scholarly journals Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

2020 ◽  
Author(s):  
Daniel Schlager ◽  
Antonia Schulte ◽  
Jan Schütz ◽  
Albrecht Brandenburg ◽  
Christoph Schell ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Real Time ◽  
Target Identification ◽  
Laser System ◽  
Laser Lithotripsy ◽  
Bladder Stone ◽  
Holmium Laser ◽  
Comparison Study ◽  
Holmium Laser Lithotripsy

Abstract Introduction and objective Thermal injuries associated with Holmium laser lithotripsy of the urinary tract are an underestimated problem in stone therapy. Surgical precision relies exclusively on visual target identification when applying laser energy for stone disintegration. This study evaluates a laser system that enables target identification automatically during bladder stone lithotripsy, URS, and PCNL in a porcine animal model. Methods Holmium laser lithotripsy was performed on two domestic pigs by an experienced endourology surgeon in vivo. Human stone fragments (4–6 mm) were inserted in both ureters, renal pelvises, and bladders. Ho:YAG laser lithotripsy was conducted as a two-arm comparison study, evaluating the target identification system against common lithotripsy. We assessed the ureters’ lesions according to PULS and the other locations descriptively. Post-mortem nephroureterectomy and cystectomy specimens were examined by a pathologist. Results The sufficient disintegration of stone samples was achieved in both setups. Endoscopic examination revealed numerous lesions in the urinary tract after the commercial Holmium laser system. The extent of lesions with the feedback system was semi-quantitatively and qualitatively lower. The energy applied was significantly less, with a mean reduction of more than 30% (URS 27.1%, PCNL 52.2%, bladder stone lithotripsy 17.1%). Pathology examination revealed only superficial lesions in both animals. There was no evidence of organ perforation in either study arm. Conclusions Our study provides proof-of-concept for a laser system enabling automatic real-time target identification during lithotripsy on human urinary stones. Further studies in humans are necessary, and to objectively quantify this new system’s advantages, investigations involving a large number of cases are mandatory.

scholarly journals Treatment of upper urinary tract stones with flexible ureteroscopy in children

2018 ◽  
Vol 13 (3) ◽  
Author(s):  
Jing Xiao ◽  
Xiangyu Wang ◽  
Jun Li ◽  
Miaomiao Wang ◽  
Tiandong Han ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Operation Time ◽  
Upper Urinary Tract ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Flexible Ureteroscopy ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Urinary Tract Stones ◽  
Free Rate

Introduction: This single-centre, retrospective study aimed to assess the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in treating children with upper urinary tract stones. Methods: From June 2014 to October 2015, a total of 100 children (74 boys and 26 girls) with upper urinary tract stones were treated using FURS. A 4.7 Fr double-J stent was placed two weeks before operation. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. The preoperative, operative, and postoperative data of the patients were retrospectively analyzed. Results: A total of 100 pediatric patients with a mean age of 3.51±1.82 years underwent 131 FURS and holmium laser lithotripsy. Mean stone diameter was 1.49±0.92 cm. Average operation time was 30.8 minutes (range 15–60). The laser power was controlled between 18 and 32 W, and the energy maintained between 0.6 and 0.8 J at any time; laser frequency was controlled between 30 and 40 Hz. Complications were observed in 69 (69.0 %) patients and classified according to the Clavien system. Postoperative hematuria (Clavien I) occurred in 64 (64.0 %) patients. Postoperative urinary tract infection with fever (Clavien II) was observed in 8/113 (7.1%) patients. No ureteral perforation and mucosa avulsion occurred. The overall stone-free rate of single operation was 89/100 (89%). Stone diameter and staghorn calculi were significantly associated with stone-free rate. Conclusions: FURS and holmium laser lithotripsy is effective and safe in treating children with upper urinary tract stones.

scholarly journals Caliceal Fluid Temperature During High-Power Holmium Laser Lithotripsy in an In Vivo Porcine Model

2018 ◽  
Vol 32 (8) ◽  
pp. 724-729 ◽  
Author(s):  
Ali H. Aldoukhi ◽  
Timothy L. Hall ◽  
Khurshid R. Ghani ◽  
Adam D. Maxwell ◽  
Brian MacConaghy ◽  
...  
Keyword(s):  
High Power ◽  
Porcine Model ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Fluid Temperature ◽  
Holmium Laser Lithotripsy

Application of Percutaneous Holmium Laser Lithotripsy in the Treatment of Bladder Calculi with Lower Urinary Tract Obstruction or Pelvic Joint Disease

2021 ◽  
pp. 1-6
Author(s):  
Xingguo Yang ◽  
Pinxin Huang ◽  
Jun Cao ◽  
Zhixiu Cao ◽  
Yong Nie
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Laser Lithotripsy ◽  
Joint Disease ◽  
Holmium Laser ◽  
Lithotomy Position ◽  
Bladder Calculi ◽  
Holmium Laser Lithotripsy ◽  
Lower Urinary Tract Obstruction ◽  
Lower Urinary

<b><i>Objective:</i></b> The aim was to summarize the experience of percutaneous holmium laser lithotripsy in the treatment of bladder calculi with lower urinary tract obstruction or pelvic joint disease in our hospital, explore its efficacy and safety, and improve the minimally invasive surgical technique for bladder calculi. <b><i>Methods:</i></b> The clinical data of 61 patients with bladder calculi combined with lower urinary tract obstructive diseases, including urethral stricture, benign prostatic hyperplasia, and bladder neck contracture or pelvic joint diseases in our hospital from 2017 to 2019 were retrospectively analyzed. All patients with bladder stones measuring 1.5–9 cm were placed in supine or lithotomy position. B-scan was conducted to locate the puncture above the pubic symphysis, establishing a 16–30 Fr bladder channel, and Lumenis holmium laser lithotripsy was subsequently performed through a Li Xun Nephroscope. The crushed stones were flushed out through the percutaneous bladder channel or taken out with foreign body forceps. After surgery, the cystostomy tube was indwelled for 3 days. <b><i>Results:</i></b> All the 61 cases were operated successfully with an average lithotripsy time of 25 min, and there was no conversion to open surgery. Postoperative reexamination showed neither residual calculi nor complications such as severe infection, massive hemorrhage, and intestinal injury. <b><i>Conclusion:</i></b> Percutaneous holmium laser lithotripsy is an improved minimally invasive surgical technique for the treatment of bladder calculi with the advantages of clear surgical field, high stone removal efficiency, less trauma, low-pressure bladder perfusion, and low incidence of accessory injury and infection. For patients with lower urinary tract obstructive disease resulting in obstruction of transurethral surgery and patients with pelvic joint disease resulting in difficult lithotomy position placement, this procedure is more advantageous than transurethral surgery. It is also suitable for bladder calculus with a long diameter &#x3e;5 cm or multiple calculi.

scholarly journals Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yue He ◽  
You-Gang Feng ◽  
Jun He ◽  
Bo Liang ◽  
Ming-Dong Jiang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Fluid Temperature ◽  
Postoperative Fever ◽  
Irrigation Fluid ◽  
Suspected Infection ◽  
Randomized Controlled ◽  
Holmium Laser Lithotripsy

Abstract Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.

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