PD34-06 FLEXIBLE URETEROSCOPY FOR LOWER POLE RENAL STONES: NOVEL SUPERPULSE THULIUM (TM) FIBER LASER LITHOTRIPSY. FIRST CLINICAL RESULTS

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD34)1 Apr 2020PD34-06 FLEXIBLE URETEROSCOPY FOR LOWER POLE RENAL STONES: NOVEL SUPERPULSE THULIUM (TM) FIBER LASER LITHOTRIPSY. FIRST CLINICAL RESULTS Dmitry Korolev*, Roman Klimov, Dmitry Tsarichenko, Mikhail Enikeev, Alim Dymov, Stanislav Ali, Gagik Akopyan, Vladimir Lekarev, Mark Taratkin, Leonid Rapoport, Dmitry Enikeev, and Peter Glybochko Dmitry Korolev*Dmitry Korolev* More articles by this author , Roman KlimovRoman Klimov More articles by this author , Dmitry TsarichenkoDmitry Tsarichenko More articles by this author , Mikhail EnikeevMikhail Enikeev More articles by this author , Alim DymovAlim Dymov More articles by this author , Stanislav AliStanislav Ali More articles by this author , Gagik AkopyanGagik Akopyan More articles by this author , Vladimir LekarevVladimir Lekarev More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , Dmitry EnikeevDmitry Enikeev More articles by this author , and Peter GlybochkoPeter Glybochko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000905.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The SuperPulse Thulium (Tm) fiber laser (wavelength of 1.94 µm) has been recently introduced as a directed-energy source for urology. Preclinical studies have shown a significant potential of the SuperPulse Tm fiber laser (SP TFL) for lithotripsy. However, clinical reports of using SP TFL to treat urolithiasis are still few and limited. Of special interest are challenging cases, e.g., lower pole stones, when extreme deflection of the instrument is required. To evaluate the effectiveness of the SuperPulse Tm fiber laser in the management of lower pole small calyceal stones during flexible ureteroscopy (F-URS). METHODS: The SuperPulse Tm fiber laser device (Urolase 2, IRE Polus, Fryazino, Russia) has been cleared for clinical use by the Ministry of Health of Russian Federation. Study protocol has been approved by the Ethical Review Committee. Between January2018 and February 2019, 130 patients with kidney stones have undergone Thulium fiber laser lithotripsy during F-URS. We retrospectively analyzed 15 of this patients with a single radiopaque lower pole calculus that were included in the present study. Stone size, stone density, lithotripsy time (from the first to last footswitch press) and “lasering” (laser emission) time were measured. The SP TFL was used for stone disintegration with different settings in dusting and fragmentation modes (0.1 – 4J, 7-300Hz, 6-40W) via a fiber with a 200-μm core diameter. Low dose CT scanning was performed on POD 90 to assess SFR. RESULTS: Stone size ranged from 4 to 17 mm and stone density varied from 350 to 1459 HU. The average lithotripsy timewas 12 min (3-30 min). The average “lasering” time was 1.3 min (0.4-2.5 min) and the mean hospital stay was 1.1 ± 0.3 days. In all cases we reached the lower pole stone containing calyx with a laser fiber. The complication rates were evaluated by using the Clavien-Dindo grading system and did not exceed GII. The overall postoperative complication rate was 26.6% (GI 20%; GII 6.6%). SFR on POD 90 was achieved in 86.6% of cases. CONCLUSIONS: F-URS with SuperPulse Tm fiber laser is safe and effective option in the management of lower pole small calyceal stones. The possibility of using small laser fibers gives better instrument deflection which make possible to reach lower pole calyceal stones even with acute lower pole infundibulopelvic angle (IPA). Source of Funding: non © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e713-e713 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Korolev* More articles by this author Roman Klimov More articles by this author Dmitry Tsarichenko More articles by this author Mikhail Enikeev More articles by this author Alim Dymov More articles by this author Stanislav Ali More articles by this author Gagik Akopyan More articles by this author Vladimir Lekarev More articles by this author Mark Taratkin More articles by this author Leonid Rapoport More articles by this author Dmitry Enikeev More articles by this author Peter Glybochko More articles by this author Expand All Advertisement PDF downloadLoading ...