduces Stone Retropulsion during Ureteroscopic Lithotripsy for Proximal Ureteral Stone. J Pers Med 2022; 12:jpm12122020. [PMID: 36556241 PMCID: PMC9785649 DOI: 10.3390/jpm12122020] [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: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The objective of this study is to investigate how different inclination angles of reverse Trendelenburg lithotomy affect stone retropulsion and stone-free rates during ureteroscopic lithotripsy for proximal ureteral stones. Patients with proximal ureteral stones undergoing ureteroscopic lithotripsy in our institution between January 2019 and December 2020 were included according to predefined criteria. The rigid ureteroscope and Holmium: YAG laser were utilized to perform lithotripsy, and a stone basket was used to keep the stone in place and to avoid retropulsion. Before initiating lithotripsy, the upper part of the patient’s body was tilted up to establish a reverse Trendelenburg posture with appropriate inclination angles. To quantify the stone-free rate, computed tomography was used to evaluate the residual stones in the kidney one month following surgery. Patients’ clinical data were obtained retrospectively, including age, gender, the largest diameter of stone, stone density on computed tomography, and the distance between stone and ureteral pelvic junction, etc. Patients were divided into four groups based on the inclination angles of reverse Trendelenburg lithotomy: 0°, 10°, 20°, and 30°. The chi-square test was used to compare stone retropulsion and stone-free rates between groups. To discover possible determinants of the stone-free rate, logistic regression analyses were used. There were 189 patients that qualified. There were no differences in clinical characteristics between groups (p > 0.05). Multiple comparisons between groups revealed that the 20° and 30° groups had less retropulsion and a greater stone-free rate than the 0° and 10° groups (p < 0.05), whereas there were no significant differences in stone retropulsion or stone-free rates between the 20° and 30° groups or between the 0° and 10° groups (p > 0.05). The inclination angles as well as distance between the stone and ureteral pelvic junction were identified by using logistic regression analyses as the related factors for the stone-free rate. According to our results, the appropriate inclination angles of reverse Trendelenburg lithotomy during ureteroscopic lithotripsy for proximal ureteral stones would help preclude stone retropulsion and increase the stone-free rate.
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Smeulders N, Cho A, Alshaiban A, Read K, Fagan A, Easty M, Minhas K, Barnacle A, Hayes W, Bockenhauer D. Shockwaves and the Rolling Stones: An Overview of Pediatric Stone Disease. Kidney Int Rep 2022; 8:215-228. [PMID: 36815103 PMCID: PMC9939363 DOI: 10.1016/j.ekir.2022.11.017] [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] [Received: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Urinary stone disease is a common problem in adults, with an estimated 10% to 20% lifetime risk of developing a stone and an annual incidence of almost 1%. In contrast, in children, even though the incidence appears to be increasing, urinary tract stones are a rare problem, with an estimated incidence of approximately 5 to 36 per 100,000 children. Consequently, typical complications of rare diseases, such as delayed diagnosis, lack of awareness, and specialist knowledge, as well as difficulties accessing specific treatments also affect children with stone disease. Indeed, because stone disease is such a common problem in adults, frequently, it is adult practitioners who will first be asked to manage affected children. Yet, there are unique aspects to pediatric urolithiasis such that treatment practices common in adults cannot necessarily be transferred to children. Here, we review the epidemiology, etiology, presentation, investigation, and management of pediatric stone disease; we highlight those aspects that separate its management from that in adults and make a case for a specialized, multidisciplinary approach to pediatric stone disease.
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Affiliation(s)
- Naima Smeulders
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Abdulelah Alshaiban
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Katharine Read
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Aisling Fagan
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Marina Easty
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Kishore Minhas
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alex Barnacle
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Wesley Hayes
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Renal Medicine, University College London, London, UK,Correspondence: Detlef Bockenhauer, Department of Renal Medicine, University College London, London, UK.
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Rai V, Walvekar RR, Verma J, Monga U, Rai D, Munjal M. Laser-Assisted Sialo lithotripsy: A Correlation of Objective and Subjective Outcomes. Laryngoscope 2022; 132:2344-2349. [PMID: 35289948 DOI: 10.1002/lary.30106] [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: 11/09/2021] [Revised: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the long-term symptomatic results of laser-assisted sialolithotripsy (LAS) in cases of obstructive sialolithiasis and correlate with objective criteria using diagnostic sialendoscopy (DS) as a method of examination. METHODS This is a retrospective study comprising 50 consecutive patients who underwent holmium-YAG LAS and completed follow-up of at least 6 months. Symptom scoring and endoscopic scoring were done at 6 weeks and 6 months intervals for further study purposes. RESULTS At the end of 6 weeks post-LAS, 70% patients were asymptomatic (A-sym) and only 30% had residual symptoms (Sym). However, obstructed duct (OB-duct) was observed on endoscopic scoring in 88% due to stenosis, residual stones, or both stenosis and residual stones. The obstructed ducts were treated in outpatient clinic and followed up over time, leading to 98% of patients being in A-sym group at the end of study period of 6 months. At the end of study, 82% of patients had clear duct (CL-duct). CONCLUSION Holmium LAS is a viable option for the management of intermediate-sized stones. LAS if used judiciously, and in properly selected cases, has high rate of stone fragmentation and symptom resolution. A vigilant postoperative protocol taking into account residual mealtime symptoms and altered salivary characteristics combined with early DS can help identify and treat patients with residual stone fragments and ductal stenosis. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2344-2349, 2022.
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Affiliation(s)
- Varun Rai
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Rohan R Walvekar
- Otolaryngology & Head Neck Surgery, LSUHSC, New Orleans, Louisiana, USA
| | - Jatin Verma
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Uday Monga
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Devinder Rai
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Munjal
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
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Han H, Kim J, Moon YJ, Jung HD, Cheon B, Han J, Cho SY, Kwon DS, Lee JY. Feasibility of Laser Lithotripsy for Midsize Stones Using Robotic Retrograde Intrarenal Surgery System easyUretero in a Porcine Model. J Endourol 2022; 36:1586-1592. [PMID: 35850514 DOI: 10.1089/end.2022.0272] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To test the safety and feasibility of laser lithotripsy for midsize renal stones using a newly developed robotic retrograde intrarenal surgery (RIRS) system (easyUretero) in a porcine model. Materials and Methods: Three urologic surgeons representing three different RIRS experience levels (beginner, intermediate, and expert) participated. Four female pigs (aged 6 months) underwent manual or robotic RIRS. Under general anesthesia, a nephrostomy tract was created ventrally, and calcium stones (diameter, 1.0-1.5 cm) were inserted at renal calices. For manual RIRS, surgeons operated a flexible ureteroscope. For robotic RIRS, the ureteroscope was attached to the robotic slave device. The Auriga XL™ Holmium laser was used for lithotripsy. Lasering and stone retrieval time were measured. Kidneys and ureters were inspected for injury at the end of each session. Results: For the expert, both lasering and stone retrieval by manual RIRS were quicker than by robotic RIRS (22.8 ± 11.0 s/stone vs 234.5 ± 102.5 s/stone, p = 0.02; 41.5 ± 0.5 s/stone vs 79.3 ± 8.1 s/stone, p = 0.02). For the intermediate and beginner, lasering and stone retrieval times were not significantly different between manual and robotic procedures (127.8 ± 93.2 s/stone vs 284.8 ± 112.3 s/stone, p = 0.08; 86.0 ± 30.5 s/stone vs 84.1 ± 21.4 s/stone, p = 0.92). All stones were removed. Grade 1 ureteral and renal injuries occurred in both manual RIRS and robotic RIRS. Conclusions: The laser lithotripsy using the easyUretero robotic system is safe and feasible in a porcine model, even for less-experienced surgeons.
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Affiliation(s)
- Hyunho Han
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byungsik Cheon
- ROEN Surgical, Inc., Daejeon, Korea
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jungmin Han
- ROEN Surgical, Inc., Daejeon, Korea
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Soo Kwon
- ROEN Surgical, Inc., Daejeon, Korea
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
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Dau JJ, Hall TL, Matzger AJ, Louters MM, Khajeh NR, Ghani KR, Roberts WW. Laser Heating of Fluid With and Without Stone Ablation: In Vitro Assessment. J Endourol 2022; 36:1607-1612. [PMID: 35904398 DOI: 10.1089/end.2022.0199] [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: 12/15/2022] Open
Abstract
Introduction: Laser lithotripsy can cause excessive heating of fluid within the collecting system and lead to tissue damage. To better understand this effect, it is important to determine the percentage of applied laser energy that is converted to heat and the percentage used for stone ablation. Our objective was to calculate the percentage of laser energy used for stone ablation based on the difference in fluid temperature measured in an in vitro model when the laser was activated without and with stone ablation. Methods: Flat BegoStone disks (15:5) were submerged in 10 mL of deionized water at the bottom of a vacuum evacuated double-walled glass Dewar. A Moses 200 D/F/L laser fiber was positioned above the surface of the stone at a distance of 3.5 mm for control (no stone ablation) or 0.5 mm for experimental (ablation) trials. The laser was activated and scanned at 3 mm/second across the stone in a preprogrammed pattern for 30 seconds at 2.5 W (0.5 J × 5 Hz) for both short-pulse (SP) and Moses distance (MD) modes. Temperature of the fluid was recorded using two thermocouples once per second. Results: Control trials produced no stone ablation, while experimental trials produced a staccato groove in the stone surface, simulating efficient lithotripsy. The mean temperature increase for SP was 1.08°C ± 0.04°C for control trials and 0.98°C ± 0.03°C for experimental trials, yielding a mean temperature difference of 0.10°C ± 0.06°C (p = 0.0005). With MD, the mean temperature increase for control trials was 1.03°C ± 0.01°C and for experimental trials 0.99°C ± 0.06°C, yielding a smaller mean temperature difference of 0.04°C ± 0.06°C (p = 0.09). Conclusions: Even under conditions of energy-efficient stone ablation, the majority of applied laser energy (91%-96%) was converted to heat.
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Affiliation(s)
- Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam J Matzger
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marne M Louters
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nikta R Khajeh
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Quiroz Y, Somani BK, Tanidir Y, Tekgul S, Silay S, Castellani D, Lim EJ, Fong KY, Garcia Rojo E, Corrales M, Hameed BMZ, Llorens E, Teoh JYC, Dogan HS, Traxer O, Bujons Tur A, Gauhar V. Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends. J Endourol 2022; 36:1511-1521. [PMID: 35972727 DOI: 10.1089/end.2022.0160] [Citation(s) in RCA: 1] [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: 02/04/2023] Open
Abstract
Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
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Affiliation(s)
- Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul Medeniyet University, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Daniele Castellani
- Department of Urology, Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Department of Urology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Garcia Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College Mangalore, Karnataka, India
| | - Erika Llorens
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Anna Bujons Tur
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
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Lee YN, Moon JH, Lee TH, Yoo HW, Yang JK, Cha SW, Cho YD, Park SH. Efficacy and safety of direct peroral cholangioscopy using a new multibending ultra-slim endoscope for the management of biliary diseases. J Hepatobiliary Pancreat Sci 2022; 29:1292-1299. [PMID: 35658104 DOI: 10.1002/jhbp.1189] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE Compared with currently available duodenoscopy-assisted systems, direct peroral cholangioscopy (DPOC) using an ultra-slim endoscope is limited by technical difficulties. The multibending (MB) ultra-slim endoscope was introduced as a dedicated cholangioscope for DPOC to challenge the technical problem. We retrospectively analyzed the clinical utility of DPOC using an MB endoscope with free-hand insertion into the bile duct in patients with biliary diseases. METHODS A total of 145 patients who underwent DPOC using an MB endoscope were analyzed. The primary outcome was the technical success rate of DPOC using the free-hand insertion of the MB endoscope. The secondary outcomes were the technical success rates of DPOC-guided diagnostic and therapeutic interventions, the diagnostic accuracy of DPOC-guided target biopsy, and adverse events related to DPOC. RESULTS Free-hand biliary insertion of a MB endoscope for DPOC was technically successful in 133 patients (91.7%). DPOC-guided target biopsy was successful in 36 of 38 patients (94.7%) and had a diagnostic accuracy of 91.7% (95% confidence interval, 82.6-100). Sixty-nine therapeutic interventions were performed; technical success was achieved in 65 (94.2%). No severe adverse events were observed. CONCLUSIONS The MB ultra-slim endoscope was technically effective to perform a DPOC including various diagnosis and therapeutic interventions without device assistance. MB endoscope is considered to contribute to expanding a role of DPOC in diagnosis and treatment of diverse biliary tract diseases.
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Affiliation(s)
- Yun Nah Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jong Ho Moon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Hae Won Yoo
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jae Kook Yang
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Sang-Woo Cha
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Young Deok Cho
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Sang-Heum Park
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
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Hall MK, Thiel J, Dunmire B, Samson PC, Kessler R, Sunaryo P, Sweet RM, Metzler IS, Chang HC, Gunn M, Dighe M, Anderson L, Popchoi C, Managuli R, Cunitz BW, Burke BH, Ding L, Gutierrez B, Liu Z, Sorensen MD, Wessells H, Bailey MR, Harper JD. First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones. J Urol 2022; 208:1075-82. [PMID: 36205340 DOI: 10.1097/JU.0000000000002864] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy to reposition ureteral stones and facilitate passage in awake subjects. MATERIALS AND METHODS Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with burst wave lithotripsy was administered by a handheld transducer to awake, unanesthetized subjects. Efficacy outcomes included stone motion, stone passage, and pain relief. Safety outcome was the reporting of associated anticipated or adverse events. RESULTS Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with burst wave lithotripsy bursts (n = 13), and stone motion was observed in 19 (66%). The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow-up in an average of 3.9±4.9 days post-procedure. Fragmentation was observed in 7 of the burst wave lithotripsy cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort with only 2.2% (18 of 820) propulsion bursts. CONCLUSIONS This study supports the efficacy and safety of using ultrasonic propulsion and burst wave lithotripsy in awake subjects to reposition and break ureteral stones to relieve pain and facilitate passage.
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Becker REN, Roberts WW, Lipkin ME, Ghani KR. Developments in ureteroscopic stone treatment: Key themes and remaining challenges. Front Surg 2022; 9:1050285. [PMID: 36684292 PMCID: PMC9847479 DOI: 10.3389/fsurg.2022.1050285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Russell E. N. Becker
- Division of Endourology, Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States,Correspondence: Russell E. N. Becker
| | - William W. Roberts
- Division of Endourology, Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Khurshid R. Ghani
- Division of Endourology, Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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