Abstract
Purpose: evaluation of the efficiency of the “hot spot” method for the fragmentation of urinary stones. Materials and methods: A retrospective analysis of clinical records of 1666 patients with urolithiasis who underwent percutaneous nephrolithoextraction/tripsy and contact ureterolithotripsy/extraction in the period from 2014 to 2017 at the urology clinic was performed to assess the incidence of postoperative infectious and inflammatory complications. The research objects were postoperative urinary stones (n-78). The X-ray density and linear dimensions of the stones were determined. Stone fragmentation was performed with a continuous-wave diode laser operating at wavelengths of 0.81 μm, 0.97 μm, and 1.47 μm. An absorbing coating of micro-size graphite powder was applied on the working tip of the optical fiber. In vitro fragmentation was carried out in liquid. Results: A group of patients (224/1666) (13.4 ± 0.86%) was identified, who developed infectious and inflammatory complications after: percutaneous nephrolithotripsy, 123/361 (34.1 ± 2.5%) cases; percutaneous nephrolithoextraction, 59/240 (24.6 ± 2.78%); contact ureterolithotripsy, 23/294 (7.8 ± 1.57%); and ureterolithoextraction, 19/771 (2.5 ± 0.56%). In liquid, the “hot spot” technique made it possible to fragment stones with an X-ray density of up to 1000 HU at a laser wavelength of 0.81 µm, up to 1400 HU at 0.97 µm, and up to 1400 HU at 1.47 µm.
Highlights
Epidemiological data indicate a steady increase in the number of patients with urolithiasis worldwide [1]
To develop a stone fragmentation technique with minimal associated inflammation, we proposed to use a laser lithotripter based on a laser equipment for surgery and power therapy, LAKHTA-MILON (Milon Laser Co., Saint-Petersburg, Russia), with a light converter
Based on the results of the laboratory blood and urine tests and an assessment of clinical examination data, a group of patients (224 people) (224/1666) (13.4 ± 0.86%) was identified, who developed infectious and inflammatory complications in the postoperative period characterized by fever and/or inflammatory changes in general blood and urine tests (Figure 2)
Summary
Epidemiological data indicate a steady increase in the number of patients with urolithiasis worldwide [1]. Holmium:YAG (Ho:YAG) laser lithotripsy allows to break up calculi of any chemical composition [3]. This method is based on water vaporization inside the stone, resulting in fragments with uncontrollable sizes. Comparative data have been reported on three fundamentally different techniques for holmium laser lithotripsy, “dusting”, “basketing”, and “popcorning” [4,5,6,7,8]. These approaches are based on the explosive rupture of a stone. According to the scientific data, this is the cause of infectious and inflammatory complications in 30% of cases [9]
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