Ureteroscopic Holmium Laser Lithotripsy Research Articles

The effect of calcium oxalate stones and uric acid stones on male sexual function.

This study compared the effects of calcium oxalate stones and uric acid stones on male sexual function. We enrolled 100 patients with ureteral stones. According to the composition of the stones, they were divided into the calcium oxalate stone group and the uric acid stone group. All patients underwent ureteroscopic holmium laser lithotripsy. General data such as age, body mass index, course of disease, stone diameter, and degree of renal hydronephrosis were compared. Sperm parameters, including sperm density, sperm viability, and sperm deformity rate, as well as International Index of Erectile Function-5 questionnaire (IIEF-5) scores, and Quality of Life (QOL) scores, were measured and compared before and 6weeks after the surgery. There were no statistically significant differences in general data and sperm parameters between the two groups before the surgery (P > 0.05). However, there were significantly lower IIEF scores but significantly higher QOL scores in the uric acid stone group. In the calcium oxalate stone group, there were no statistically significant differences in sperm parameters, IIEF score, and QOL score before and after the surgery (P > 0.05). In the uric acid stone group, there were no statistically significant differences in sperm parameters before and after surgery (P > 0.05), whereas there were significantly higher IIEF scores but significantly lower QOL scores after the surgery (P < 0.05). The prevalence of erectile dysfunction (ED) in the uric acid stone group was 38.18% (21/55), which was significantly higher compared to 20.00% (9/45) in the calcium oxalate stone group (P < 0.05). The multivariate binary logistic regression analysis showed that the independent risk factor related to ED was uric acid stones (odds ratio: 2.637, 95% confidence interval 1.040-6.689, P = 0.041). No statistically significant differences were found in sperm parameters between patients with and without ED. Compared with the calcium oxalate stone group, patients with uric acid stones had a higher prevalence of ED and poorer sexual performance.

Application Analysis of Low-Pressure Perfusion Combined with Occluder in Holmium Laser Lithotripsy for Patients with Middle and Upper Ureteral Calculi.

Ureteroscopic holmium laser lithotripsy has become one of the main methods of treating ureteral calculi. However, in the treatment of middle and upper ureteral calculi, ureteroscopy is difficult to operate owing to the high location of calculi. Thus, how to improve the treatment effect and reduce the stone migration has become the focus in clinical settings. On this basis, we evaluated the application effect of low-pressure perfusion combined with occluder in holmium laser lithotripsy for patients with middle and upper ureteral calculi. This retrospective study selected 107 patients with middle and upper ureteral calculi who underwent low-pressure perfusion combined with ureteroscopic holmium laser lithotripsy from January 2021 to December 2022. We excluded 7 patients who did not meet the criteria, and ultimately included 100 patients. According to whether the occluder was used during the surgery, 100 patients were divided into groups A (n = 52, occluder) and B (n = 48, without occluder). The stone-migration rate during surgery, stone-clearance rate at 3 months after surgery, perioperative indicators, postoperative complication rate, and postoperative quality of life between the two groups were compared. The stone-migration rate in group A was significantly lower than that in group B, with statistically significant difference (p < 0.05). Both groups had no significant difference in stone-clearance rate at 3 months after surgery (p > 0.05). Group A had a significantly lower index of EuroQol (EQ) Five Dimensions Questionnaire and significantly higher score of EQ-Visual Analogue Scale than group B (all p < 0.001). Compared with the simple application of low-pressure perfusion, the combined application of low-pressure perfusion and occluder in ureteroscopic holmium laser lithotripsy can effectively reduce the stone migration and improve the postoperative quality of life.

Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro.

To evaluate the cooling effect and other advantages of a novel circulation system for ureteroscopic holmium laser lithotripsy (URSL) in a standardized in vitro model. The novel circulation system was assembled by connecting a 4Fr ureteral catheter and a filter. Trails were divided into a new URSL group and a conventional URSL group. First, different power settings (18-30W) of the holmium laser and irrigation flow rates (20-50mL/min) were used to evaluate the thermal effect on the lithotripsy site of all groups. Then, renal pelvic temperature and pressure were assessed during URSL at a power of 1.5J/20Hz and irrigation flow rates of (20-50mL/min). Finally, the whole process of lithotripsy was performed at 1.5J/20Hz (operator duty cycle ODC: 50%) with an irrigation flow rate of 30mL/min. The time required for lithotripsy, visual field clarity, and stone migration were observed. Temperature of the lithotripsy point was significantly lower in the new URSL group than in the conventional group (P < 0.05) with irrigation rates (20, 30mL/min). The renal pelvic pressure of the new group was significantly lower than that of the conventional group in which intrarenal hypertension developed at an irrigation rate of 50ml/min. The new group had better visual clarity and lesser stone upward migration when lithotripsy was performed at 1.5J/20Hz and 30ml/min. The novel circulation system is more effective in reducing the thermal effects of URSL, pelvic pressure, stone upward migration, and improving the visual clarity of the operative field.

Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial

BackgroundEtomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients. The present study was to evaluate the effects of the combination of etomidate and dexmedetomidine with different anaesthesia time on postoperative cognitive function in older patients.MethodsA total of 132 older patients undergoing ureteroscopic holmium laser lithotripsy were randomly divided into EN group and ED group equally. Patients whose surgery time was less than or equal to 1 h in each group were allocated to short-time surgery group (EN1 group and ED1 group), and whose surgery time was more than 1h were allocated to long-term surgery group (EN2 group and ED2 group). The primary outcome was the score of the Mini-Mental State Examination. The secondary outcomes were State-Trait Anxiety Inventory scores, Riker sedation agitation scores, Zung Self-Rating Depression Scale scores, the memory span for Arabic numerals, the plasma concentrations of S-100 calcium-binding protein B and neuron specific enolase, the time to spontaneous respiration, recovery, and extubation.ResultsThe MMSE scores at t2-3 were higher in ED1 and ED2 groups than in EN1 and EN2 groups (p<0.05). Compared with ED1 and ED2 groups, the ZSDS scores, the S-AI scores and the T-AI scores at t1-2 were higher in EN1 and EN2 groups (p<0.05), respectively. The recalled Arabic numbers at t1-3 were higher in ED2 group than in EN2 group (p<0.05). The plasma concentration of S-100β at t1-2 in EN1 group and t1-3 in EN2 group were higher than that in ED1 and ED2 groups (p<0.05), respectively. Compared with ED1 and ED2 groups, the plasma concentrations of NSE were higher at t1-3 in EN1 group and t1-4 in EN2 group (p<0.05), respectively.ConclusionThe administration of dexmedetomidine could improve postoperative cognitive dysfunction, emergence agitation, depression and anxiety, attenuate the plasma concentrations of S-100β and NSE in older patients undergoing total intravenous anaesthesia with etomidate.Trial registrationRegistration number: ChiCTR1800015421, Date: 29/03/2018.

Ureteric Laser Tripsy with and without Stone Cone

Stones may block the ureter causing pain and discomfort. Ureteric laser lithotripsy, a notable breakthrough in urology, has transformed the treatment of urinary tract stones. Objectives: To compare the efficacy of ureteroscopic laser lithotripsy with and without stone cone. Methods: This retrospective analysis was done at LRH Peshawar's urology department from 1st December 2022 to 31th October 2023. Over the time, 50 patients had ureteroscopic holmium laser lithotripsy. Our research comprised adults over 18 with proximal ureteric stones (&gt;10mm) and hydro ureters on CT KUB. Patients were split into two groups. Group A included 27 patients and employed a 7mm stone cone (Boston Scientific Corp, Natick, MA). No stone cone was utilized in group B (23). Results: This prospective research included 50 adults with radiologically confirmed uretric stones in diverse ureteric sites. Male 35 (70%) and female 15 (30%) were 21–68 years old (mean 38.6 years). Stones size varied from 6 to 20 mm, averaging 12.6mm. Proximal stones were 8–20mm (mean 13.9). Mid-ureter stones were 7–18mm (mean 12.6). Lower ureter stones ranged from 6 to 16mm, with a mean of 11.9mm. Ten (20%) patients have normal pelvicalyceal systems. Patients with moderate hydronephrosis were 27 (55%). Conclusions: The use of a stone cone during ureteroscopic lithotripsy is a safe and effective technique for the management of ureteric stones.

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.

A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

ObjectiveMany studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter. The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the “ureter” during the ureteroscopic holmium laser lithotripsy in vitro. MethodsAn in vitro lithotripsy was performed using a modified catheter (5 Fr) as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet. Different laser power settings (10 W, 20 W, and 30 W) with various firing times (3 s, 5 s, and 10 s) and rates of irrigation (15 mL/min, 20 mL/min, and 30 mL/min) were applied in the experiment. Temperature changes in the “ureter” were recorded with a thermometer during and after the lithotripsy. ResultsDuring the lithotripsy, the local highest mean temperature was 60.3 °C and the lowest mean temperature was 26.7 °C. When the power was set to 10 w, the temperature was maintained below 43 °C regardless of laser firing time or irrigation flow. Regardless of the power or firing time selected, the temperature was below 43 °C at the rate of 30 mL/min. There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing (3 s, 5 s, or 10 s) compared to with not drainage (p<0.05) except for two conditions of 0.5 J×20 Hz, 30 mL/min, firing 5 s, and 1.0 J×10 Hz, 30 mL/min, firing 5 s. ConclusionOur modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect, especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Effects of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients: a double-blind randomized controlled trial

Etomidate has been advocated to be used in anesthesia for the elderly and the critically ill patients due to its faint effect on cardiovascular system. But the dose-dependent suppression of etomidate on adrenal cortex function leads to the limitation of its clinical application. Clinical research showed that dexmedetomidine could reduce the dose requirements for intravenous or inhalation anesthetics and opioids, and the hemodynamics was more stable during the operation. The objective was to observe the effect of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients. 180 elderly patients scheduled for elective ureteroscopic holmium laser lithotripsy were randomly allocated to PR group anesthetized with propofol-remifentanil, ER group anesthetized with etomidate-remifentanil, and ERD group anesthetized with dexmedetomidine combined with etomidate-remifentanil. Patients in each group whose operation time was less than or equal to 1 h were incorporated into short time surgery group (PR1 group, ER1 group and ERD1 group), and whose surgical procedure time was more than 1 h were incorporated into long time surgery group (PR2 group, ER2 group and ERD2 group). The primary outcome was the serum cortisol and ACTH concentration. The secondary outcomes were the values of SBP, DBP, HR and SpO2, the time of surgical procedure, the dosage of etomidate and remifentanil administered during surgery, the time to spontaneous respiration, recovery and extubation, and the duration of stay in the PACU. The Serum cortisol concentration was higher at t1~2 in ERD1 group compared to ER1 group (P < 0.05). The Serum cortisol concentration at t1~3 was higher in ERD2 group than in ER2 group (P < 0.05). The Serum ACTH concentration was lower at t1~2 in ERD1 group compared to ER1 group (P < 0.05). The Serum ACTH concentration at t1~3 was lower in ERD2 group compared to ER2 group (P < 0.05). The SBP at T1 and T3 were higher in ER2 and ERD2 group than in PR2 group (P < 0.05). The DBP in ER1 and ERD1 group were higher at T1 compared to PR1 group (P < 0.05). The dosage of etomidate was significantly lower in ERD1 group and ERD2 group than in ER1 group and ER2 group (P < 0.05), respectively. The administration of dexmedetomidine combined with etomidate can attenuate the inhibition of etomidate on adrenocortical function in elderly patients and maintain intraoperative hemodynamic stability.

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.

Retrospective Analysis of the Risk Factors and Drug Resistance of Pathogenic Bacteria in Systemic Inflammatory Response Syndrome After Ureteroscopic Holmium Laser Lithotripsy for Impacted Ureteral Calculi.

ObjectiveTo investigate the risk factors, pathogen distribution, and drug resistance of systemic inflammatory response syndrome (SIRS) after holmium laser ureteroscopic lithotripsy for impacted ureteral calculi (HLULIUC).Patients and MethodsThe clinical data of 293 patients with HLULIUC in our hospital from October 2017 to February 2021 were retrospectively collected, including age, BMI, stone size, operation time, urine routine, urine culture, basic illness, complete blood count, liver and kidney function, etc. Patients were divided into SIRS and non-SIRS groups according to whether they had SIRS or not. Then the differences in clinical data, blood and urine bacterial culture results, and drug resistance between the two groups were analyzed.ResultsThe incidence of SIRS after HLULIUC was 17.75%. Logistic regression analysis showed that the risk factors of SIRS after HLULIUC include ureteral calculi≥1cm (OR=2.839, 95% CI=1.341–5.647, P=0.021), long operation time (OR=4.534, 95% CI=2.597–12.751, P=0.017), diabetes mellitus (OR=3.137, 95% CI=1.142–7.319, P=0.012), increased preoperative C-reactive protein (OR=1.864, 95% CI=1.05–4.347, P=0.032), and positive urine leukocytes (OR=3.514, 95% CI=1.7237–9.734, P=0.007) and culture (OR=6.034, 95% CI=3.097–15.751, P<0.001) before operation. The main pathogens causing SIRS after HLULIUC were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa. The pathogenic bacteria are sensitive to drugs including piperacillin/tazobactam, meropenem, tigecycline, teicoplanin, vancomycin, and imipenem. The resistance rates to quinolones (such as levofloxacin) and to the second- and third-generations of cephalosporins were as high as 52.94%–90.19%.ConclusionUreteral calculi≥1cm, long operation time, diabetes, increased C-reactive protein, and preoperative positive urine leukocytes and culture are independent risk factors of SIRS after HLULIUC. Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa are the main pathogenic bacteria for SIRS after HLULIUC. The pathogenic bacteria are sensitive to drugs, including piperacillin/tazobactam, meropenem, tigecycline, teicoplanin, vancomycin, and imipenem.

The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experiences

ObjectiveTo analyze the characteristics of ureteral stricture after ureteroscopic holmium laser lithotripsy and summarize our experience with the reconstructive strategies. MethodsThis study retrospectively reviewed 42 patients with ureteral stricture after ureteroscopic holmium laser lithotripsy between December 2009 and December 2019. Patient demographics, laboratory data, imaging studies, perioperative variables, complications, and follow-up data were recorded. Surgical success was defined as relief of symptoms, improved/stabilized hydronephrosis, and stable renal function. ResultsThe upper, middle, and lower thirds of the ureter were affected in 27, 6, and 7 cases, respectively. Multiple ureteral strictures were found in 2 patients. The median length of the stricture was 3.5 cm (range 1–30 cm). In the upper ureteral strictures, lingual mucosal ureteroplasty (8/27, 29.6%) is the most commonly used treatment method for stricture longer than 3 cm but shorter than 6 cm, followed by appendiceal onlay ureteroplasty (5/27, 18.5%). Four lower ureteral strictures ranging from 3 to 8 cm were repaired with Boari flap. Reconstructive strategies of the middle ureteral strictures included Boari flap, appendiceal onlay ureteroplasty and ureteroureterostomy. Patients with the length of the stricture longer than 8 cm or multiple strictures underwent ileal ureter replacement. The median follow-up was 27.3 ± 17.2 months. The overall success rate was 97.6%. ConclusionUpper ureter is more vulnerable in ureteroscopic holmium laser lithotripsy. Sufficient follow-up and appropriate examination are necessary for diagnosis. Different treatment strategies need to be flexibly selected according to the location and length of the injury.

Nursing Effect Analysis of Soft Ureteroscopic Holmium Laser Lithotripsy

Nursing Effect Analysis of Soft Ureteroscopic Holmium Laser Lithotripsy

The effects of remifentanil-propofol combined with dexmedetomidine on cognitive dysfunction in elderly patients after ureteroscopic holmium laser lithotripsy: a double-blind randomized controlled trial

BackgroundA clinical study indicated that infusion of dexmedetomidine without a loading dose administered intraoperatively provided a smooth and hemodynamically stable emergence and improved the quality of recovery with fewer postoperative side effects and reduced analgesic requirements. The objective was to determine whether administering remifentanil-propofol combined with dexmedetomidine during general anesthesia would decrease the incidence and severity of postoperative emergence agitation, anxiety, and depression without affecting cognitive dysfunction in elderly patients.MethodsA total of 120 elderly patients scheduled for ureteroscopic holmium laser lithotripsy were randomly allocated to the PR group and administered normal saline, and the PRD group was administered dexmedetomidine 0.4 μg kg−1 h−1 intravenously after the induction of anesthesia and stopped 30 min before the end of surgery. The primary outcome was the Mini-Mental State Examination score. The secondary outcomes were the Richmond Agitation Sedation, the State-Trait Anxiety Inventory, and the Zung Self-Rating Depression Scale scores; the memory span for Arabic numerals; the duration of surgery; and the time to spontaneous respiration, recovery, and extubation.ResultsThe MMSE scores were lower at T1–2 in the two groups (P < 0.001). The dosage of propofol and remifentanil decreased more significantly in the PRD group than in the PR group (P < 0.001). Both the RASS scores and the incidence of emergence agitation (EA) in the PRD group were significantly lower than those in the PR group at t1–3 (P < 0.001). Compared to the PR group, the ZSDS scores and STAI scores at T1–2 were lower in the PRD group (P < 0.005). The number of the Arabic numbers that were accurately recalled from memory was lower at T2 in the PR group than in the PRD group (P < 0.001).ConclusionDexmedetomidine administration has no influence on postoperative cognitive dysfunction but could reduce both the dosage of remifentanil and propofol needed during ureteroscopic holmium laser lithotripsy and the incidence and severity of postoperative emergence agitation, anxiety, and depression in elderly patients.Trial registrationChinese Clinical Trial Registry ChiCTR1900021254. Registered on 3 February 2019

Nursing Analysis of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi

Nursing Analysis of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi

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.

COMPARAȚIA METODELOR DE TRATAMENT AL LITIAZEI RENOURETERALE PRIN URETEROSCOPIE LASER HOLMIUM ȘI LITOTRIȚIE EXTRACORPOREALĂ CU UNDE DE ȘOC (ESWL)

In contemporary era the urologists have several options for treating reno uretheral stones in the range of 5- 20mm. Of that range, this study makes a comparison between ESWL and ureteroscopic holmium laser lithotripsy in the treatment of reno uretheral stones. Acording of that ureteroscopy and ESWL such as a methods of treatment are invasive procedures, still there is controversy which of them is more acceptable for treating reno ureteral stones disease. Generally, the total cost, the procedural time and analgesia requirements and were noticeably variant. Additionally, gross hematuria and renal colic were more frequent with ESWL procedure, while the voiding symptoms show more frequency with ureteroscopy procedure.

Comparison of Clinical Effects of Percutaneous Nephrolithotomy and Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi

In this study, 114 cases of upper urinary calculi were retrospectively analyzed to compare the efficacy of microchannel percutaneous nephrolithotripsy (MPCNL) and flexible ureteroscopic lithotripsy (URHL) for the treatment of renal calculi, and to analyze the efficacy and complications of the two surgical methods, so as to provide a more suitable scheme for the selection of surgical methods for upper urinary calculi. Microchannel percutaneous nephrolithotripsy and flexible ureteroscopic lithotripsy were divided into two groups with 57 cases in each group. There was no significant difference in stone clearance rate between MPCNL group and URHL group. Supine MPCNL group USES the oblique cut stone, relative to the prone position and other positions, patients are more likely to tolerate, 14 f ~ 16 f the microchannel renal tissue injury and reduce bleeding risk reduction, intraoperative for complexity or MPCNL for Angle is too small to deal with a difficult calculi can adopt double mirror combination therapy, made clear the effect of the stone, but because of indwelling renal fistula, postoperative hospital stay longer. The URHL group was more inclined to minimally invasive treatment. It was difficult to lithotripsy for hard stones, and the operation time was relatively long, so the risk of infection was increased. However, patients recovered quickly, the length of hospital stay was short, and the duration of ureteral stent implantation was long. Preoperative surgery should be based on the patient's desire and the actual situation such as stone load to choose a more appropriate way of operation.

Thermal effect of holmium laser during ureteroscopic lithotripsy

BackgroundHolmium laser lithotripsy is the most common technique for the management of ureteral stone. Studies founded that holmium laser firing can produce heat which will cause thermal injury towards ureter. The aim of our current study is to explore factors affecting thermal effect of holmium laser during ureteroscopic lithotripsy.MethodsAn in vitro experimental model is design to simulate the ureteroscopic lithotripsy procedure. Different laser power settings (10w (0.5JX20Hz, 1.0 JX10Hz), 20w (1.0 JX20Hz, 2.0 JX10Hz), 30w (1.5JX20Hz, 3.0 JX10Hz)) with various firing time (3 s, 5 s, 10s) and irrigation flow rates(10 ml/min, 15 ml/min, 20 ml/min and 30 ml/min) were employed in the experiment. The temperature around the laser tip was recorded by thermometer.ResultsThe temperature in the “ureter” rises significantly with the increasing laser power, prolonging firing time and reducing irrigation flow. The highest regional temperature is 78.0 °C at the experimental set-up, and the lowest temperature is 23.5 °C. Higher frequency setting produces more heat at the same power. Laser power < =10w, irrigation flow> = 30 ml/min and “high-energy with low-frequency” can permit a safe working temperature.ConclusionWe clarify that the thermal effect of holmium laser is related with both laser working parameters and irrigation flow. The proper setting is the key factor to ensure the safety during ureteroscopic holmium laser lithotripsy.