Flexible Ureteroscopic Holmium Laser Research Articles

Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy

BackgroundTo compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones.MethodsFrom March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score.ResultsThere were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05).ConclusionsThe contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Analysis of the Efficacy of Flexible Ureteroscopy and Rigid Ureteroscopy with Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Stones in the Elderly

Objective: To compare the clinical efficacy of rigid ureteroscopy and flexible ureteroscopy with holmium laser lithotripsy in elderly patients with upper ureteral stones. Methods: 12 elderly cases of upper ureteral stones were selected and divided into two groups according to the type of surgery. The control group and the observation group adopted rigid ureteroscopic holmium laser lithotripsy and flexible ureteroscopic holmium laser lithotripsy, respectively. General observation indicators, laboratory indicators, and short-term efficacy-related indicators of surgery were compared between the two groups. Results: The operation time, ambulation time, and hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P &lt; 0.05). There was no significant difference in the total primary/secondary stone clearance rate, postoperative complications, and disease recurrence rate after six months of follow-up in the two groups (P &gt; 0.05). Conclusion: Compared with rigid ureteroscopic holmium laser lithotripsy, flexible ureteroscopic holmium laser lithotripsy for elderly patients with upper ureteral stones is more conducive to shortening the treatment and postoperative recovery time, and simultaneously, it causes no severe complications and is worthy of promotion.

Temperature changes of renal calyx during high-power flexible ureteroscopic Moses holmium laser lithotripsy: a case analysis study.

The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve. The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80Hz/0.3J and 32 W, 80Hz/0.4J) were performed for each patient with room temperature (25°C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80Hz/0.3J, 32 W, 80Hz/0.4J and 40 W, 80Hz/0.4J) with warmed (37°C) and room temperature (25°C) irrigation. Twenty-two patients were enrolled in our study. With 30ml/min or 60ml/min irrigation, the local temperature of the renal calyx did not reach 43°C in any patient under 25°C irrigation after 60s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25°C. Under the irrigation of 37°C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43°C at the setting of 32 W, 30ml/min and 40 W, 30ml/min after continuing laser activation. In the irrigation of 60ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32W or higher power holmium laser in the renal calyces for more than 60s in the limited irrigation of 30ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.

Clinical Effect of Flexible Ureteroscope and Laparoscope in the Treatment of Parapelvic Cyst.

Objective Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst. Method A total of 82 patients with parapelvic cyst who underwent surgical treatment in our hospital from May 2019 to May 2020 were selected. Patients were randomly divided into a control group and an observation group; the control group underwent laparoscopic parapelvic cyst topical decompression; the observation group underwent transurethral flexible ureteroscope holmium laser incision and drainage of parapelvic cyst. The intraoperative (operative time, intraoperative blood loss, and ventilation time), postoperative (time of getting out of bed, pain score, and length of hospital stay), and recurrence were compared between the two groups. Results (1) The operative time and intraoperative blood loss in the observation group were significantly better than those in the control group (P < 0.05), while the ventilation time had no significant difference (P > 0.05). (2) The pain score and length of hospital stay in the observation group were better than those in the control group (P < 0.05). There was no significant difference in the time of getting out of bed (P > 0.05). (3) There was no serious infection or bleeding in either group. The observation group had no recurrence, and the postoperative recurrence rate was 0. There were 11 cases of recurrence in the control group, and the postoperative recurrence rate was 26.83%. The postoperative recurrence rate of the observation group was significantly lower than that of the control group, with statistical significance (χ2 = 4.604, P < 0.05). Conclusion Flexible ureteroscope for the treatment of parapelvic cyst could effectively reduce the operative time, intraoperative blood loss, and pain; in addition, the postoperative recovery was fast and the recurrence is rare, which was worth popularizing.

Clinical efficacy of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts

ObjectiveThis study aims to investigate the efficacy and safety of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts, and to review recently published relevant literature.MethodThis is a retrospective study in which the clinical data of 47 patients who underwent flexible ureteroscopic holmium laser incision and internal drainage of parapelvic cysts in our center from March 2017 to March 2021 were retrospectively analyzed. A literature search was conducted to review and summarize relevant reports on endoscopic treatment of parapelvic cysts published in the past 10 years.ResultsAmong 47 patients with parapelvic cysts who underwent flexible ureteroscopic holmium laser incision and internal drainage, 12 (25.53%) cases had a typical cyst wall bulging into the collecting system under flexible ureteroscope. As the cyst wall was thin and translucent in these cases, ultrasound was not used during the operation. The cysts of the remaining 35 patients were located with the aid of intraoperative real time ultrasound, and all underwent successful operation. No serious surgical complications occurred after surgery. The patients were followed up for 12–24 months after operation. The cyst in one case was observed larger than its original size before operation, so recurrence was considered. In another two cases, the diameters of the cysts were more than half of their original diameters before operation. Thus, the efficacy was poor in the three cases. For the remaining 44 cases, there was no obvious cyst observed or the diameter of the cysts was less than half their preoperative level.ConclusionThe approach of ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts is safe and effective, which helps to solve the problem of localization of atypical parapelvic cysts on endoscopic findings.

Retrospective analysis of stone basket combined with flexible ureteroscope holmium laser lithotripsy in the treatment of lower calyceal stones.

The aim of the study was to investigate the efficacy of stone baskets combined with flexible ureteroscope holmium laser lithotripsy (FURL) in the treatment of lower calyceal stones (LCS). A total of 216 patients with LCS who underwent FURL in our hospital were analyzed retrospectively and divided into observation group (n=129, with stone basket) and control group (n=87, without the stone basket), according to whether the stone basket was used during FURL. The operation time, stone size, stone clearance rate, steinstrasse incidence rate and complication rate were collected and analyzed. There were no significant differences between the two groups in preoperative gender, BMI, age, stone size and comorbid diseases (p > 0.05); no significant differences between the two groups in the change of procalcitonin, C-reactive protein, white blood cell count and hemoglobin after the operation (p>0.05); the operation time in the observation group was significantly higher than that in the control group (80.12±8.25 vs. 61.93±6.55, p=0.019); the short-term stone clearance rate (85.27% vs. 66.67%, p 0.001) and long-term stone clearance rate (95.35% vs. 85.06%, p=0.021) of the observation group were significantly higher than those of the control group; the incidence rate of steinstrasse (0% vs. 8.05%, p<0.001) and overall complications (7.75% vs. 16.09%, p=0.009) in the observation group were significantly lower than those in the control group. Stone basket combined with FURL is safe and feasible for the treatment of LCS, which can improve the stone clearance rate and reduce the risk of steinstrasse formation after the operation.

Risk factors for diagnosis of Escherichia coli infection after flexible ureteroscope holmium laser lithotripsy by imaging information technology under Nomogram mathematical model

The evaluation value of Nomogram mathematical model was investigated for risk factors of Escherichia coli infection after flexible ureteroscope holmium laser lithotripsy (f-URL) under the diagnosis of imaging information technology. A total of 124 cases with upper urinary tract calculi (UUTC) were selected as the research objects, and they were rolled into an infection group (41 cases) and a control group (83 cases) according to whether Escherichia coli infection occurred after the surgery. The difference of surgical indicators between the two groups was compared, and the Nomogram mathematical prediction model was established based on Logistic regression risk factors. Besides, the predictive ability of the Nomogram mathematical model was analyzed with indicators such as the integrated discrimination improvement (IDI), the area under the curve (AUC), and GiViTI calibration curve band. The results found that age, diabetes, stone size, surgical time, and antibiotic use time were all risk factors for Escherichia coli infection after surgery. The AUC of the different risk factors of the Nomogram mathematical model was between 0.752 and 0.814, the sensitivity was 57.45%, the specificity was 97.96%, the C-index was 0.734 (95% confidence interval (CI): 0.631–0.837). Both the 80% and 95% CI regions of the Giviti calibration curve band did not cross the 45° diagonal bisector, and P = 0.518. Moreover, the Nomogram model showed an increase of 8.9% (95% CI: 0.061–1.1874 and P = 0.043) compared with the Logistic regression analysis model. Therefore, these results indicated that the Nomogram mathematical model can markedly improve the prediction ability of Escherichia coli infection risk after f-URL, which had great value in the assessment and early diagnosis and treatment of Escherichia coli infection after f-URL.

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

BackgroundFlexible 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.MethodsThis 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).ResultsThere 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.ConclusionWarming 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.

Ultrasonography-assisted flexible ureteroscope for the treatment of parapelvic renal cysts: A comparison between the 1470-nm diode laser and the holmium laser.

The present study aimed to compare the efficacy and safety of a flexible ureteroscopic holmium laser incision with flexible ureteroscopic 1470-nm diode laser incision for the treatment of parapelvic renal cysts. The current study collected and analysing the clinical data of 90 independent renal cysts cases retrospectively, including 43 renal cysts cases that received holmium laser surgery (holmium laser group) and 47 renal cysts cases that received 1470-nm diode laser surgery (1470-nm diode laser group). Each group was divided into a thin-walled cyst subgroup and thick-walled cyst subgroup according to cyst wall thickness. Intracapsular hematoma was significantly lower in the 1470-nm diode laser group compared with the holmium laser group (0/47 vs. 4/43; P=0.048). The incision diameter in the 1470-nm diode laser group was significantly larger than the holmium laser group in the thick-walled parapelvic renal cysts subgroup [1.70(1.50,1.90) vs. 1.30(1.25,1.70) cm; P=0.007]. The renal cystic diameter of the two groups was markedly reduced one and six months after surgery. The difference was non-significant in the diameter of the renal cyst in the thin-walled cysts subgroups between the two laser groups 6 months after surgery (1.01±0.38 vs. 1.03±0.53 cm; P=0.454). However, the diameter of the renal cyst in the thick-walled cysts subgroup treated with the 1470-nm diode laser was significantly lower compared with the thick-walled cysts subgroup treated with the holmium laser 6 months after surgery (1.21±0.57 vs. 1.88±0.94 cm; P=0.002). The results demonstrated that the use of a 1470-nm diode laser or holmium laser surgery under a flexible ureteroscope is a safe and effective treatment for parapelvic renal cysts. For thick-walled parapelvic renal cysts, the 1470-nm diode laser appears to exhibit a lower postoperative recurrence rate and better long-term postoperative effects due to its improved haemostatic effect and larger intraoperative incision diameter.

Clinical significance of pretreatment with double J stent indwelling in the treatment of impacted Ureteral Calculi

Objective To analyze the clinical effects and safety of ureteroscopic lithotripsy (URL) in the treatment of impacted ureteral calculi by pretreatment with double-J stent indwelling. Methods Ninety-six patients with impacted ureteral calculi were enrolled in the study and were divided into one-stage group and two-stage group(pretreatment with double-J stent indwelling), with 48 patients in each group. The clinical effects and safety of the two groups were compared. Results The operative time and the hospital stay in two-stage group were significantly shorter than that in one-stage group, respectively (P<0.05). The success rate of stone clearance rate within 1 month in one-stage group were lower than that in two-stage group (P<0.05). One-stage group has a higher rate of complications compared with two-stage group(P<0.05). Conclusions Rigid combined with flexible ureteroscopic holmium laser lithotripsy is an effcacious and feasible approach for the treatment of impacted ureteral calculi, pretreatment with double-J stent indwelling can increase calculi clearance and improve efficacy and safety. Key words: Ureteral Calculi; Ureteroscopy; Cannula

Use of Intravenous Furosemide to Prevent Febrile UTI Following Flexible Ureterorenoscopic Laser Lithotripsy

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Flexible ureterorenoscopic laser lithotripsy is the preferred management option for renal stones less than 2 cm. However, flexible ureterorenoscopic laser lithotripsy is not without complications and urinary tract infection is the most common reported complication. Prophylactic antibiotic use, access sheath, low pressure irrigation are few methods to reduce incidence of urinary tract infection. We have studied whether routine use of intravenous furosemide reduces the incidence of febrile urinary tract infection.&#x0D; Methods: A total of 70 patients were randomized into two groups where one received intravenous furosemide at the beginning of the procedure and another did not. Flexible ureteroscopic holmium laser lithotripsy was done and patients were followed up for development of febrile urinary tract infection within one week of the procedure.&#x0D; Results: 14% of patients who received furosemide and 20% of patients who did not receive developed post- operative febrile urinary tract infection within one week. Two patients in each group had bacteriuria.&#x0D; Conclusions: Although the incidence of febrile UTI is lesser with routine use of intravenous furosemide during flexible ureterorensocopic laser lithotripsy, statistical significance could not be proved.&#x0D; &#x0D; &#x0D; &#x0D;

Efficacy and Complication of Flexible Ureteroscopic Holmium Laser Incision for Simple Renal Cysts: A Retrospective Study.

Objective: The aim of this research was to verify the efficacy and complication of flexible ureteroscopic holmium laser incision for simple renal cysts (SRCs). Patients and Methods: We retrospectively reviewed 116 patients who not only had done flexible ureteroscopic holmium laser incision or laparoscopic decortication for SRC in our institution but also had sufficient data: preoperative information and >1-year follow-up records. The following variables were recorded: age, gender, side, cyst size, location (upper pole, lower pole, and interpolar), blood loss, operative duration, complications during and after surgery, pathology report, and presence or absence of flank pain. The primary endpoint was the efficacy of the treatment; secondary endpoints were safety, pain, and the resolution of other complications. All patients underwent radiologic imaging of the kidneys with a repeated CT, before the operation, 3 and 12 months after surgery. If there were no cysts on the most recent imaging, we defined it as a radiologic success. Results: No statistically significant difference in the background variable in patients of group A (64 patients, flexible ureteroscopic holmium laser incision) and group B (52 patients, laparoscopic decortication) was found, including age, gender, cyst's side, cyst's location, and cyst size before the operation. There were less blood loss by surgeons' evaluation and shorter operative duration (p < 0.001) in group A. In group A, there were three patients who had failed in the first time of operation (two patients failed to place flexible ureteroscope through ureter because of ureteral stricture, and one patient was unable to find the renal cyst in the view of flexible ureteroscope), and no severe postoperative complication was observed. The number of postoperative radiologic failure was five at 3 months and three at 12 months in group A, whereas all the procedures were completed laparoscopically, and no conversion was necessary for group B. But there was one patient who had obvious hematuresis for 1 month after the operation and then it was resolved spontaneously at 3 months. There was only one patient who had a radiologic failure in group B, with the cyst of ∼2 cm at 3 months, and his cyst cannot be seen in CT imaging at 12 months without further treatment. There was no statistically significant difference in the rate of effective operation and complication between the two groups. Conclusion: The operation of flexible ureteroscopic holmium laser incision for SRC had the advantages of less blood loss, short operation time, with a similar rate of operative success and radiologic success after the operation, compared with the process of laparoscopic decortication. It was a good option for urologists to deal with endogenous renal cysts.

Flexible ureteroscopic holmium laser lithotripsy without preoperative stent treat ureteral stone in tortuous ureter

Objective To investigate the safety, efficacy and feasibility of flexible ureteroscopic holmium laser lithotripsy without preoperative stent treating ureteral stone in tortuous ureter. Methods 69 patients with ureteral stone in tortuous ureter retrospectively analyzed from March 2017 to December 2018 were enrolled and analyzed retrospectively. There were 30 males and 39 females, aged from 19 to 67 years old, with an average age of 45 years. The burden of ureteral stones was 0.6-3.0 cm, with an average of 1.1 cm. 24 patients with CT scan or intravenous urography showed tortuous ureter at the distal end of the ureteral calculi. The remaining 45 patients were found to have tortuous ureter during surgery. None of patients had preoperative ureteral stents. All preoperative urine cultures were negative. During the operation, the ureteral sheath was placed in the distal position of tortuous ureter, and the flexible ureteroscope was inserted into the ureter via sheath. Under continuous perfusion, the flexible ureteroscope was curved and pushed along the direction of the ureteral tortuosity. After through the tortuous position, the stone was pushed back to the kidney and crushed. For stones that could not be pushed, the stones were broken into pieces in the ureter and pushed back to the kidney for further pulverization. The ureteral stent was routinely placed at the end of surgery. Results Among a total of 69 patients, 64 patients were treated by flexible ureteroscopic holmium laser lithotripsy without preoperative stent, and the success rate was 92.8%. Among the 5 patients who failed the operation, 1 patient underwent ureterolithotomy because the tortuous ureteral wall was weak, resulting in ureteral perforation by flexible ureteroscope; in 1 case, after the flexible ureteroscope passed through the tortuosity, the calculi could not be pushed back to kidney and the in situ lithotripsy could not be performed because of the huge size of calculi(3.0 cm), so ureterolithotomy were performed; 1 patient underwent PCNL because flexible ureteroscope could not pass through the tortuosity; 1 patient failed to insert the ureteral sheath because of ureterostenosis and underwent flexible ureteroscopic lithotripsy after stent implantation; 1 patient underwent stent implantation because of infective urine. Among the 64 patients who had successful operations, the stone clearance rate at the first month and the third month after surgery were 90.6% (58/64) and 95.3% (61/64). 4 patients had fever after the surgery, and 1 patient had renal area pain. Clavien classification gradeⅠ-Ⅱ.The complication rate was 7.8%. Conclusions Flexible ureteroscopic holmium laser lithotripsy without preoperative stent was a safe, effective and feasible treatment for patients with ureteral stone in tortuous ureter. Key words: Ureteral stone; Tortuous ureter; Flexible ureteroscope; Holmium laser

Study on the clinical effect of digital flexible ureteroscopic holmium laser lithotripsy combined with nitinol stone baskets in the treatment of 2-4 cm diameter renal calculus

Objective To study the clinical effect of digital flexible ureteroscopic holmium laser lithotripsy (FURL) combined with nitinol stone baskets in the treatment of 2-4 cm diameter renal calculus by retrospective analysis. Methods The clinical data of 98 patients with renal calculus underwent FURL in our department were collected. The diameter of the calculus was 2-4 cm. Among them, 47 cases (control group) underwent FURL and the other 51 cases (observation group) who were treated with FURL also and had used the nitinol stone baskets during the operation. The operation time, hospitalization time, number of operation, the one-time stone clearance rate, postoperative bleeding and fever rate, and steinstrasse formation rate were compared. Results There was no significant difference in the sex ratio, mean age, maximum diameter of calculus and average CT value of calculus in the two groups. The observation group's postoperative hospital stay and the number of operation were less than the control group(P<0.05), but the average operation time was (118.82 ± 40.36)min, longer than the control group(P<0.05), the average operation time was (101.30 ± 35.06)min, the one-time stone clearance rate of the observation group(80.39%) was significantly higher than 57.45% in the control group. The steinstrasse formation rate in the control group was 4.26%, which was significantly higher than that in the observation group. There was no significant difference between the two groups in the postoperative bleeding and fever rate. Conclusions It is safe and feasible to treat 2-4 cm renal calculus with FURL combined with nitinol stone baskets, which can significantly improve the one-time stone clearance rate, reduce the risk of steinstrasse formation and shorten the hospitalization time, reduce the number of operations, very suitable for application and promotion in the qualified hospitals. Key words: Kidney Calculi; Ureteroscopy; Lasers, Solid-State; Holmium; Lithotripsy, Laser

Clinical analysis of ureteroscopic holmium laser lithotripsy for the treatment of nephrolithiasis

The objective of the study is to evaluate the clinical value of ureteroscopic holmium laser lithotripsy for the treatment of nephrolithiasis. Clinical data of 44 patients treated for renal stones with polyscope modular flexible ureter- oscopic holmium laser lithotripsy from May 2014 to April 2015 were retrospectively analysed. Following the operation, F4.7 D-J stents were routinely indwelled for 4 weeks and catheterization for 1-3 days. A plain kidney, ureter, and blad- der (KUB) X-ray was performed on postoperative days too. A total of four success cases were determined following the first treatment. The remaining 40 cases were first placed with double-J stent and the surgery was performed one week later. Stone sizes between 0.8-4.0 cm in diameter were defined. The operation time for the treatment was 80-180 minutes. Patients were discharged within 3-5 days, and the double-J stent was removed within 1-3 months. 39 patients were found to be completely stone-free at approximately three months postoperatively. However, five patients were shown to have 11.1% of residual stones after treatment. No blood transfusion, septic shock, ureteral injury, or other complications were reported. Flexible ureteroscopic holmium laser lithotripsy is safe and effective for the treatment of nephrolithiasis. This approach could be a valuable choice for the treatment of patients with renal stones.

Clinical analysis of ureteroscopic holmium laser lithotripsy for the treatment of nephrolithiasis

The objective of the study is to evaluate the clinical value of ureteroscopic holmium laser lithotripsy for the treatment of nephrolithiasis. Clinical data of 44 patients treated for renal stones with polyscope modular flexible ureter- oscopic holmium laser lithotripsy from May 2014 to April 2015 were retrospectively analysed. Following the operation, F4.7 D-J stents were routinely indwelled for 4 weeks and catheterization for 1-3 days. A plain kidney, ureter, and blad- der (KUB) X-ray was performed on postoperative days too. A total of four success cases were determined following the first treatment. The remaining 40 cases were first placed with double-J stent and the surgery was performed one week later. Stone sizes between 0.8-4.0 cm in diameter were defined. The operation time for the treatment was 80-180 minutes. Patients were discharged within 3-5 days, and the double-J stent was removed within 1-3 months. 39 patients were found to be completely stone-free at approximately three months postoperatively. However, five patients were shown to have 11.1% of residual stones after treatment. No blood transfusion, septic shock, ureteral injury, or other complications were reported. Flexible ureteroscopic holmium laser lithotripsy is safe and effective for the treatment of nephrolithiasis. This approach could be a valuable choice for the treatment of patients with renal stones.

Analysis of therapeutic effect of flexible ureteroscope holmium laser in treatment of parapelvic cyst complicated with renal calculus: report of 9 cases

Objective With the use of flexible ureter in kidney stone disease and the unique cutting function of holmium laser, some clinicians have used holmium laser under ureteroscope for one-stage treatment of parapelvic cyst complicated with renal calculi (PCCRC). The purpose of this article is to further explore the safety and clinical effect of this operation. Methods To retrospectively analysis the clinical data of 9 patients in our hospital, who were diagnosed with PCCRC and treated with combined flexible ureteroscope in the same phase. Results All 9 patients were successfully operated at one time, and the operation time was 23-45 min, with an average of 32 min. There were no complications such as massive hemorrhage or septic shock during or after the operation. After the follow-up period of 1-12 months, all the cysts were reduced or disappeared, and the stones were completely re-moved or just no clinical significance stones remains. Conclusions Using the combined flexible ureteroscopein the treatment of the PCCRC can achieve satisfactory clinical efficacy and is worthy of being further applied and discussed by clinicians. Key words: Kidney Calculi; Ureteroscopy; Lasers, Solid-State; Holmium; Cysts; Kidney Pelvis

Flexible ureteroscopic holmium laser lithotripsy with PolyScope for senile patients with renal calculi.

The present study reported the clinical experience of using a PolyScope with holmium laser lithotripter in managing renal calculi in senile patients. Between December 2013 and December 2016, 157 senile patients (69.1±6.1 years old) were treated with PolyScope holmium laser lithotripsy for renal calculi at Xin Hua Hospital (Shanghai, China). The mean stone digitized surface area was 154.2±57.7 mm2 (range, 55.8–478.3 mm2). A thorough medical history investigation, and laboratory and radiological examination were followed by proper preoperative management. The PolyScope was then passed into the renal cavities following the position of the ureteral access sheath, with laser energy maintained at 1.0–2.0 J, frequency 10–15 Hz. The demographical and operative information of senile patients were compared with that of the 332 non-senile patients operated at the same period time. The average operative time was 54.6±13.2 min (range, 37–124 min). No major complications, including ureteral perforation or sepsis were encountered. The single session stone-free rate (SFR) was 81.5% and the overall SFR was 89.2%, similar to that of the non-senile group. PolyScope combined with holmium laser lithotripter is safe and effective in managing renal calculi in senile patients compared with non-senile patients, with considerately high SFRs and low complication rates.

A model for predicting the systemic inflammatory response syndrome after flexible ureteroscope lithotripsy for upper urinary tract calculi

Objective To analyze the risk factors that affect severe infection following flexible ureteroscope Holmium laser lithotripsy for upper urinary tract calculus, and to construct the regression model and nomogram for predicting the probability of postoperative SIRS. Methods We retrospectively analyzed the clinical data from 457 cases (male 302 and female 155) of upper urinary calculi treated by flexible ureteroscopy from January 2014 to May 2016, with mean age of 49.9 (ranged 20-76) years. The mean maximum size of stones was (16.5±3.0)mm (ranged 12-22mm). There were 51 cases (11.2%) with a recent infectious febrile history related to stones. The patients were divided into two groups as patients developing SIRS or not. Univariate and multivariate statistical analyses were performed to determine factors affecting the development of postoperative SIRS, and then a nomogram was built based on regression coefficients. Results The incidence of SIRS after flexible ureteroscopic lithtripsy was 5.9% (27/457). Multivariable logistic regression analysis identified febrile history related to urinary stones (OR=1.5569, P=0.009), without preoperative placement of ureteral stent (OR=1.4004, P=0.004), small-caliber (F 13-14)ureteral access sheath (OR=1.1120, P=0.016), endoscopic signs of infection (OR=2.0176, P=0.000) and infectious stones (OR=1.0981, P=0.013) as independent risk factors for postoperative SIRS. The concordance index was 0.845 in the nomogram model sample and 0.79 in the validation sample. Conclusions Febrile history related to urinary stones, without preoperative placement of ureteral stent, small-caliber ureteral access sheath, endoscopic signs of infection and infectious stones would be independent risk factors to predict SIRS after flexible ureteroscope holmium laser lithtripsy. A nomogram based on perioperative clinical factors could be used to predict the risk of SIRS. Key words: Flexible ureteroscopy; Lithotripsy, laser; Systemic inflammatory response syndrome; Risk factors; Nomogram

The Novel Use of Flexible Ureteroscopy and Holmium: YAG Laser in the Management of Parapelvic Renal Cysts

Kidneys are very common sites of cysts in the human body, prevalence of renal cysts was estimated to be about 10% in the general population and the incidence increases with age. Parapelvic and peripelvic cysts grow near renal collecting system; these types of cysts are most likely to be symptomatic. There are a number of reports describing successful laser incision drainage of parapelvic cysts into the renal pelvis using flexible ureteroscopy transurethrally. This review focuses on specific aspects of clinical usage and novelty of flexible ureteroscopy and holmium laser in the management of parapelvic cysts. A systematic review of articles written in the English language on the subject appearing in the medical journals was conducted using Medline database. Cysts that grow near and inside renal pelvis almost always present with symptoms and require treatment intervention. The intervention is guided by the size of the cyst and severity of the symptoms. Flexible ureteroscopic holmium laser marsupialization of parapelvic cysts is less morbid and complications when compared to laparoscopic decortication approach which is technically very challenging due to the locations of these types of cysts. Retrograde marsupialization of parapelvic cysts is a novel technique which does not need any skin incision at all, thus improving cosmesis after surgery. This approach is a pure and of classical natural orifice transluminal endoscopic surgery (NOTES), it reduces morbidity, mortality, and surgical complications.