scholarly journals Micropercutaneous Laser Lithotripsy: How to Improve Stone Free Rate

2020 ◽  
Vol 2 (4) ◽  
Keyword(s):  
Kidney Stones ◽  
Laser Lithotripsy ◽  
Ureteral Access Sheath ◽  
Endoscopic Control ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Group A ◽  
Thulium Fiber Laser ◽  
Group B ◽  
Free Rate

Introduction: Micropercutaneous Nephrolithotomy is a novel technique with the creation of a 4.85-8F working channel. The advantage of micro-PCNL is the possibility of kidney puncture under direct endoscopic control. Materials and Methods: 99 patients aged 47,3 ± 16.9 years were included in the study. 78 patients had isolated kidney stones (78.8%). The stone size ranged from 8 to 38 mm (13.9 ± 5.4 mm). Group A included stones smaller than 15 mm (57 patients, 57,6%) and Group B included stones larger than 15 mm (42 patients, 42,4%). A 4.85 F percutaneous sheath was used in 38 (38,4%) patients, 8 F sheath was used in 61 (61,6%) patients. A holmium laser for lithotripsy was used in 46.5% cases, the thulium fiber laser in 53.5%. Results: The average surgery time was 39,9 ± 13.7 min (from 13 to 75 min). A stone-free rate (SFR) for patients of both groups was 88.8%. A Double-J stent was placed in 39 (39.4%) patients. In one case conversion to the mini-PCNL was done. In four cases (4%) retrograde stone manipulations were performed through ureteral access sheath. 5 (5.1%) patients required the second micro-PCNL tract. 3 (3%) patients required stenting postoperatively. In 7.1% of cases the episode of acute pyelonephritis developed. In 7 cases (7,1%), Extracorporeal Shock Wave Lithotripsy was required due to residual stones. Conclusions: We recommend using the laser micro-PCNL for the category of patients with severe comorbidities, including coagulopathy. The micro-PCNL could be safely performed in patients with kidney stones larger than 1.5 cm.

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 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.

Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

2021 ◽  
pp. 1-7
Author(s):  
Ahmed El-Sakka ◽  
Abdelnaser Elgamasy ◽  
Karim Sallam ◽  
Mohamed G. Soliman
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Randomized Trial ◽  
Percutaneous Nephrolithotomy ◽  
Standard Technique ◽  
Prospective Randomized Trial ◽  
Stone Free Rate ◽  
Group A ◽  
Group B ◽  
Free Rate

<b><i>Objective:</i></b> This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. <b><i>Methods:</i></b> This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. <b><i>Results:</i></b> Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (<i>p</i> = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

scholarly journals MANAGEMENT OF URETER STONES USING ESWL COMPARED TO URS

2013 ◽  
Vol 20 (2) ◽  
Author(s):  
Muhammad Omar Rusydi ◽  
Djoko Rahardjo
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Laser Lithotripsy ◽  
Therapeutic Modality ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Dj Stent ◽  
Ureter Stones ◽  
Free Rate

Objective: To evaluate the management of ureterolithiasis using Extracorporeal Shock Wave Lithotripsy (ESWL) EDAP Sonolith Technomed compared to ureteroscopy (URS) with holmium:YAG laser lithotripsy. Material & Method: Research was conducted at Central Pertamina Hospital Jakarta by comparative analysis. The data was taken from patients’ medical records diagnosed with ureterolithiasis who had been treated from January to Desember 2009.Results: Central Hospital Pertamina Jakarta had treated 127 patients with urolithiasis from January to December 2009. Most frequent therapeutic modality was URS, which was followed by ESWL.Double J stents were used in 19,8% of the treatmentin combination with URS, more common than ESWL. Stone free rate in urolithiasis was not significantly different between treatment with URS and ESWL, although stone free rate of URS was higher than ESWL.Use of DJ stent didn’t affect stone free rate of urolithiasis from two of these modalities.Conclusion: Stone free rate of these modalities was below of stone free rate at literatures published, because evaluation from stone free rate of this research was taken after the treatment or 1-2 days after the treatment with imaging of KUB and USG.Keywords: Urolithiasis, extracorporeal shock wave lithotripsy, ureteroscopic,DJ stent, stone free rate.

scholarly journals ESWL EFFECTIVENESS FOR LOWER POLE KIDNEY STONES

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
Riza Mazidu Sholihin ◽  
Soetojo Soetojo ◽  
Haviv Muris
Keyword(s):  
General Hospital ◽  
Kidney Stones ◽  
Clearance Rate ◽  
Kidney Stone ◽  
Lower Pole ◽  
Stone Size ◽  
Chi Square ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Free Rate

Objective: To describe the profile of lower pole kidney stone patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) and the clearance rate of ESWL for lower pole kidney stones at Soetomo General Hospital from 2012 to 2016. Material & Methods: This research design was analytical retrospective, lower pole kidney stone patients who underwent ESWL in Soetomo General Hospital from 2012 to 2016 who fulfill inclusion criteria become samples in this research. Samples were divided into two group, stone size <15 mm and 15-20 mm. Results: Total samples in this study were 128, consist of 81 males and 47 females. The age average was 48 ± 11.124. The stone size average was 9.5 ± 4.5 mm consisted of 109 patients with stone size <15 mm and 19 patients with stone size 15-20 mm. There were 119 single lower pole kidney stones and 9 multiple ones. From all patients, 77 patients (60.2%) were stones free and the rest (39.8%) were not. Stone free rate for lower pole kidney stones was higher in stone size <15 mm compared with 15-20 mm, 65.2% and 31.5% respectively. Statistical analysis with Chi-square showed significant ESWL clearance rate difference between lower pole kidney stone size <15mm group and 15-20 mm (p<0.05). Conclusion: ESWL was a safe option for lower pole kidney stones with high success rate. There was significant relationship between stone size and stone clearance rate. ESWL was effective for lower pole kidney stones size <15 mm. 

scholarly journals Comparison of the clinical efficacy of holmium and thulium ureterolithotripsy

2020 ◽  
Vol 13 (4) ◽  
pp. 30-34
Author(s):  
S.V. Popov ◽  
◽  
I.N. Orlov ◽  
D.A. Sytnik ◽  
M.M. Suleimanov ◽  
...  
Keyword(s):  
New Technologies ◽  
City Centre ◽  
Thulium Laser ◽  
Annual Increase ◽  
Stone Free Rate ◽  
Group A ◽  
Cavity System ◽  
The Moment ◽  
Group B ◽  
Free Rate

Introduction. Urolithiasis is one of the most common pathologies in modern urology. This disease is registered in 10% of the population and is manifested by an annual increase. Despite all the effectiveness and safety of Ho:YAG, in recent years, the thulium laser has attracted more and more interest. At the moment, in the modern literature there is not enough information about thulium and holmium ureterolithotripsy. The aim of this study is to compare the effectiveness of thulium and holmium ureterolithotripsy. Material and Methods. Since from October 2018 to October 2019 in City Centre Endoscopic Urology and New Technologies Clinical Hospital of St. Luke; St. Petersburg, 420 patients underwent contact ureterolithotripsy with using of thulium (group Б) or holmium (group А) lasers for calculi localized in the ureter. Results. Patients in group B had an advantage in terms of such indicators as the time of surgery, the time of lithotripsy in the Dusting and Fragmentation modes for ureteral calculi of any localization compared with group A. The SFR level in the two groups was relatively identical. Patients in group B had a lower rate of retropulsion during lithotripsy compared to patients in group A. And also in group B there was no migration of calculus into the renal cavity system. Conclusion. Our data indicate the same level of stone free rate when using both thulium and holmium lasers in the dusting and fragmentation modes. However, there is a higher efficiency during ureterolithotripsy using a thulium laser compared to ureterolithotripsy using a holmium laser, regardless of the lithotripsy mode.

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 IS RETROGRADE INTRARENAL SURGERY PREFEREABLE OVER MINI PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH RENAL CALCULUS OF LESS THAN OR EQUAL TO 2 CM SIZE?

2020 ◽  
pp. 1-4
Author(s):  
Girish H M ◽  
Sanman K N ◽  
G G Laxman Prabhu ◽  
Ranjit Shetty
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Calculus ◽  
Complication Rates ◽  
Operative Outcomes ◽  
Stone Free Rate ◽  
Group A ◽  
Laboratory Investigations ◽  
Group B ◽  
Free Rate

Objective: To compare intraoperative and post-operative outcomes between mini-percutaneous Nephrolithotomy (miniPCNL) and Retrograde intrarenoscopy (RIRS) groups. Materials and methods: A total of 66 patients were alternatively allocated to undergo miniPCNL (33patients, group A) and RIRS (33patients, group B) groups. All patients were evaluated by history, laboratory investigations, X-ray Kidney ureter bladder (KUB), Ultrasonography and computerized tomography (CT) scan to determine stone number, location and size. Operative time, stone free rate, duration of hospital stay and complications were compared between both groups. Results: Demographic parameters were comparable between two groups. Stone free rate was similar in both groups. Mean duration of procedure was less for miniPCNL when compared to RIRS with P < 0.0001. Duration of post-operative stay for miniPCNL was longer when compared to RIRS with P < 0.0001. Complications like intra operative bleeding, post-operative fever and blood transfusion were similar in both groups. The RIRS group patients experienced reasonably less pain postoperatively as per Visual analogue scale (VAS) score when compared to miniPCNL group with P < 0.0001. Conclusion: Though RIRS and miniPCNL have good and comparable stone free rate with low complication rates, favourable pain score and less hospital stay makes RIRS a preferred option over miniPCNL.

Stone attenuation value on computed tomography is not associated with stone-free rate after retrograde intrarenal surgery for kidney stones

2017 ◽  
Vol 16 (7) ◽  
pp. e2481-e2483
Author(s):  
A. Bahshaliyev ◽  
C.V. Öztekin ◽  
S. Pasali ◽  
A. Memis ◽  
C. Özden ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Kidney Stones ◽  
Retrograde Intrarenal Surgery ◽  
Attenuation Value ◽  
Stone Free Rate ◽  
Free Rate

scholarly journals COMPARISON OF THE SUCCESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) WITH AND WITHOUT DJ STENTING IN PROXIMAL URETERIC STONE

2020 ◽  
Vol 11 (2) ◽  
pp. 21-24
Author(s):  
Dr. Mudassar Saeed Pansota
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
P Value ◽  
Ureteric Stone ◽  
Extracorporeal Shock Wave ◽  
Dj Stent ◽  
Group A ◽  
Group B ◽  
Average Size

BACKGROUND & OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions. RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 231 (51.67%) were women.Mean body mass index (BMI) was 28.30±2.20 kg/m . The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone.

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