Intracorporeal Laser Lithotripsy Research Articles

A Comparative Study between Dusting and Fragmentation in Intracorporeal Laser Lithotripsy in Distal Ureteric Stone

Background: Ureteric stones commonly have an impact on the quality of life of the patient. There are many treatment choices for the condition, including medical treatment, extra-corporeal shock wave lithotripsy (ESWL), endoscopic intervention by ureteroscope (URS), or surgery (open or laparoscopic). Semi-rigid URS with laser lithotripsy is used to fragment ureteric stones, especially those in the distal ureter. Objectives: To assess the efficacy and complications of the dusting versus the fragmentation method for lower ureteric stones using holmium laser lithotripsy by analyzing intra-operative and post-operative variables. Patients and methods: One hundred and twenty patients with distal ureteric stones were included in the current study conducted in Ghazi AL-Hariri Teaching Hospital for Surgical Specialties from December 2020 to July 2022. The cases were divided into two groups: The first is the dusting group and the second is the fragmentation group. Both groups are further subdivided into the 10-15 mm and < 10 mm stone groups. The time of the operation, the rate of being stone-free, stone size, the rate of Double-J stents (DJS), and intraoperative complications were compared for the study groups. Results: the operative time was more among Group A (dusting) than Group B (fragmentation) with a statistically significant association, stone-free rate more in Group A (dusting) than Group B (fragmentation) without a statically significant Need for DJ in Group b (fragmentation) than group a (dusting) with statically significant association Regard intraoperative complication (mucosal injury, stone migration, perforation) more in group b (fragmentation) a (dusting) without any significant association. Conclusion: The dusting method resulted in fewer intraoperative complications (mucosal injury, stone migration, perforation) and a lower need for DJ insertion than the fragmentation method. However, it needed a longer operative time than the fragmentation method. Received: Nov,, 2022 Accepted: April, 2023 Published: Oct.2023

PD45-04 TEMPERATURE EFFECT OF MOSES TM 2.0 DURING FLEXIBLE URETEROSCOPY: AN IN VITRO ASSESSMENT

You have accessJournal of UrologyCME1 Apr 2023PD45-04 TEMPERATURE EFFECT OF MOSESTM 2.0 DURING FLEXIBLE URETEROSCOPY: AN IN VITRO ASSESSMENT José Villena, Vicente Elorrieta, and José Salvadó José VillenaJosé Villena More articles by this author , Vicente ElorrietaVicente Elorrieta More articles by this author , and José SalvadóJosé Salvadó More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One of the main issues related to the use of high-power lasers is the associated rise in temperature. The aim of this study was to characterize temperature variations with activation of the Moses 2.0 laser. METHODS: An in vitro experimental study was designed using a high-fidelity uretero-nephroscope simulation model to assess changes in temperature during intracorporeal laser lithotripsy. Renal and ureteral temperature records were obtained from the treatment of BegoStones positioned in the renal pelvis. Different laser settings over three time periods and two possible irrigation flow speeds were evaluated. We considered 43°C as the threshold since it is associated with denaturation of proteins. The Wilcoxon–Mann–Whitney test was used to assess quantitative variables and the Kruskal–Wallis test for categorical variables. RESULTS: The highest increase in intrarenal temperature was reached with 30 s of laser activation at a laser setting of 0.5 J/100 Hz (50 W) and a flow of 10 mL/min. Only 15 s of activation was sufficient for most combinations of settings to exceed the threshold of 43°C. The ureteral temperature did not increase significantly, regardless of the combination of laser setting, time, or irrigation flow, except when 30 W was used for a 30 s period. Multivariate analysis showed that an irrigation flow of 20 mL/min produced an intrarenal temperature decrease of 4.7–9.2°C (p<0.001). CONCLUSIONS: The use of high-power lasers, both for the ureter and kidney, should involve consideration of the temperature increases evidenced in this study, due to the potential biological risk entailed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1163 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information José Villena More articles by this author Vicente Elorrieta More articles by this author José Salvadó More articles by this author Expand All Advertisement PDF downloadLoading ...

Temperature effect of Moses™ 2.0 during flexible ureteroscopy: an in vitro assessment.

One of the main issues related to the use of high-power lasers is the associated rise in temperature. The aim of this study was to characterize temperature variations with activation of the Moses™ 2.0 laser. An in vitro experimental study was designed using a high-fidelity uretero-nephroscope simulation model to assess changes in temperature during intracorporeal laser lithotripsy. Renal and ureteral temperature records were obtained from the treatment of BegoStones positioned in the renal pelvis. Different laser settings over three time periods and two possible irrigation flow speeds were evaluated. We considered 43°C as the threshold since it is associated with denaturation of proteins. The Wilcoxon-Mann-Whitney test was used to assess quantitative variables and the Kruskal-Wallis test for categorical variables. The highest increase in intrarenal temperature was reached with 30 seconds of laser activation at a laser setting of 0.5 J/100 Hz (50 W) and a flow of 10 mL/min. Only 15 seconds of activation was sufficient for most settings to exceed 43°C. The ureteral temperature did not increase significantly, regardless of the combination of laser setting, time, or irrigation flow, except when 30 W was used for a 30 second period. Multivariate analysis showed that an irrigation flow of 20 mL/min produced an intrarenal temperature decrease of 4.7-9.2°C (p <0.001). Use of high-power lasers, both for the ureter and kidney, should involve consideration of temperature increases evidenced in this study, due to the potential biological risk entailed.

Outcome of Digital Cholangioscopy and Laser Lithotripsy for Impacted Biliary Stones

Abstract Background and Aims Impacted stones in the bile duct are difficult to extract, and are predictor of failure of conventional endoscopic retrograde cholangiopancreatography techniques including mechanical lithotripsy and large balloon dilatation. Intracorporeal lithotripsy may be an effective technique for these stones. The aim of this study is to report the efficacy and safety of intracorporeal laser lithotripsy for impacted stones in the bile duct. Method This study is retrospective analysis of prospectively collected data. Patients with impacted stones in the bile duct underwent cholangioscopy with spyglass DS system and laser lithotripsy. Outcome measures were proportion of patients with complete clearance of bile duct after the first session, number of sessions required for complete clearance, and the complications. Results Forty-three patients (27 female) with mean age of 56.12 ± 15.16 years underwent digital cholangioscopy and laser lithotripsy. Mean bilirubin value was 1.8 ± 1.6 mg/dL, 20 (46.51%) patients had single stone, 35(81.39%) patients had only bile duct stones, and 8(18.61%) patients had additional stones in cystic duct or intrahepatic biliary radical. Mean size of largest stone was 16.2 ± 4.4mm. Average duration of the procedure was 69.11 ± 28.12minutes, and complete clearance was achieved in 41/43 (95.34%) patients after the first session. Mean number of sessions required for complete clearance was 1.02 ± .26. Postprocedure cholangitis occurred in one patient. Conclusion Intracorporeal laser lithotripsy is an effective and safe modality for the clearance of impacted bile duct stones.

Intrarenal temperature measurement associated with holmium laser intracorporeal lithotripsy in an ex vivo model.

IntroductionThe aim of this article was to quantify the effect of the use of holmium laser during intracorporeal lithotripsy in an ex vivo model.Material and methodsA simulated model for laser nephro-lithotripsy was designed. Two ex vivo porcine kidneys were used. Electronic thermometer electrodes were inserted on the upper calyx. Intracorporeal lithotripsy was simulated with a holmium laser. Intrarenal temperature was recorded both at the beginning and after one minute of laser use with delta temperature (DT) defined as the difference between them. Measurements were made at different irrigation heights (30, 40, and 50 cm H2O), frequency (Hz), and laser energy (J) in addition to the presence or absence of the access sheath. Analysis of factors associated with temperature change was performed.ResultsThirty-eight observations were recorded. The measurement without the use of access sheath showed an average DT of 4.9, 5.1, and 6.5°C for 5, 10, and 15 Hz, respectively; however, with a sheath, DTs were 0.2, 0.5, and 1.5°C. In terms of energy, mean DTs of 4.3, 6.1, 5.2, and 13.9°C for 0.5, 0.8, 1.0, and 1.5 J were recorded; in contrast, with a sheath, averages of 0.4, 0.5, 0.5, and 3.8°C, respectively were noted. In the adjusted model, energy, frequency, and use of sheath and water height were significant.ConclusionsThe configuration of the laser significantly modifies the intrarenal temperature and height of the bladder irrigation. The use of an access sheath provides lower intrarenal temperatures regardless of laser configuration and water height.

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

PurposeTo summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety.MethodsA scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark.Results and conclusionsLasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.

Inflammatory damage during both shock wave and intracorporeal laser lithotripsy

Inflammatory damage during both shock wave and intracorporeal laser lithotripsy

3D video-assisted trans-oral removal of deep hilo-parenchymal sub-mandibular stones.

SUMMARYThe aim of this paper is to describe the intra-operative findings and surgical results of the first application of 3D high-definition (HD) endoscopic support to the trans-oral surgical treatment of five patients with deep hilo-parenchymal sub-mandibular stones who underwent clinical and ultrasonographic (US) follow-up examinations at one month after the procedure. Five patients undergoing 2D-HD video-assisted transoral surgery for the same condition were used as controls. The results were classified as successful (US - demonstrated complete clearance) or unsuccessful (US - demonstrated total or partial persistence). Visual analogue scales (VAS) were used post-surgically to evaluate the sharpness and brightness of the 2D and 3D images on the screen and stereoscopic depth perception (SDP) of the 3D-HD endoscope. Successful stone removal and significant subjective improvement (lack of obstructive symptoms) was obtained in all but one of the patients in the 3D group, in whom the one-month US evaluation revealed a residual 3 mm asymptomatic hilo-parenchymal stone that was successfully treated by sialendoscopy-assisted intra-corporeal laser lithotripsy. Wharton’s duct and the lingual nerve were identified and preserved in all cases. The mean 3D-HD VAS results were brightness 7 (range 6-8), sharpness 7.8 (range 7-9) and SDP 8.2 (range 8-9); the mean 2D-HD results were brightness 7.8 (range 7-9) and sharpness 7 (range 7-8). Our findings confirm the safety and efficacy of conservative transoral surgical treatment of hilo-parenchymal sub-mandibular stones. From a surgeon’s perspective, 3D-HD guided exploration of the oral floor seems to provide a better view of Wharton’s duct and the lingual nerve, especially near the sub-mandibular parenchyma. The 3D-HD video-assisted transoral removal of deep hilo-parenchymal sub-mandibular stones can therefore be considered a useful new means of preserving the function of an obstructed salivary gland.

Viability and biocompatibility of an adhesive system for intrarenal embedding and endoscopic removal of small residual fragments in minimally-invasive stone treatment in an in vivo pig model.

To evaluate the viability and biocompatibility of a novel, patented bioadhesive system for intrarenal embedding and retrieval of residual fragments after endoscopic lithotripsy. Complete stone clearance via active removal of residual fragments (RF) after intracorporeal laser lithotripsy may be time-consuming and fail in many cases. Therefore, the novel adhesive has been developed and evaluated for the first time in an in vivo pig model in the present work. Four female domestic pigs underwent flexible ureteroscopy (RIRS) or percutaneous nephrolithotomy (PNL) under general anesthesia (8 kidneys, 4×RIRS, 4×PNL) evaluating the bioadhesive system. RIRS without adhesive system (sham procedure, kidney I); 3×RIRS using the bioadhesive system (kidneys II-IV); and 4×PNL using the bioadhesive system (V-VIII). We endoscopically inserted standardized human stone probes followed by comminution using Ho:YAG lithotripsy. The bioadhesive (kidney II-VIII) was then applied and the adhesive-stone fragment complex extracted. After nephrectomy, all kidneys were evaluated by two independent, blinded pathologists. Endpoints were the procedure's safety and adhesive system's biocompatibility. We observed no substantial toxic effects. We were able to embed and remove 80-90% of fragments. However, because of the pig's hampering pyelocaliceal anatomy, a quantified, proportional assessment of the embedded fragments was compromised. For the first time, we demonstrated the proven feasibility and safety of this novel bioadhesive system for embedding and endoscopically removing small RF in conjunction with a lack of organ toxicity in vivo.

Endoscopic management of radio-opaque bile duct stones.

Majority of the bile duct stones (BDS) are radiolucent (RL) and are amenable to conventional endoscopic extraction techniques. There is no publication that specifically discusses the optimal management of radio-opaque (RO) BDS and makes a distinction from the strategy followed for RL BDS. Data of patients with BDS managed endoscopically from January 2009 till June 2015 were retrospectively reviewed. Diagnosis of RO stone was established during initial fluoroscopy, just prior to obtaining a cholangiogram. Endoscopic retrograde cholangiopancreatography (ERCP) was done using therapeutic duodenoscope. Stone extraction was attempted initially using conventional techniques. Balloon sphincteroplasty or mechanical lithotripsy (ML) or both were done if conventional techniques failed. Cholangioscopy-guided intracorporeal holmium laser lithotripsy (LL) was done when all the above techniques failed. Fifteen patients were found to have RO stones in the bile duct during the study period. ERCP was successful in all patients. Discrepancy of the stone size in relation to the lower CBD diameter was seen in eight patients (53.34 %). Stone extraction with conventional techniques was successful in 2/15 patients (13 %). Successful controlled radial expansion (CRE) balloon sphincteroplasty/ML was possible in 5/15 patients (33 %). Cholangioscopy guided LL was done in eight patients (53.34 %) with successful pulverization of RO BDS (100 %). RO bile duct stones provide unique challenges for endoscopic management with success of conventional techniques in only about half of them (46 %). RO stones detected on fluoroscopy are extremely hard and difficult to crush with lithotripsy basket probably due to high calcium content. Cholangioscopy guided LL provides an excellent alternative management strategy.

A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones &lt;2 cm: A Single Center Experience

The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures. Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21). Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.

A Prospective Randomized Comparison Between Shock Wave Lithotripsy and Flexible Ureterorenoscopy for Lower Caliceal Stones ≤2 cm: A Single-Center Experience

The optimal management method of lower caliceal calculi is still undefined. We performed a prospective randomized comparison to evaluate safety and efficacy of shock wave lithotripsy (SWL) and flexible ureteroscopy (RIRS) for lower caliceal calculus ≤2 cm. Between December 2011 and January 2012, 195 patients with single radio-opaque lower caliceal calculi ≤2 cm were included in the study. Randomization was done into two groups-group A: SWL performed as an outpatient procedure using the electromagnetic lithotripter (Dornier compact delta) and group B: RIRS was performed using the 6F/7.5F flexible ureteroscope (Richard Wolf) with holmium laser intracorporeal lithotripsy. Demographic characteristics, success, retreatment, and auxiliary procedure rates and complications were analyzed statistically. Of 195 patients, 97 and 98 patients were enrolled in group A and B, respectively. Mean stone size was 12.1 mm in group A vs 12.3 mm in group B (p=0.52). The overall 3 month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (p=0.34); for stones <10 mm, it was (45/55) 84.9% for group A vs (43/51) 87.7% for group B (p=0.32) and for 10-20 mm stones, it was (29/35) 78.4% for group A vs (35/39) 85.4% for group B (p=0.12). Retreatment rate was significantly greater in group A compared with group B (61.1% vs 11.1%; p<0.001). Auxiliary procedure rate was comparable (21.1% vs 17.7%; p=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (p=0.21). Both SWL and RIRS are safe and efficacious for lower caliceal calculi ≤20 mm. For stones <10 mm, SWL was less invasive and safer than RIRS with efficacy comparable to it. However, for 10-20 mm stones, RIRS was more effective, with lesser retreatment rate.

Uso de un gel polimérico para evitar migración durante la litotripsia en un paciente con litiasis ureteral

The results of laser lithotripsy in ureteral stones can be affected by the retropulsion it causes due to the frequency and energy utilized. Different anti-repulsion devices have been tested for the purpose of improving stone resolution rates and eliminating the additional cost produced by stone migration. BackStop™ Gel is a polymer with reverse thermal sensitivity that has been tested in various studies with good results. Our aim was to describe the efficacy and safety of the BackStop™ as an antirepulsion device in a patient presenting with lithiasis in the distal third of the ureter who underwent Holmium laser intracorporeal lithotripsy.A patient with a stone in the distal portion of the right ureter underwent rigid ureteroscopy and Holmium laser intracorporeal lithotripsy with a 365 nm fiber, 2J of energy, and a frequency of 8 Hz, procedures that were carried out after the application of BackStop™Gel inside the ureter. The stone was completely fragmented through the lithotripsy; none of the fragments migrated to the cavities and there was no retropulsion. There were no intraoperative complications related to the use of the gel.The BackStop™ is a safe and efficacious tool for reducing ureteral stone migration in patients undergoing ureteroscopy with laser lithotripsy.

V1 Selecting the right Ho:laser intracorporeal lithotripsy mode during retrograde flexible ureteroscopic approach

V1 Selecting the right Ho:laser intracorporeal lithotripsy mode during retrograde flexible ureteroscopic approach

Laser‐Assisted Lithotripsy in the Minimally Invasive Treatment of Sialolithiasis

Objectives: In the minimally invasive treatment of sialolithiasis, lasers can be used to fracture stones, allowing for the endoscopic extirpation of larger lesions. The purpose of the current study was to evaluate outcomes following the use of the holmium YAG laser for intracorporeal salivary lithotripsy. Methods: Review of prospectively collected data regarding patients who underwent interventional sialoendoscopy for sialolithiasis was performed, recording patient demographics, surgical findings, and clinical outcomes. Patients who were treated with intracorporeal laser lithotripsy were compared with those who had simple basket retrieval or endoscopic assisted open removal. Patients were surveyed by phone for current symptom follow-up. Results: Thirty-one patients (average age 56, range 14-84) were treated for sialolithiasis with endoscopic techniques at our academic institution from 2011-2012. Sialoliths averaged 5.9 mm in size (range 2-20mm), arising from the submandibular ducts (n=20), parotid (n=10), or both (n=1). The holmium YAG laser was used in 16 patients. Of these cases, 6 patients required additional maneuvers to open the duct to allow for stone extraction compared to 10 cases in which the laser was not used. At last follow-up, 77% of patients who had laser assistance reported improvement of symptoms compared with 56% of the non-laser group. Complications in all patients included ductal stenosis (n=1), residual stone fragments (n=2), salivary fistula (n=1), and the need for additional procedures (n=6). Conclusions: The results of our series indicate that intracorporeal laser assisted lithotripsy is an effective addition to the armamentarium of sialoendoscopy.

Mo1445 Lithotripsy As an Adjunct Approach to Endotherapy Improves Technical Outcomes in Patients With Chronic Calcific Pancreatitis

Endoscopic management of chronic calcific pancreatitis (CCP) is challenging but may offer a less invasive alternative to surgical therapy. There is a paucity of data regarding the evolving role of adjunct therapy to improve the clearance of pancreatic duct stones. These therapies include extracorporeal shock wave lithotripsy (ESWL), intracorporeal laser lithotripsy (LL) or electrohydraulic lithotripsy (EHL). The aim of this study was to evaluate the efficacy of these adjunct approaches in the endoscopic therapy of pancreatic duct stones.

1827 A PROSPECTIVE RANDOMIZED COMPARISON BETWEEN SHOCK WAVE LITHOTRIPSY AND FLEXIBLE URETERORENOSCOPY FOR LOWER CALYCEAL STONES LESS THAN 2 CM:A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131827 A PROSPECTIVE RANDOMIZED COMPARISON BETWEEN SHOCK WAVE LITHOTRIPSY AND FLEXIBLE URETERORENOSCOPY FOR LOWER CALYCEAL STONES LESS THAN 2 CM:A SINGLE CENTER EXPERIENCE ANUP KUMAR, BISWAJIT NANDA, and NEERAJ KUMAR ANUP KUMARANUP KUMAR DELHI, India More articles by this author , BISWAJIT NANDABISWAJIT NANDA DELHI, India More articles by this author , and NEERAJ KUMARNEERAJ KUMAR DELHI, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have performed a prospective randomized comparison between flexible ureterorenoscopy(URS) and shock wave lithotripsy(SWL) for lower calyceal stones less than 2 cm to evaluate safety and efficacy of these procedures. METHODS All the patients with a single radio-opaque lower calyceal stone less than 2 cm undergoing treatment between Jan 2011 and May 2012 in our department were included. Patients were randomized into 2 groups : Group A : SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Alpha Compact); Group B: Flexible URS was performed using 6/8.8 Fr dual channel flexible ureterorenoscope with holmium laser intracorporeal lithotripsy energy. The statistical analysis was performed in 2 groups regarding patient demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. RESULTS 90 patients were enrolled in each group. The mean stone size was 12.1 mm in group A vs. 12.3 mm in group B (p= 0.43). The overall 3 month stone free rate was (60/90) 66.6% for group A vs (78/90)86.6% for group B (p=0.02).For stone size < 10 mm, 3 month stone free rates were (38/53) 71.6% for group A vs (43/49)87.7% for group B(p=0.32).For stone size between 10-20 mm, 3 month stone free rates were (22/37)59.4% for group A vs (35/41)85.4% for group B (p=0.02).The retreatment rate was significantly greater in group A in comparison to group B (67.1% vs 1.1%, respectively; p < 0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; p=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (p=0.21). CONCLUSIONS Flexible URS was safe and highly efficacious in the treatment of lower calyceal stones less than 20mm.For upper ureteric stones < 10 mm,SWL was safer, less invasive and with comparable efficacy in comparison to flexible URS.However,for upper ureteric stones between 10-20 mm,flexible URS was more effective, with a lesser retreatment rate than SWL. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e750 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information ANUP KUMAR DELHI, India More articles by this author BISWAJIT NANDA DELHI, India More articles by this author NEERAJ KUMAR DELHI, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pancreatoscopy-guided intracorporeal laser lithotripsy for difficult pancreatic duct stones: a case series with prospective follow-up (with video)

Pancreatic stones develop in patients with chronic pancreatitis, with as many as 90% of alcoholic chronic pancreatitis patients bearing ductal stones during long-term follow-up. 1 Main pancreatic duct calculi can lead to an outflow obstruction with increased parenchymal pressure, upstream dilation (ie, toward the tail of the pancreas), and ischemia. Untreated stones can also trigger bouts of acute pancreatitis sometimes associated with life-threatening adverse events. Pain is the predominant symptom in most patients with obstructive chronic pancreatitis, often alleviated only by narcotics and inducing anorexia, malabsorption, and weight loss. It is only with main pancreatic duct decompression from impacted stones that such adverse events can be avoided. 2,3 Small stones can be extracted by using various endoscopic techniques during ERCP, such as pancreatic sphincterotomy with balloon or basket sweeping, pancreatic duct stricture dilation, or stent placement. Larger and impacted stones typically require lithotripsy or surgery. Endoscopic lithotripsy options include (1) mechanical lithotripsy, for which data are scarce but suggest that this procedure may carry an increased risk of adverse events when compared with lithotripsy for biliary stones 2 ; (2) extracorporeal shock wave lithotripsy (ESWL), which overcomes the problem of size by fragmenting calculi and reducing the stone burden, thus facilitating endoscopic duct clearance 3 ; (3) contact lithotripsy by using pancreatoscopy with a mother-baby endoscope system. 4 Directcontact lithotripsy of biliopancreatic stones can be achieved by means of electrohydraulic lithotripsy (EHL) or pulseddye laser, both of which must be done under direct vision. Scant clinical outcome data are available regarding the application of these methods for pancreatic duct stone fragmentation. 5 Our aim was to evaluate the endoscopic treatment at our center by intracorporeal laser lithotripsy (ILL) with a single-operator mini-endoscope (SpyGlass; Boston Scientific, Natick, Mass) during ERCP, for its performance, feasibility, and safety in the treatment of difficult main pancreatic duct stones.

Extra corporeal shock wave lithotripsy and intracorporeal laser lithotripsy for distal ureteric calculi - a comparative study of efficacy and safety

DOI: http://dx.doi.org/10.3329/jdmc.v21i1.13231 J. Dhaka Med. Coll. 2012; 21(1): 8-11

Strahlenbelastung der Patienten bei der ureterorenoskopischen Steinentfernung

We determined the intraoperative patient radiation exposure during ureteroscopic extraction of ureteral or renal stones. The investigation was carried out in 215 patients who underwent ureteroscopy for ureteral or renal stone extraction. Radiation exposure was measured as dose-area product (DAP) within the X-ray beam. The effective abdominal dose was calculated using the specific conversion factor of 0.00323 mSv/µGy×m². Depending on the stone location (i.e. ureter or kidney), the type of ureteroscopy (i.e. semirigid or flexible) and type of stone removal (i.e. simple stone extraction or intracorporeal laser lithotripsy), the intraoperative patient radiation exposure (effective dose ED) ranged from 0.67 mSv (DAP 221.9 µGy×m²) to 2.23 mSv (DAP 744.2 µGy×m²). Patient radiation exposure during ureteroscopic stone extraction is comparable to patient radiation exposure using plain film urography or low-dose non-contrast-enhanced computed tomography for diagnosis of urolithiasis.