scholarly journals Application of Pneumatic Lithotripter and Holmium Laser in the Treatment of Ureteral Stones and Kidney Stones in Children

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Marcin Życzkowski ◽  
Rafał Bogacki ◽  
Krzysztof Nowakowski ◽  
Bartosz Muskała ◽  
Paweł Rajwa ◽  
...  
Keyword(s):  
Operative Time ◽  
Treatment Options ◽  
Population Based ◽  
Holmium Laser ◽  
Ureteral Stones ◽  
Stone Free Rate ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Free Rate

Objective.Treatment options for urolithiasis in children include URSL and RIRS. Various types of energy are used in the disintegration of deposits in these procedures. We decided to evaluate the usefulness of URSL and RIRS techniques and compare the effectiveness of pneumatic lithotripters and holmium lasers in the child population based on our experience.Materials and Methods.One hundred eight (108) children who underwent URSL and RIRS procedures were enrolled in the study and divided into two (2) groups according to the type of energy used: pneumatic lithotripter versus holmium laser. We evaluated the procedures’ duration and effectiveness according to the stone-free rate (SFR) directly after the procedure and after fourteen (14) days and the rate of complications.Results.The mean operative time was shorter in the holmium laser group. A higher SFR was observed in the holmium laser but it was not statistically significant in the URSL and RIRS procedures. The rate of complications was similar in both groups.Conclusions.The URSL and RIRS procedures are highly efficient and safe methods. The use of a holmium laser reduces the duration of the procedure and increases its effectiveness in comparison with the use of a pneumatic lithotripter.

scholarly journals Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Ahmed Issam Ali ◽  
Ali M. Abdel-Karim ◽  
Ahmed A. Abd El Latif ◽  
Amr Eldakhakhny ◽  
Ehab M. Galal ◽  
...  
Keyword(s):  
Operative Time ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Stone Migration ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Free Rate

Abstract Background Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate. Results The mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group. Conclusion The stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.

scholarly journals A prospective comparative study of ureterorenoscopy with and without DJ stenting for the management of ureteric stones

2021 ◽  
Vol 8 (12) ◽  
pp. 3606
Author(s):  
Dinesh Prasad ◽  
Yogesh Satani ◽  
Shivam Singh ◽  
Darpen Gajera
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Operative Time ◽  
Ureteral Stones ◽  
Safe Alternative ◽  
Stone Free Rate ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
Free Rate

Background: Urolithiasis is the most common urological disease. Surgical treatment of ureteral stones consists of four minimally invasive modalities including ESWL, URS, PCNL, and laparoscopic or robotic-assisted stone surgery. URS and ESWL are the most widely used techniques. However, the use of ureteral stents for the treatment of ureteral stones is still controversial. Herein, we did a comparative study of URS with and without DJ stenting for the management of ureteric stones. Objectives of current study were to compare prevalence of post-operative complications in patients undergoing ureterorenoscopy without ureteral stenting as compared to patients undergoing stenting procedure, to study the frequency of morbidity in patients during post -operative period in both ‘stent’ and ‘no stent’ groups. Stone free-rate, operative time, complications, hospital stay and need for re-treatment in both groups will be determined.Methods: 50 patients with ureteric stones admitted in our hospital-SMIMER fulfilling our inclusion and exclusion criteria were randomly divided in two groups- patients in group A (25) underwent URS without DJ stenting and group B (25) underwent URS with DJ stenting.Results: URS without DJ stenting had less operative time, less postoperative complications like pain, requirement of analgesia, hematuria, UTI, dysuria, fever, less readmission rate and less hospital stay, similar stone free rate compared to URS with DJ stenting but it requires higher surgical endoscopy skills with urological expertise.Conclusions: Thus, after adequate training, URS without DJ stenting can be recommended as a safe alternative procedure than URS with DJ stenting for management of ureteric stones. 

scholarly journals Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

2021 ◽  
Vol 10 (13) ◽  
pp. 2742
Author(s):  
Amelia Pietropaolo ◽  
Thomas Hughes ◽  
Mriganka Mani ◽  
Bhaskar Somani
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Stone Fragmentation ◽  
System Versus ◽  
Number Of Patients ◽  
Higher Power ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Second Procedure

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

scholarly journals Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi

2021 ◽  
Vol 8 ◽  
Author(s):  
Longhui Lai ◽  
Wenzhao Zhang ◽  
Fangjian Zheng ◽  
Tao Wang ◽  
Peide Bai ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Operative Time ◽  
Ureteral Calculi ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Ureteral Access Sheath ◽  
Hospitalization Cost ◽  
Access Sheath ◽  
Stone Free Rate ◽  
Free Rate

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi.Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group.Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications.Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.

scholarly journals Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

2021 ◽  
pp. 039156032110318
Author(s):  
Noam Bar-Yaakov ◽  
Haim Hertzberg ◽  
Ron Marom ◽  
Jemal Jikia ◽  
Roy Mano ◽  
...  
Keyword(s):  
Operative Time ◽  
Statistical Significance ◽  
Hounsfield Units ◽  
Stone Size ◽  
Stone Clearance ◽  
Stone Free Rate ◽  
Average Operative Time ◽  
Group A ◽  
Group B ◽  
Free Rate

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p < 0.05). The average operative time was 99 and 78 min, SCR 143 and 200 mm3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

scholarly journals Transurethral use of nephroscope in the management of bladder stone

2014 ◽  
Vol 9 (1) ◽  
pp. 14-18
Author(s):  
Ghanshyam S Sigdel ◽  
A Agarwal ◽  
N Laminchhane ◽  
WK Belokar
Keyword(s):  
Medical Records ◽  
Operative Time ◽  
Bladder Stone ◽  
Endoscopic Management ◽  
Medical Sciences ◽  
Stone Size ◽  
Bladder Stones ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Objective: Endoscopic management of bladder stone is a well established procedure. The objective of this study was to evaluate the usefulness of transurethral use of nephroscope in the management of bladder stones. Materials and methods: We retrospectively analyzed the medical records of patients who had undergone treatment of bladder stones through transurethral use of nephroscope in our hospital. Various demographic, stone related, intraoperative and postoperative parameters were studied. Results: The mean stone size was 18.1± 6.8 millimetres. Mean operative time and duration of hospital stay were 42.2 minutes and 2.4 days respectively. Intraoperative and postoperative complications occurred in 8 and 16 percent respectively, which were minor and managed without further interventions. Stone free rate was 100 percent. Conclusion: Bladder stones in adults can be effectively managed with the transurethral use of nephroscope without significant complications. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 14-18 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9668

scholarly journals The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

2019 ◽  
Vol 18 (2) ◽  
pp. 42-47
Author(s):  
Bikash Bikram Thapa ◽  
Bina Basnet ◽  
Bikash Bahadur Rayamajhi ◽  
Narayan Thapa ◽  
Bharat Bhadur Bhandari
Keyword(s):  
Learning Curve ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Medium Size ◽  
Stone Size ◽  
Access Sheath ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy. Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value <0.05 was considered significant. Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin. Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.  

scholarly journals TRANSITION FROM PRONE TO SUPINE PERCUTANEOUS NEPHROLITOTOMY: EVALUATING THE LEARNING CURVE FROM THE SINGLE SURGEON EXPERIENCE

2021 ◽  
Vol 28 (2) ◽  
pp. 147-152
Author(s):  
Zulfikar Ali ◽  
Andika Afriansyah
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Hemoglobin Level ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

Objective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL.

scholarly journals Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Ioannis Mykoniatis ◽  
Ayman Isid ◽  
Ofer N. Gofrit ◽  
Shilo Rosenberg ◽  
...  
Keyword(s):  
Operative Time ◽  
Fluoroscopy Time ◽  
Ureteral Stones ◽  
Ureteroscopic Lithotripsy ◽  
Antegrade Approach ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Stone Characteristics ◽  
Length Of Hospitalization ◽  
Free Rate

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones.Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques.Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients’ demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p=0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p<0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p<0.001). No difference was found between the groups (p=0.745) regarding postoperative complications.Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

The Outcomes of Pre-Stenting on Renal and Ureteral Stones: A Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Han Chen ◽  
Yang Pan ◽  
Min Xiao ◽  
Jingruo Yang ◽  
Yong Wei
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Ureteroscopic Lithotripsy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Meta Analyses ◽  
Free Rate

<b><i>Background:</i></b> Pre-stenting (PS) on the outcomes of semirigid and flexible ureteroscopic lithotripsy for a different upper urinary urolithiasis remains controversial. We performed a meta-analysis comparing the outcomes of ureteroscopic lithotripsy between PS and non-PS. <b><i>Materials and Methods:</i></b> Randomized, controlled trials and observational studies comparing PS and non-PS were identified from electronic databases. Stone-free rate (SFR), operative time, and complications were compared by qualitative and quantitative syntheses (meta-analyses). <b><i>Results:</i></b> Eleven articles were included in this study. Nearly, all of recently published studies exhibited relatively moderate or high quality during quality assessment. PS was more likely to achieve good SFR compared with non-PS (<i>p</i> &#x3c; 0.00001). The subgroup results indicated that PS improved the SFR for renal stones and the stones dealt by flexible ureteroscopy (<i>p</i> = 0.0002; <i>p</i> &#x3c; 0.0001, respectively; some ureteral stones were dealt by flexible ureteroscopy). Ureteral stones and the stones dealt by semirigid ureteroscopy were not influenced by PS (<i>p</i> = 0.62; <i>p</i> = 0.90, respectively). PS is equal as non-PS in terms of operative time for renal stones and the renal and ureteral stones dealt by flexible ureteroscopy (<i>p</i> = 0.47; <i>p</i> = 0.05). No significant difference was found in major complications between the 2 groups for total or for the subgroup of renal stones (<i>p</i> = 0.3; <i>p</i> = 0.69). <b><i>Conclusions:</i></b> For ureteral stones or the stones dealt by semirigid ureteroscopy, PS does not show any benefits. For renal stones or the stones dealt by flexible ureteroscopy, PS improves the SFR and may be as safe as non-PS.

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