Stone Volume Research Articles

MP23-12 CLINICAL EFFICIENCY OF THULIUM FIBER LASER FOR RIRS IN LARGE VOLUME STONES (15-25MM): A MULTICENTRIC EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP23-12 CLINICAL EFFICIENCY OF THULIUM FIBER LASER FOR RIRS IN LARGE VOLUME STONES (15-25MM): A MULTICENTRIC EXPERIENCE Abhishek Singh, Soundarya Ganesan, Rohan Batra, Abhijit Patil, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai, and ChandraMohan Vaddi Abhishek SinghAbhishek Singh More articles by this author , Soundarya GanesanSoundarya Ganesan More articles by this author , Rohan BatraRohan Batra More articles by this author , Abhijit PatilAbhijit Patil More articles by this author , Arvind GanpuleArvind Ganpule More articles by this author , Ravindra SabnisRavindra Sabnis More articles by this author , Mahesh DesaiMahesh Desai More articles by this author , and ChandraMohan VaddiChandraMohan Vaddi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Thulium fiber laser (TFL) is a promising new tool in the field of endoscopic laser lithotripsy, but is it efficacious in managing large stones using flexible ureteroscopy remains to be seen. Our objective was to analyse the clinical efficiency of TFL in large volume stones during retrograde intrarenal surgery. METHODS: Patients with large volume renal stones (>1000 mm3) and size of 15-25 mm, operated at two different centers, from May 2020 to April 2021, were enrolled in this study. Retrograde intrarenal surgery was performed using 60 W Superpulse thulium fiber laserTM (IPG Photonics, Russia). Demographic data, stone parameters, lasing time, total operating time were recorded, laser efficacy(J/mm3) and ablation speed(mm3/sec) were calculated. Complications were assessed using Clavien Dindo grading. NCCT KUB was done at 1month post operatively to calculate stone free rate. RESULTS: A total of 76 patients were included and analysed in the study. Mean stone volume was 1860.79±1172.61 (1169.27-2193.25) mm3, mean stone density was 1099.80 ± 313.65 (875.00-1317.00) HU, mean laser time was 537.79±689.89 (21.00-1080.00) sec, mean total operating time was 43.38±12.96 (35.00-51.25) min, mean laser efficacy was 20.30±15.5 (8.88-25.57) J/mm3, mean ablation speed was 1.32±0.7 (0.82-1.64) mm3/sec. A strong positive correlation between stone volume and ablation speed (r=0.659, p=0.000), a moderate negative correlation between volume and laser efficacy (J/mm3) (r=-0.392, p=0.000). With increasing volume of the stone, J/mm3 decreased significantly and ablation speed increased significantly (p<0.001). Complications occurred in 21.05% (16/76) patients, most of which were Clavien grades 1-2. Overall SFR is 96.05%. CONCLUSIONS: With an increase is stone volume, laser efficiency increases as less energy is required to ablate every mm3 of stone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e311 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Singh More articles by this author Soundarya Ganesan More articles by this author Rohan Batra More articles by this author Abhijit Patil More articles by this author Arvind Ganpule More articles by this author Ravindra Sabnis More articles by this author Mahesh Desai More articles by this author ChandraMohan Vaddi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-18 HOLMIUM VERSUS TRILOGY IN KIDNEY STONES GUY&amp;ACUTE;S 1-2 (TRIHOLMIUM) PRELIMINARY ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP26-18 HOLMIUM VERSUS TRILOGY IN KIDNEY STONES GUY&ACUTE;S 1-2 (TRIHOLMIUM) PRELIMINARY ANALYSIS Braulio Manzo, Edgard Lozada, Pompeyo Alarcon, Edson Flores, Juan Galvan, Yonathan Gomez, Jonathan Jimenez, and Allan Casale Braulio ManzoBraulio Manzo More articles by this author , Edgard LozadaEdgard Lozada More articles by this author , Pompeyo AlarconPompeyo Alarcon More articles by this author , Edson FloresEdson Flores More articles by this author , Juan GalvanJuan Galvan More articles by this author , Yonathan GomezYonathan Gomez More articles by this author , Jonathan JimenezJonathan Jimenez More articles by this author , and Allan CasaleAllan Casale More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The desire to reduce complications related to percutaneous access and morbidity related to tract size has led researchers to evaluate PCNL using smaller-caliber instruments. In this context, mini-PCNL has emerged. Furthermore, its efficacy and safety have been demonstrated at the cost of a lower stone-free rate. Currently, mini-PCNL has been performed with High power laser lithotripsy; therefore, it is convenient to make a comparison between the results of lithotripsy with Ho:YAG laser energy and the new LithoClast Trilogy EMS; and thereby determine which is the most effective method in the resolution of kidney stones through a miniaturized percutaneous tract. METHODS: A total of 116 patients will be subjected to simple randomization with a table of random numbers; 58 patients will undergo a mini-PCNL with Trilogy EMS probe 1.5 mm (Group1), and the remaining will undergo mini-PCNL with 100 W laser lithotripsy (group 2). Comparing both groups will be made by evaluating lithotripsy rate, stone-free status, operation time, and complications. RESULTS: We present the preliminary results of 32 randomized patients (18 in group 1 and 14 in group 2). Demographic data were homogeneous between both groups, including age, the side affected, BMI, maximum stone diameter, and stone volume (p values: 0.362, 0.221, 0.441, 0.569, and 0.120, respectively). Total fluoroscopy screening time was 24.3 and 26.4 seconds for groups 1 and 2, respectively (p: 0.547). Endoscopic stone-free status at the end of the surgical procedure was not statistically different in both groups (p: 0.394). Lithotripsy rate (195.09 sd 82.9 group 1 vs 202.7 sd: 99.38 for group 2) and operative time (94.28 sd: 34 for group1 vs 81.2 sd: 28.8 for group 2) were not statistically different in both groups (p: 0.815 and p: 0.268, respectively). The overall mean stone-free rate was 78.9 % (80.9% and 76.9%, respectively, with a p-value: of 0.371). The complications rate was similar in both groups (5.6 vs. 7.1% for groups 1 and 2, respectively, with a p-value: of 0.854). CONCLUSIONS: Our preliminary data show that mini-PCNL with Trilogy lithotripsy (1.5 mm probe) shows similar results and efficacy to the current energy to perform mini-PCNL (high power holmium laser) by means of stone-free rate, lithotripsy rate, operative time, and complications rate. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e360 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Braulio Manzo More articles by this author Edgard Lozada More articles by this author Pompeyo Alarcon More articles by this author Edson Flores More articles by this author Juan Galvan More articles by this author Yonathan Gomez More articles by this author Jonathan Jimenez More articles by this author Allan Casale More articles by this author Expand All Advertisement PDF downloadLoading ...

PD45-08 THULIUM FIBER LASER VS HOLMIUM:YAG LASER: A PROSPECTIVE CASE-CONTROL STUDY IN LARGE URETERIC STONES

You have accessJournal of UrologyCME1 Apr 2023PD45-08 THULIUM FIBER LASER VS HOLMIUM:YAG LASER: A PROSPECTIVE CASE-CONTROL STUDY IN LARGE URETERIC STONES Mohamed Hatem, Abdullah Aljarod, Hatem Kamkoum, Tawiz Gul, Mohamed Ebrahim, Mohamad Rejeb, Kalpana Singh, Abdulla AL-Ansari, Omar Aboumarzouk, and Morshed Salah Mohamed HatemMohamed Hatem More articles by this author , Abdullah AljarodAbdullah Aljarod More articles by this author , Hatem KamkoumHatem Kamkoum More articles by this author , Tawiz GulTawiz Gul More articles by this author , Mohamed EbrahimMohamed Ebrahim More articles by this author , Mohamad RejebMohamad Rejeb More articles by this author , Kalpana SinghKalpana Singh More articles by this author , Abdulla AL-AnsariAbdulla AL-Ansari More articles by this author , Omar AboumarzoukOmar Aboumarzouk More articles by this author , and Morshed SalahMorshed Salah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The new Thulium Fiber Laser (TFL) has been recently introduced as an alternative lithotripsy technology. TFL is a promising alternative to Holmium:YAG (Ho:YAG) owing to its use of a more suitable TFL wavelength, smaller fibers, and potential for using a smaller and less expensive laser system. TFL has already showed its efficacy and safety in lithotripsy. We aimed to compare between TFL and Ho:YAG ureteroscopic lithotripsy for large stones >1cm. METHODS: We prospectively case controlled studied patients with ureteral calculi in the period between June 2020-July 2022. All adult patients with ureteric stones that required to undergo ureterolithotripsy were included. TFL or HO:YAG were used alternatively between the two modalities. The age, co-morbidities, body mass index (BMI), stone size, and volume were recorded. The evaluated parameters were stone-free rate (SFR), operative time, and complication rate. The surgical research section review board approved the study. Chi-Square tests with standardized residuals were calculated to see association with categorical variables and the groups. RESULTS: A total of 172 adult patients with ureteric stones >1cm were included in this study. 87 patients in the TFL group with a mean age of 37.9+-8.8 and 85 in the Ho:YAG group with a mean age of 39.4+-10.5 (p=0.34). There was no difference regarding BMI (26+-3.6 vs 26+-3.7)(p=0.96), Co-morbidity (16% vs 24% with multiple comorbidities)(p=0.49), anaesthesia type using general or spinal (57% vs 55%) (p=0.77), stone volume (1.6+-0.5 vs 1.5+-0.5)(p=0.41), or basket use (15% vs 15%)(p=0.95). Interestingly, the TFL group took longer to perform, with higher operative time than the Ho:YAG group (81.7+-42.2 vs 67+-35.1 (p=0.016)). This was likely due to the fact the TFL group did have more multiple stones requiring lithotripsy than the Ho:YAG group, however this was not statistically significant, but clearly, clinically significant whereby there was a 27% vs 19% multiple stones rate (p=0.23). There was no difference in the SFR (95% vs 96% (p=0.72)), second look ureteroscopy (14% vs 8%) (p=0.25)) or early or late complication rates, 1% vs 4% (p=0.3) and 0% vs. 1% (p=0.31), respectively. All patients were stone and complication free on follow up. CONCLUSIONS: TFL has proven its efficacy and safety with high SFR and low early and late complication rates. TFL ureteroscopic lithotripsy took longer to perform than Ho:YAG, probably due to having a higher stone burden, however statistically not significant. Source of Funding: No funding for this review was received. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1165 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Hatem More articles by this author Abdullah Aljarod More articles by this author Hatem Kamkoum More articles by this author Tawiz Gul More articles by this author Mohamed Ebrahim More articles by this author Mohamad Rejeb More articles by this author Kalpana Singh More articles by this author Abdulla AL-Ansari More articles by this author Omar Aboumarzouk More articles by this author Morshed Salah More articles by this author Expand All Advertisement PDF downloadLoading ...

MP16-20 ASYMPTOMATIC SPONTANEOUS STONE PASSAGE IS FREQUENT IN RECURRENT KIDNEY STONE FORMERS: RESULTS OF THE PROSPECTIVE, RANDOMIZED NOSTONE TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP16-20 ASYMPTOMATIC SPONTANEOUS STONE PASSAGE IS FREQUENT IN RECURRENT KIDNEY STONE FORMERS: RESULTS OF THE PROSPECTIVE, RANDOMIZED NOSTONE TRIAL Kevin Stritt, Olivier Bonny, Daniel Fuster, Andreas Christe, and Beat Roth Kevin StrittKevin Stritt More articles by this author , Olivier BonnyOlivier Bonny More articles by this author , Daniel FusterDaniel Fuster More articles by this author , Andreas ChristeAndreas Christe More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney stones are a common healthcare problem, and both prevalence and incidence are increasing worldwide. Kidney stone recurrences are frequent. Still, a number of kidney stones pass without symptoms and are not noticed by the patient. Data are limited regarding the frequency of asymptomatic spontaneous stone passage. The aim of the study is to evaluate the frequency of asymptomatic spontaneous stone passage and its predictive factors. METHODS: We analyzed the data from the NOSTONE trial, a prospective, multicenter, double-blind, placebo-controlled randomized trial to assess the efficacy of hydrochlorothiazide (HCT) in the prevention of recurrence in patients with recurrent calcium containing kidney stones. We identified all asymptomatic spontaneous stone passages by comparing the total number of kidney stones on low-dose non-intravenous contrast CT imaging at the beginning and at the end of the 3-year follow-up, taking into account the symptomatic spontaneous stone passages and the surgical stone removals. Association of independent variables identified in the data set and the number of asymptomatic spontaneous stone passages using linear regression analyses. RESULTS: A total of 416 patients were randomized and included in the NOSTONE trial, 5 outliers were removed, therefore we analyzed 411 patients. Median follow-up was 35 months (IQR: 29 – 41); median patient age was 49 years (IQR: 39 – 55); 84/411 (20%) patients were female. A total of 476 stone events occurred in 224 of 411 patients (55%); 245/476 (52%) were symptomatic spontaneous stone passages, 73/476 (15%) were surgical stone removals, and 158/476 (33%) were asymptomatic spontaneous stone passages. The median size of asymptomatic stones (2.4 mm; IQR: 1.95-3.4) and the size of symptomatic stones (2.15 mm; IQR: 1.68-2.79) that passed spontaneously were not significantly different (p=0.366). The number of asymptomatic spontaneous stone passages was significantly influenced by a higher number of stones on CT imaging at randomization (p=0.001) and a lower total stone volume (p=0.001). CONCLUSIONS: Stone recurrence in recurrent calcium containing kidney stone formers is high. A relevant number of stones, however, pass spontaneously, many of these being asymptomatic (39%). Predictive factors for asymptomatic spontaneous stone passages are the number and the total volume of stones. Our data presented should encourage urologists to counsel patients about the possibility of a conservative approach if kidney stones are present. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e210 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Stritt More articles by this author Olivier Bonny More articles by this author Daniel Fuster More articles by this author Andreas Christe More articles by this author Beat Roth More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

MP23-03 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SUCCESS RATES IN PATIENTS WITH ELEVATED BODY MASS INDEX, A COMPARATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP23-03 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SUCCESS RATES IN PATIENTS WITH ELEVATED BODY MASS INDEX, A COMPARATIVE STUDY Dolev Perez, David Dotan, Binyamin Neeman, Boris Chertin, and Ilan Kafka Dolev PerezDolev Perez More articles by this author , David DotanDavid Dotan More articles by this author , Binyamin NeemanBinyamin Neeman More articles by this author , Boris ChertinBoris Chertin More articles by this author , and Ilan KafkaIlan Kafka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for the treatment of renal stones larger than 20 mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than fluoroscopy. A higher body mass index (BMI) can make ultrasound- guided renal access more difficult and unsuccessful. We present a retrospective analysis and comparison of ultrasound- guided PCNL in patients with normal and increased body mass index. METHODS: We performed a retrospective comparison of patients who underwent ultrasound- guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-Obese) were compared to those with BMIs less than 30 (mean 25.69-non-Obese). Demographic, preoperative, and follow- up data were collected, analyzed, and included in this study. RESULTS: The study included a total of 98 consecutive patients, with 49 patients in each group. No statistically significant differences were observed in terms of stone volume (p=0.085), stone density (p=0.5590), location of renal access (p=0.108), surgery duration (p=0.38), blood loss (p=0.54), or laboratory changes after surgery (p=0.60). 91.84 precent of obese patients were stone- free per CT scan at follow- up, compared to 77.5 percent of normal- weight patients (p=0.089). According to Clavien Dindo classification, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to five patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications. CONCLUSIONS: There was no significant correlation between body mass index and the or safety of ultrasound- guided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone- free status post- operatively, and can diminish or even avoid both patient's and medical team's exposure to ionizing radiation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dolev Perez More articles by this author David Dotan More articles by this author Binyamin Neeman More articles by this author Boris Chertin More articles by this author Ilan Kafka More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment of factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital of Nepal

Retrograde intrarenal surgery (RIRS) is an effective and safe method for the management of intrarenal stone showing high stone-free rates. Its main advantage is decrease in operative morbidity for the patient, as well as a faster recovery. The current study aimed to study the factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital. It is an observational descriptive cross sectional study using purposive sampling method which was conducted among 188 patients who underwent retrograde intrarenal surgery (RIRS) for management of nephrolithiasis in Department of Urology of B&amp;B hospital, Lalitpur, Nepal. The baseline information of the factors affecting operating time were obtained like age, gender, site of renal stone, prestented or not, body mass index (BMI), ureteral access sheath (UAS) use, stone volume and stone density. The mean operating time was high in renal stone with calcium ammonium urate composition. On linear regression analysis, operative times significantly increased with greater stone volumes and also pre-stenting and ureteral access sheath use did significantly difference on operative time. It revealed stone volume to be the most significant predictor of operative time. Thus, the present study provides valuable information regarding the factors influencing operating time during retrograde intrarenal surgery for renal stone.

El bloqueo del plano del músculo erector espinal antes de la litotricia extracorpórea por ondas de choque reduce el tiempo de fluoroscopia y facilita el tratamiento de la litiasis renal: estudio prospectivo aleatorizado

Introduction and ObjectivesTo compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. Patients or MaterialsThe study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. ResultsA total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p:0.002, p:0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p<0.001). ConclusionsWe observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.

Impact of Vacuum-Assisted Mini-Endoscopic Combined Intrarenal Surgery for Staghorn Stones: Analysis of Perioperative Factors of Postoperative Fever and Stone-Free Status.

Background and Objective: This retrospective cohort study aimed to evaluate the clinical outcomes of vacuum-assisted mini-endoscopic combined intrarenal surgery (vmECIRS) for staghorn stones. Patients and Methods: We analyzed a total of 61 cases treated with initial vmECIRS using 14F/16F ClearPetra® percutaneous sheaths for staghorn stones. We primarily measured complications and stone-free rates (SFRs) to evaluate the safety and efficiency of vmECIRS. In addition, pre- and intraoperative factors in patients who experienced postoperative fever >38°C and achieved an initial stone-free status were evaluated. Results: The percentages of staghorn stones were 36.1% and 63.9% for complete and partial stones, respectively. The median stone volume was 8.48 cm3. The median operation time was 117 minutes, and the mean number of procedures was 1.54. Regarding postoperative complications, postoperative fever >38°C was reported in 18 patients (29.5%). The initial and final SFRs were 50.8% and 91.8%, respectively. Among patients with emerging fever >38°C, positive urine culture was the only significant risk factor in the multivariate analysis (odds ratio [OR], 7.500; 95% confidence interval [CI], 1.772-31.751; p = 0.006). Moreover, for achieving initial stone-free status, body mass index and stone volume were significant risk factors in the multivariate analysis (OR, 0.872; 95% CI, 0.776-0.980; p = 0.021; and OR, 0.882; 95% CI, 0.784-0.994; p = 0.039, respectively). Conclusions: These findings suggest that vmECIRS is safe and effective for treatment of staghorn stones. Although current guidelines suggest that percutaneous nephrolithotomy is the gold standard surgical technique for staghorn stones, vmECIRS could also be a treatment strategy. The Clinical Trial Registration number (ID: 2022-05-17-1).

Is there a superiorıty of the stone volume measured in 3-d non-contrast tomography (3-D NCCT) to the stone area in predicting the stone-freeness of the retrograde intrarenal surgery success (RIRS)

Objectives: To examine the predictive effect of preoperative measurements of stone volume (SV) against stone area (SA) on stone-free status (SF) following retrograde intrarenal surgery (RIRS). &#x0D; &#x0D; Methods: We retrospectively examined the medical records of 68 RIRS patients with renal calculi who were eligible. Patients having non-contrast computed tomography ( NCCT ) before and subsequent to RIRS were included, however staghorn stones and inability to access were omitted. SF status was determined by the absence of visible stones on the NCCT three months after RIRS. Using a software reconstruction tool using 3-D NCCT, a radiologist determined stone load characteristics, such as SA and SV. Using a logistic regression model, the assessment of potential SF status determinants was conducted. &#x0D; &#x0D; Results:Age, stone density, quantity and position of stones, usage of access sheath, failed prior Shock Wave Lithotripsy (SWL), and procedures were not substantially linked with non-SF status, however gender (p = 0.014), SA (p

Comparative study of thulium fiber laser versus holmium:yttrium-aluminum-garnet laser for ureteric stone management with semi-rigid ureteroscopy: A prospective, single-center study

ObjectiveTo compare the efficacy and safety of thulium fiber laser (TFL) and holmium:yttrium-aluminum-garnet (Ho:YAG) laser for ureteric stone management with semi-rigid ureteroscopy. MethodsIn a prospective study from January 2020 to December 2021, we compared 40 patients in each group who underwent semi-rigid ureteroscopic lithotripsy with TFL and that with Ho:YAG laser. Stone volume, stone density, stone fragmentation rates, total lasing time, total operative time, endoscopic vision, retropulsion and stone free rates were analyzed in both groups and compared. ResultsMean stone volume was comparable in the TFL group and the Ho:YAG laser group (282.45 [standard deviation, SD 139.79] mm3vs. 279.49 [SD 312.52] mm3; p=0.964). Mean stone density was also comparable in the TFL group and the Ho:YAG laser group (1135.30 [SD 317.04] Hounsfield unit vs. 1131.75 [SD 283.03] Hounsfield unit; p=0.959). The mean stone fragmentation rates calculated as stone volume divided by lasing time were 25.85 (SD 10.61) mm3/min and 21.37 (SD 14.13) mm3/min in the TFL group and the Ho:YAG laser group, respectively (p=0.113). The mean total lasing time (10.15 [SD] 4.69 min vs. 11.43 [SD 4.56] min; p=0.222), mean operative time (25.13 [SD 9.51] min vs. 25.54 [SD 10.32] min; p=0.866), and mean total hospital stay (2.62 [SD 0.77] days vs. 2.61 [SD 0.84] days; p=0.893) were comparable in the TFL group and in the Ho:YAG group. The vision was better and retropulsion was less in the TFL group. The stone-free rate at 1 month postoperatively was slightly better in the TFL group (100% vs. 90%; p=0.095). ConclusionTFL technology was associated with the comparable total surgical time, total lasing time, and stone fragmentation rate with Ho:YAG laser. However, TFL had better endoscopic vision, lesser stone retropulsion, and slightly better stone-free rates.

Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population.

Triple D score was developed using skin-to-stone distance, stone density, and stone volume for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones smaller than 2 cm in children however it was not validated in pediatric population. The present paper aims to validate Triple D score in pediatric patients. Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), and stone density (SD) variables. Receiver operator characteristic analysis was used to set cut-off values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. The median age of the study group was 7 (range 1 to 16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Our study confirms that Triple D scores supports the SWL outcomes in pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL.

Non-contrast computed tomography-based factors in predicting ESWL success: A systematic review and meta-analysis.

We assessed the efficacy of some predictive factors that can be measured with non-contrast computed tomography and may affect ESWL success with a systematic review and meta-analysis. All data sources were broadly investigated up to April 2022. Data were extracted from the relevant studies and analyzed with RevMan software. In a random effects model, standard mean difference (SMD) and risk ratio (RR) values were given with 95% confidence intervals. In total, pooled analysis included 7148 patients in 43 studies. The combined effect estimate showed significant differences between the ESWL success and ESWL failure groups in terms of Hounsfield unit (HU), Hounsfield density (HD), skin to stone distance (SSD), ureteral wall thickness (UWT), stone volume, stone area, abdominal fat parameters, diameter of proximal ureter, and hydronephrosis. However, perinephric stranding and renal cortical thickness were not found to be statistically significant between the study groups. HU, HD, SSD, UWT, stone volume, stone area, abdominal fat parameters, diameter of proximal ureter and hydronephrosis are effective factors for prediction of ESWL success. It is important to decide on treatment before the procedure for stones with appropriate diameter for ESWL.

Does Time and Size Matter in Retrograde Intrarenal Surgery? Results Analysis Using a Low-Pressure Technique.

Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the treatments of choice. We analyzed the results from our patients who underwent retrograde intrarenal surgery at controlled pressure. We conducted an observational, descriptive, retrospective study of 403 patients who underwent retrograde intrarenal surgery at the Hospital Clínico Universitario Lozano Blesa (Zaragoza, Spain) between January 2013 and December 2019. The mean surgical time was 111.1 minutes, with a mean stone volume of 3.5 cm3 (maximum volume, 38.3 cm3). A total of 70 patients (17.3%) developed postoperative Clavien-Dindo complications-64 minor (91.4%) and 6 major (8.6%). In addition, 28 patients (6.9%) presented with an early complication (<3 months), with urinary tract infection and pyelonephritis being the most common. The stone-free rate was 69.0%, with a retreatment rate of 4.7%. Sex was statistically significantly related to the onset of minor Clavien postoperative complications (p = 0.001). Similarly, corticosteroid use was associated with the onset of major Clavien complications (p = 0.030). Neither surgical time nor stone volume was found to be statistically significantly related to the onset of Clavien postoperative complications or early complications.

Single-Session Impact of High-Power Laser with Moses Technology for Lower Pole Stones in Retrograde Intrarenal Surgery: Retrospective Study

Background: This study aimed to evaluate the efficacy of a high-power holmium laser with Moses technology (MT) for the treatment of lower pole stones during retrograde intrarenal surgery (RIRS). Methods: Herein, 305 patients with lower pole stones who underwent RIRS using a high-power holmium laser with MT were retrospectively classified into the stone-free (SF) and non-SF groups. We measured the stone burden, stone volume, stone hardness, pre- or post-operative stent placement, infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height in terms of pelvicalyceal anatomy using retrograde pyelograms and evaluated the predictive factors of postoperative SF. Results: A total of 173 (56.7%) and 229 (75.1%) patients achieved a SF status on postoperative day one and at one month, respectively. Operation time in the SF group was shorter than that in the non-SF group (51.0 vs. 74.5 min). There were no significant differences in postoperative complications between the SF and non-SF groups. Significantly predictive risk factors in postoperative SF included total stone volume (odds ratio (OR), 1.056; 95% CI, 1.015-1.099; p = 0.007), IPA (OR, 0.970; 95% CI, 0.956-0.993; p = 0.009), and IW (OR, 0.295; 95% CI, 0.121-0.718; p = 0.007). The cut-off values of stone volume, IPA, and IW were 515.2 mm3, 46.8°, and 7.75 mm, respectively. Conclusions: A high-power holmium laser with MT in lower pole stones is a valuable option for positive outcomes and patient's safety. Larger stone volume, acute IPA, and narrow IW were negative predictors related to postoperative SF status.

Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones

This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ -0.375, p = 0.001) and stone density (ρ -0.283, p = 0.011). ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.

In Vivo Prediction of Kidney Stone Fragility Using Radiomics-Based Regression Models.

Introduction: The surgical technique for urinary stone removal is partly influenced by its fragility, as prognosticated by the clinician. This feasibility study aims to develop a linear regression model from CT-based radiomic markers to predict kidney stone comminution time in vivo with two ultrasonic lithotrites. Materials and Methods: Patients identified by urologists at our institution as eligible candidates for percutaneous nephrolithotomy were prospectively enrolled. The active engagement time of the lithotrite in breaking the stone during surgery denoted the comminution time of each stone. The comminution rate was computed as the stone volume disintegrated per minute. Stones were grouped into three fragility classes (fragile, moderate, hard), based on inverse of the comminution rates with respect to the mean. Multivariable linear regression models were trained with radiomic features extracted from clinical CT images to predict comminution times in vivo. The model with the least root mean squared error (RMSE) on comminution times and the fewest misclassification of fragility was finally selected. Results: Twenty-eight patients with 31 stones in total were included in this study. Stones in the cohort averaged 1557 (±2472) mm3 in volume and 5.3 (±7.4) minutes in comminution time. Ten stones had nonmoderate fragility. Linear regression of stone volume alone predicted comminution time with an RMSE of 6.8 minutes and missed all 10 stones with nonmoderate fragility. A fragility model that included stone volume, internal morphology, shape-based radiomics, and device type improved RMSE to below 3.3 minutes and correctly classified 20/21 moderate and 6/10 nonmoderate stones. Conclusions: CT metrics-based fragility models may provide information to surgeons regarding kidney stone fragility and facilitate the selection of stone removal procedures.

Software-Estimated Stone Volume Is Better Predictor of Spontaneous Passage for Acute Nephrolithiasis.

Purpose: To evaluate whether computer program-estimated urolith stone volume (SV) was a better predictor of spontaneous passage (SP) compared with program-estimated stone diameter (PD) or manually measured stone diameter (MD), and whether utilizing SV and MD together provided additional value in SP prediction compared with MD alone. Materials and Methods: Retrospective analysis of patients with acute renal colic and single renal/ureteral stone on CT from July 2017 to April 2020. Diameter obtained from radiology reports or manually measured when report not available. Semiautomated stone analysis software (qSAS) was used to estimate SV and PD. ROC analysis was performed to compare accuracy of SV vs MD vs PD in predicting SP by 2, 4, and 6 weeks. Subgroup analysis was performed by stone size (</≥6 mm) and location (proximal/distal). Results: Among 172 patients analyzed, SP occurred in 71 (41%). Patient age (mean 53), gender (38%F), and stone history/side did not differ significantly by SP. Average MD, PD, and SV were significantly smaller among SP stones vs stones requiring surgery (MD 4.3 mm vs 8.0 mm, PD 5.5 mm vs 9.4 mm, and SV 40 mm3 vs 312 mm3; p < 0.001). ROC analysis showed significantly higher area under curve (AUC) for SV for predicting SP by 4 and 6 weeks compared with MD and PD (AUC 0.93 vs 0.86 vs 0.85 4 weeks, p < 0.001; 0.92 vs 0.85 vs 0.86 6 weeks, p < 0.003). AUC difference between SV vs MD was much greater among stones ≥6 mm or proximal stones. Utilizing SV and MD together yielded improved positive predictive value and negative predictive value for SP prediction. Conclusions: SV is a more accurate predictor of SP compared with linear stone dimensions, especially in the setting of larger and/or more proximal stones. Utilizing SV and diameter together yielded improved SP predictions compared with using either metric alone. Prospective studies are indicated to investigate the clinical utility of SV for SP prediction.

Comparison of Superpulse Thulium Fiber Laser vs Holmium Laser for Ablation of Renal Calculi in an In Vivo Porcine Model.

Introduction and Objectives: We sought to compare the effectiveness and efficiency of the superpulse thulium fiber laser (sTFL to the holmium: yttrium-aluminum-garnet [Ho:YAG] laser for ureteroscopic "dusting" of implanted renal stones in an in vivo porcine model. Methods: Twenty-four porcine kidneys (12 juvenile female Yorkshire pigs) were randomized to Ho:YAG or sTFL treatment groups. Canine calcium oxalate stones were scanned with computed tomography to calculate stone volume and stone density; the stones were randomized and implanted into each renal pelvis via an open pyelotomy. In all trials, a 14F, 35 cm ureteral access sheath was placed. With a 9.9F dual lumen flexible ureteroscope, laser lithotripsy was performed using dusting settings: Ho:YAG 200 μm laser fiber at 16 W (0.4 J, 40 Hz) or sTFL 200 μm laser fiber at 16 W (0.2 J, 80 Hz). Lithotripsy continued until no fragments over 1 mm were observed. No stone basketing was performed. Throughout the procedures, intrarenal and renal pelvis temperatures were measured using two percutaneously positioned K-type thermocouples, one in the upper pole calyx and one in the renal pelvis. After the lithotripsy, the ureteropelvic junction was occluded, the kidneys were bivalved, and all residual fragments were collected, dried, weighed, and then measured with an optical laser particle sizer. Results: Implanted stones were similar in volume and density in both groups. Intraoperative collecting system temperatures were similar for both groups (all <44°C). Compared to Ho:YAG, sTFL ablated stones faster (9 vs 27 minutes, p < 0.001) with less energy expenditure (8 vs 26 kJ, p < 0.001), and a greater stone clearance rate (73% vs 45%, p = 0.001). After sTFL lithotripsy, 77% of the remaining fragments were ≤1 mm vs 17% of fragments ≤1 mm after Ho:YAG treatment (p < 0.001). Conclusions: In an in vivo porcine kidney, using dusting settings, sTFL lithotripsy resulted in shorter ablation times, higher stone clearance rates, and markedly smaller stone fragments than Ho:YAG lithotripsy.

Validation of the Trifecta Scoring Metric in Vacuum-Assisted Mini-Percutaneous Nephrolithotomy: A Single-Center Experience.

Scoring metrics to assess and compare outcomes of percutaneous nephrolithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kidney stones. Data from 287 participants who underwent vmPCNL were analysed. Patients' and stones' characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxiliary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p &lt; 0.001), a higher rate of single stones (p &lt; 0.001), shorter operative time (p &lt; 0.01), and a higher rate of single percutaneous tract (p &lt; 0.01) than -trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p &lt; 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respectively, all p &lt; 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone volume were independent unfavourable risk factors for trifecta.