Ureteroscopic Laser Lithotripsy Research Articles

Extracorporeal shock wave lithotripsy versus laser lithotripsy in the treatment of post-SWL steinstrasse: a randomized comparative study.

To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3-4weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. The success rate was higher in the ureteroscopy group than in the SWL group (p = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group (p = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group (p = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30h in the ureteroscopy group. SWL was performed without the need for hospital admission. Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

How Effective Is Ureteroscopic Irrigation at Evacuating Stone Dust?

Ureteroscopic laser lithotripsy results in the formation of small and numerous stone fragments. These have the potential to act as a nidus for stone recurrence, and the effectiveness of irrigation via the ureteroscope at clearing them is not well understood. Using an in vitro quartz-based model, fragments of known sizes from <63 µm to 2mm are irrigated at rates of 15 mL/min, 30 mL/min and 120 mL/min. Clinically achievable rates of 15-30 mL/min are unable to wash out larger particles >500 µm, and even 120 mL/min irrigation was able to wash out less than half of these larger particles. Complete stone clearance is unlikely to be achievable by intraoperative irrigation alone and requires additional technologies such as suction.

Getting hot in here! Comparison of Holmium vs. thulium laser in an anatomic hydrogel kidney model.

As laser technology has advanced, high-power lasers have become increasingly common. The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has long been accepted as the standard for laser lithotripsy. The thulium fiber laser (TFL) has recently been established as a viable option. The aim of this study is to evaluate thermal dose and temperature for the Ho:YAG laser to the TFL at four different laser settings while varying energy, frequency, operator duty cycle (ODC). Utilizing high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system (PCS) with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Ho:YAG laser or TFL. At a standard power (40W) and irrigation (17.9ml/min), we evaluated four different laser settings with ODC variations with different time-on intervals. Temperature was measured at two separate locations. In general, the TFL yielded greater cumulative thermal doses than the Ho:YAG laser. Thermal dose and temperature were typically greater at the stone when compared away from the stone. Regarding the TFL, there was no general trend if fragmentation or dusting settings yielded greater thermal doses or temperatures. The TFL generated greater temperatures and thermal doses in general than the Ho:YAG laser with Moses technology. Temperatures and thermal doses were greater closer to the laser fiber tip. It is inconclusive as to whether fragmentation or dusting settings elicit greater thermal loads for the TFL. Energy, frequency, ODC, and laser-on time significantly impact thermal loads during ureteroscopic laser lithotripsy, independent of power.

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model.

With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. Using high-fidelity, 3D printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time.

Editorial letter to: Incidence of Ureteric Strictures Following Ureteroscopic Laser Lithotripsy: Holmium: YAG Versus Thulium Fiber Laser.

Dear Editor, The original paper by Ahmad Para S et al1 analyzed the incidence of ureteral strictures following holmium: yttrium aluminum garnet (Ho:YAG) and thulium fiber laser (TFL) endocorporeal laser lithotripsy (ELL) for ureteral stones. The authors should be commended for their work because this is the first prospective randomized controlled trial comparing the ureteric stricture rates between these 2 laser technologies for ELL. This study concluded that the TFL had a higher incidence of ureteral strictures than the Ho: YAG laser. Our editorial letter aims to clarify and highlight some key points.

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.

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.

Safety and Efficacy of Ureteroscopic Laser Lithotripsy in the Management of Ureteric Calculi in Pregnancy-Experience of a Tertiary Care Center.

Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy. This is a prospective observational study of 3years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones. A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3years. The mean age of patients was 33.5 ± 6.2years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9weeks. The average stone size was 8.3 ± 3.6mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9min, and the average laser energy spent was 4.3 ± 1.1kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5days. Complete stone clearance was achieved in 93.1% of cases. Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy.

Evaluating Financial Toxicity in Urologic Practice

To evaluate financial toxicity in Urologic surgery using the Comprehensive Score for financial Toxicity (COST) as well as validate a single item measure of toxicity. A cross-sectional study of 182 patients undergoing oncologic and benign urologic procedures at a single academic medical center. Oncologic procedures included robotic assisted laparoscopic prostatectomy, transurethral resection of bladder tumor, and radical cystectomy. Benign procedures included holmium laser enucleation of the prostate, intravesical chemodenervation, ureteroscopy laser lithotripsy, and ureteral stent exchange. Retrospective review, patient interviews, and the previously validated COST survey, as well as a novel single item measure of toxicity were used pre and post-op. Descriptive statistics and logistic regression models compared COST scores by type of urologic procedure. Eighty (44%) patients underwent oncologic procedures and 102 (56%) benign procedures. Benign patients were most likely to have lower income and be younger than oncologic patients, with a median age of 56.7 vs64.9. One in 4 patients undergoing urologic procedures experienced moderate to severe financial toxicity, without a statistically significant difference between the benign and the oncology groups pre- or post-operatively. Single item measure strongly correlated with COST (r = -0.80) pre- and post-operative. The COST survey and a single-item financial toxicity measure are both valid tools that can be used to measure financial toxicity in urology. Further research is needed to elicit the exact cause of financial toxicity in the heterogenous urologic patient population.

Ureteroscopic lithotripsy by thulium fiber laser versus holmium laser: A single-center prospective randomized study.

Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications. A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6-10 Hz, 1J) for TFL and up to 10 W for HO: YAG (5-10 Hz, 0.5-1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded. Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2-25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4-38.5), and it was statistically significant (P = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2-10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3-18.4) (P = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group. TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups.

Incidence of Ureteric strictures Following Ureteroscopic Laser Lithotripsy: Holmium:YAG Versus Thulium Fiber Laser.

We aimed to compare the incidence of ureteric strictures between holmium:yttrium aluminum garnet and thulium fiber laser following ureteroscopic laser lithotripsy. In the present era of miniaturization of endourologic armamentarium and better optics, how safe are lasers to fire inside ureter? It is a prospective comparative study over a period of 2 years that included patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Patients were randomly divided into 2 groups: group A underwent holmium:yttrium aluminum garnet laser lithotripsy and group B underwent thulium fiber laser lithotripsy. A total of 478 patients were analyzed after excluding patients not willing to participate and patients lost to follow-up. Two hundred forty patients underwent holmium:yttrium aluminum garnet laser lithotripsy (group A) and 238 patients underwent thulium fiber laser lithotripsy (group B). The demographic data of 2 groups were comparable. The mean age of patients in group A and group B was 36.5 ± 12.52 years and 38.62 ± 10.71 years, respectively. The mean operative time in group A and group B was 47 ± 15 and 36 ± 13 minutes, respectively, while the mean laser time in group A and group B was 13.5 ± 45 minutes and 9.25 ± 3.2 minutes, respectively. Four (1.67%) patients in group A and 11 (4.62%) patients in group B developed ureteric strictures during follow-up, and the difference was statistically significant (P <.001). The mean length of stricture was 2.67 ± 1.27 cm in group A and 4.42 ± 2.2 cm in group B, and the difference was statistically significant. Thulium fiber laser, projected as safe laser previously, has a higher incidence of ureteric strictures compared to holmium:yttrium aluminum garnet laser when used for ureteroscopic laser lithotripsy.

The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications.

To assess the safety and effectiveness of the 4.5/6.5Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA). A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications. The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0-1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005). TIUA had an equal surgical success rate and controlled patients' intraoperative pain as SA. It was superior in terms of TIUA's patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.

MP23-10 ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY: A RANDOMIZED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP23-10 ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY: A RANDOMIZED TRIAL Alan Yaghoubian, Roman Shimonov, Blair Gallante, Raymond Khargi, Dara Lundon, Johnathan Khusid, Manishkumar Patel, Kai Nie, Hui Xie, Jingjing Xi, Nicholas Zaki, Seunghee Kim Schulze, William Atallah, Natasha Kyprianou, and Mantu Gupta Alan YaghoubianAlan Yaghoubian More articles by this author , Roman ShimonovRoman Shimonov More articles by this author , Blair GallanteBlair Gallante More articles by this author , Raymond KhargiRaymond Khargi More articles by this author , Dara LundonDara Lundon More articles by this author , Johnathan KhusidJohnathan Khusid More articles by this author , Manishkumar PatelManishkumar Patel More articles by this author , Kai NieKai Nie More articles by this author , Hui XieHui Xie More articles by this author , Jingjing XiJingjing Xi More articles by this author , Nicholas ZakiNicholas Zaki More articles by this author , Seunghee Kim SchulzeSeunghee Kim Schulze More articles by this author , William AtallahWilliam Atallah More articles by this author , Natasha KyprianouNatasha Kyprianou More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The high power Holmium (Ho:YAG) and thulium fibre lasers (TFL) generate enough heat in surrounding fluid to cause renal cellular damage, yet the degree to which this occurs has yet to be quantified. We aim to establish a relative safety profile of the TFL and Ho:YAG by quantifying the degree of renal damage during ureteroscopic laser lithotripsy (URSLL). METHODS: This is an ongoing randomized controlled trial of patients undergoing URSLL with unilateral non-obstructing renal stones. Patients are randomized to undergo URSLL with either the TFL or Ho:YAG laser. Each patient’s urine is collected immediately pre-op (V1), 1 hour post-op (V2), and 10 days post-op (POD#10, V3). Samples are analyzed by enzyme-linked immunosorbent assay (ELISA) for the following biomarkers: Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), and β2-microglobulin (β2M), then normalized to urine creatinine. Primary outcome is degree of renal injury based on urinary biomarker changes. RESULTS: To date 26 patients (16 TFL, 10 Ho:YAG) have been included. Baseline patient and stone characteristics were similar. Relative to controls, both lasers caused pronounced rises in biomarkers in the immediate postoperative period with a trend back towards baseline by postoperative day 10 (Figure 1). However, the Ho:YAG laser caused a persistent rise in NGAL at 10 days. In terms of percent change from baseline, there were no significant differences between cohorts for any of the biomarkers (Figure 2). CONCLUSIONS: Our pilot analysis suggests that there is notable laser-induced renal parenchymal damage for both TFL and Ho:YAG. The renal damage safety profile appears similar for both lasers. Source of Funding: This work was funded in part by a grant from the New York Academy of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e309 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan Yaghoubian More articles by this author Roman Shimonov More articles by this author Blair Gallante More articles by this author Raymond Khargi More articles by this author Dara Lundon More articles by this author Johnathan Khusid More articles by this author Manishkumar Patel More articles by this author Kai Nie More articles by this author Hui Xie More articles by this author Jingjing Xi More articles by this author Nicholas Zaki More articles by this author Seunghee Kim Schulze More articles by this author William Atallah More articles by this author Natasha Kyprianou More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-06 SINGLE-USE PLASTIC WASTE IN COMMON ENDOUROLOGIC CASES: CHARACTERIZATION OF A GROWING ENVIRONMENTAL CRISIS AND IMPACT OF POSSIBLE INTERVENTIONS

You have accessJournal of UrologyCME1 Apr 2023MP06-06 SINGLE-USE PLASTIC WASTE IN COMMON ENDOUROLOGIC CASES: CHARACTERIZATION OF A GROWING ENVIRONMENTAL CRISIS AND IMPACT OF POSSIBLE INTERVENTIONS John M. Masterson, Peris Castaneda, Aurash Naser-Tavakolian, Jeremiah Dallmer, Lior Taich, Jordan Kramer, Andrew Chen, Paige Kuhlmann, Maurice M. Garcia, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Jeremiah DallmerJeremiah Dallmer More articles by this author , Lior TaichLior Taich More articles by this author , Jordan KramerJordan Kramer More articles by this author , Andrew ChenAndrew Chen More articles by this author , Paige KuhlmannPaige Kuhlmann More articles by this author , Maurice M. GarciaMaurice M. Garcia More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Operating room waste is often in the form of single-use plastics (SUP), which contribute to landfill waste and ocean pollution and have been shown to have a detrimental impact on public health. We quantified the weight of SUP waste generated by three common endourologic cases—ureteroscopy/laser lithotripsy (URSLL), ureteral stent placement, and transurethral resection of prostate (TURP)—and projected annual SUP waste for these cases at a national level. We also estimated potential impact of waste reduction strategies: including removal of frequently unused SUP items from standard supply packs, replacement with reusable alternatives, and recycling. METHODS: We prospectively sampled 20 URS/LL, 20 ureteral stent placement, and 20 TURP cases; then recorded used items in the EMR case supplies list and contemporaneously recorded unused SUP items in real time. Individual SUP items were weighed to create a standard metric. We projected our findings to annual case volumes at a national level using Urologic Diseases in America (UDA) 2012 data. We then modeled the potential impact of waste reduction by removing, replacing, and recycling SUP items based on current viable pathways. RESULTS: Across our analytic sample of 60 patients, URSLL, stent placement, and TURP generated a mean (SD) of 6.27 (0.76), 5.23 (0.55), and 8.18 (0.68) lbs of SUP waste per case, respectively. Unused plastic waste for URSLL, stent placement, and TURP were 2.16 (0.78), 2.60 (0.62), and 0.73 (0.57) lbs per case, respectively. This amounts to a total of 1.3 million lbs of SUP waste annually. Removal of variable-use SUP items, replacing SUP items with reusable alternatives, and recycling SUP items by current potential pathways would reduce this number by 47,029 (4%), 368,892 (29%), and 166,528 pounds (13%), respectively, for a total SUP waste reduction of 582,451 pounds (46%) (Table 1). CONCLUSIONS: Common outpatient endourologic cases generate a substantial amount of SUP plastic waste, which has a negative impact on environmental and public health. Our field should take an active role in mitigating this health risk for future generations. Small changes such as removal of unused items from standard supply packs or replacement with reusable items can significantly reduce SUP waste. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e55 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Peris Castaneda More articles by this author Aurash Naser-Tavakolian More articles by this author Jeremiah Dallmer More articles by this author Lior Taich More articles by this author Jordan Kramer More articles by this author Andrew Chen More articles by this author Paige Kuhlmann More articles by this author Maurice M. Garcia More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-15 PAIN CATASTROPHIZING IS ASSOCIATED WITH STENT-RELATED PAIN AFTER URETEROSCOPIC LASER LITHOTRIPSY

You have accessJournal of UrologyCME1 Apr 2023MP35-15 PAIN CATASTROPHIZING IS ASSOCIATED WITH STENT-RELATED PAIN AFTER URETEROSCOPIC LASER LITHOTRIPSY Alan J. Yaghoubian, Sarah Mozafarpour, Roman Shimonov, Raymond Khargi, Blair Gallante, Dara Lundon, Johnathan A. Khusid, William M. Atallah, and Mantu Gupta Alan J. YaghoubianAlan J. Yaghoubian More articles by this author , Sarah MozafarpourSarah Mozafarpour More articles by this author , Roman ShimonovRoman Shimonov More articles by this author , Raymond KhargiRaymond Khargi More articles by this author , Blair GallanteBlair Gallante More articles by this author , Dara LundonDara Lundon More articles by this author , Johnathan A. KhusidJohnathan A. Khusid More articles by this author , William M. AtallahWilliam M. Atallah More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stent-related pain varies in intensity for different patients. While stent-specific factors (e.g. stent position) may influence symptoms, patient-specific factors remain elusive. The pain catastrophizing scale (PCS) is a validated questionnaire quantifying the degree to which an individual may catastrophize painful stimuli. We aim to determine whether PCS score is associated with stent symptoms after ureteroscopic laser lithotripsy (URSLL). METHODS: This is an ongoing prospective study of patients undergoing URSLL. All patients completed the PCS prior to undergoing URSLL with stent placement and were labeled as catastrophizers (top third), non-catastrophizers (bottom third), or semi-catastrophizers (middle third). The ureteral stent symptom questionnaire (USSQ) was completed at 2 time points: post-op day (POD)#1 and POD#10. Prescriptions for phenazopyridine, ibuprofen, and oxybutynin were given. Outcomes included USSQ scores, total analgesic pills taken, pain-related office phone calls, and need for narcotic prescriptions. RESULTS: In sum 41 patients have been enrolled. Median USSQ pain scores on POD#10 were significantly higher among catastrophizers as compared to non-catastrophizers (24.5 vs. 14.0, p=0.036). There were no differences between all 3 groups in other USSQ domains. Catastrophizers took more tablets of phenazopyridine (11.0 vs. 5.5, p=0.027) and total prescribed tablets (26.5 vs. 15.5, p=0.023) compared to non-catastrophizers. Differences between number of pain-related calls between catastrophizers and non-catastrophizers approached significance (46.2% vs. 0%, p=0.057). Semi-catastrophizers had no significantly different outcomes from the other two groups. CONCLUSIONS: Pain catastrophizers have higher post-URSLL pain index scores, use more pain medications, and likely call the office more frequently. The PCS may ultimately become a practical tool to personalize patient care by identifying those at highest risk for severe stent pain. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e475 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Yaghoubian More articles by this author Sarah Mozafarpour More articles by this author Roman Shimonov More articles by this author Raymond Khargi More articles by this author Blair Gallante More articles by this author Dara Lundon More articles by this author Johnathan A. Khusid More articles by this author William M. Atallah More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

PD28-03 EFFICACY AND SAFETY OF A MAGNETIC HYDROGEL FOR STONE FRAGMENT REMOVAL: AN IN VITRO AND IN VIVO STUDY

You have accessJournal of UrologyCME1 Apr 2023PD28-03 EFFICACY AND SAFETY OF A MAGNETIC HYDROGEL FOR STONE FRAGMENT REMOVAL: AN IN VITRO AND IN VIVO STUDY Daniel Massana Roquero, T. Jessie Ge, Grace H. Holton, Kathleen E. Mach, Zachary Kornberg, Ryan Sun, Simon Conti, Shan X. Wang, and joseph C. Liao Daniel Massana RoqueroDaniel Massana Roquero More articles by this author , T. Jessie GeT. Jessie Ge More articles by this author , Grace H. HoltonGrace H. Holton More articles by this author , Kathleen E. MachKathleen E. Mach More articles by this author , Zachary KornbergZachary Kornberg More articles by this author , Ryan SunRyan Sun More articles by this author , Simon ContiSimon Conti More articles by this author , Shan X. WangShan X. Wang More articles by this author , and joseph C. Liao joseph C. Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopic laser lithotripsy is the standard treatment for kidney stones<2 cm. Following lithotripsy, fragments<3 mm are often left behind due to limitations of standard stone retrieval tools and time. Residual stone fragments that do not pass contribute to recurrence. We have developed MagSToNE, an integrated stone fragment removal system consisting of a magnetic hydrogel to coat and magnetize stone fragments and a magnetic wire for extraction. Here we compare MagSToNE with standard nitinol basket extraction in an in vitro model and assess the safety of the approach in vivo in a porcine model. METHODS: Stone fragments (15-30, < 3 mm) were loaded in an ex vivo kidney model to compare ureteroscopic removal time and efficiency using MagSToNE and a conventional basket. With APLAC approval MagSToNE was assessed in vivo in porcine models. Fragments were introduced endoscopically to the kidneys of female pigs under general anesthesia. Magnetic hydrogel components were injected via flexible ureteroscopy, and magnetized stones were captured with a magnetic wire inserted through the working channel of the ureteroscope. Pigs were immediately euthanized or monitored for up to 72 hours post-procedure. Blood was collected at regular intervals, starting at hydrogel injection, for complete blood count (CBC) and metabolic panels. After nephrectomy, kidneys were bivalved for gross examination and processed for histology. RESULTS: In the in vitro model, we found that MagSToNE provided a faster (up to 57 %) and more efficient approach for extraction of kidney stone fragments than conventional basketing. Further, we demonstrated the feasibility of MagSToNE in in vivo porcine models. The injection catheter and magnetic wire (1 mm diameter) showed excellent compatibility with a disposable clinical ureteroscope, and magnetized fragments were removed through the ureteral access sheath. Initial results from in vivo MagSToNE application indicate that the hydrogel and extraction method are safe as no significant changes in vitals, blood count, or metabolic serum chemistries were observed in the porcine models. Visual inspection of the bivalved kidneys post procedure confirmed the absence of visible hydrogel. Survival studies in the porcine model are ongoing to further assess the safety of MagSToNE. CONCLUSIONS: MagSToNE is a promising approach to render patients stone free during ureteroscopy. We demonstrated that MagSToNE is superior to basketing in model systems, and we applied our technology in vivo to demonstrate the safe magnetic extraction of kidney stone fragments. Source of Funding: NIH R21DK131776 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e819 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Massana Roquero More articles by this author T. Jessie Ge More articles by this author Grace H. Holton More articles by this author Kathleen E. Mach More articles by this author Zachary Kornberg More articles by this author Ryan Sun More articles by this author Simon Conti More articles by this author Shan X. Wang More articles by this author joseph C. Liao More articles by this author Expand All Advertisement PDF downloadLoading ...

MP05-05 ANTIMICROBIAL AND ANTIBIOFILM PROPERTIES OF CHITOSAN: AN EX VIVO STUDY ON KIDNEY STONES

You have accessJournal of UrologyCME1 Apr 2023MP05-05 ANTIMICROBIAL AND ANTIBIOFILM PROPERTIES OF CHITOSAN: AN EX VIVO STUDY ON KIDNEY STONES Grace H. Holton, Daniel Massana Roquero, T. Jessie Ge, Kathleen E. Mach, Timothy J. Lee, Timothy C. Chang, and Joseph C. Liao Grace H. HoltonGrace H. Holton More articles by this author , Daniel Massana RoqueroDaniel Massana Roquero More articles by this author , T. Jessie GeT. Jessie Ge More articles by this author , Kathleen E. MachKathleen E. Mach More articles by this author , Timothy J. LeeTimothy J. Lee More articles by this author , Timothy C. ChangTimothy C. Chang More articles by this author , and Joseph C. LiaoJoseph C. Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 40% of kidney stones are colonized by bacterial biofilms. Stone fragmentation by ureteroscopic (URS) laser lithotripsy or percutaneous nephrolithotomy (PCNL) can disperse bacteria thereby increasing the risk of post-surgical infection, urosepsis, and stone recurrence. We hypothesized that the addition of chitosan, an established biopolymer with reported antimicrobial properties, may eradicate uropathogens and bacterial biofilms associated with kidney stones. METHODS: With IRB approval and patient consent, preoperative urine and intraoperative stone fragments were collected from patients undergoing URS and PCNL. In vitro biofilms and planktonic bacteria were assessed and quantitated by scanning electron microscopy. Colony forming units on agar plate culture and optical density were used to measure the bactericidal effects of chitosan on common uropathogens found in kidney stones. Stones were divided into a control group treated with saline for 90 minutes and an experimental group with a chitosan solution in saline. All samples were analyzed to determine bacterial presence, species, and biofilm integrity. RESULTS: In vitro culture demonstrated that as low as 0.0001% (w/v) chitosan inhibited growth in the planktonic form of the most common uropathogens found in stone formers (i.e. E. coli, Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus aureus). Further, up to 90% of biofilms grown in vitro on a synthetic support or calcium oxalate stone were disrupted with 0.0005% (w/v) chitosan. Ex vivo experiments measuring the effect of chitosan on patient derived urine and stone fragments are underway to assess differences in urine and stone culture and if chitosan can effectively disrupt complex in vivo formed biofilms. CONCLUSIONS: Chitosan inhibits growth of both gram-negative and gram-positive uropathogens and disrupts their biofilms in vitro on kidney stones. Ex vivo experiments with patient derived stones will confirm the antimicrobial effects of chitosan on complex biofilms. Chitosan may be a promising additive to the saline irrigation to reduce post-surgical infections in kidney stone surgery. Source of Funding: NIH R21 DK131776 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e45 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace H. Holton More articles by this author Daniel Massana Roquero More articles by this author T. Jessie Ge More articles by this author Kathleen E. Mach More articles by this author Timothy J. Lee More articles by this author Timothy C. Chang More articles by this author Joseph C. Liao More articles by this author Expand All Advertisement PDF downloadLoading ...

On the way to residue-free stone fragment removal after ureteroscopic laser lithotripsy - Significance of the hydrogel method

On the way to residue-free stone fragment removal after ureteroscopic laser lithotripsy - Significance of the hydrogel method

Use of the Deniz™ rigid stone basket for treating ureteral calculi.

Advancements in ureteroscope and stone basket design have introduced ureteroscopy to the forefront of surgical stone management. However, different issues, such as stone migration and ureteral injury, remain a challenge among urologists. The Deniz™ rigid stone basket is a patented product (patent number: TR 2016 00421 Y) manufactured in Turkey. Herein, we report our initial experience with the Deniz™ rigid stone basket for managing urinary calculi and compare the use of this device with other methods to optimize ureteroscopic stone management. Fifty patients undergoing ureteroscopic laser lithotripsy for urinary calculi were retrospectively evaluated by two surgeons. The Deniz™ rigid stone basket was utilized to prevent retrograde ureteral stone migration or to facilitate fragmentation and extraction of ureteral calculi. In total, 29 men and 21 women, with a mean age of 46.5 (range: 21-69) years, were treated for upper (n = 30), medium (n = 7), and lower (n = 13) ureter calculi. The mean stone diameter was 13.08 (range: 7-22) mm; the mean operative time, 46 (range: 20-80) min; the mean energy utilization, 2.98 (range: 1.5-3.5) kJ; and the mean laser frequency, 6.96 (range: 6-12) hz. None of the patients developed complications, and 46 (92%) patients who underwent ureteroscopic laser lithotripsy using the Deniz™ rigid stone basket were declared stone-free. Four patients had residual stones measuring < 3 mm on post-operative imaging. The Deniz™ rigid stone basket is safe and effective for preventing stone migration and facilitating ureteroscopic laser lithotripsy procedure and stone extraction.

Value of preoperative ureteral wall thickness in prediction of impaction of ureteric stones stratified by size in laser ureteroscopic lithotripsy

ObjectivesTo evaluate the role of preoperative UWT in the prediction of impaction of ureteral stones stratified according to stone size in ureteroscopic laser lithotripsy.Patient and methodsThis study included 154 patients submitted to URSL for ureteral stones. Radiological data comprised the presence of hydronephrosis, anteroposterior pelvic diameter (PAPD), proximal ureteric diameter (PUD), and maximum UWT at the stone site. Collected stone characteristics were stone size, side, number, site, and density.ResultsThe study included 154 patients subjected to URSL. They comprised 74 patients (48.1%) with impacted stones and 80 (51.9%) with non-impacted stones. Patients were stratified into those with stone size ≤ 10 mm and others with stone size > 10 mm. In the former group, we found that stone impaction was significantly associated with higher PAPD, PUD, and UWT. In patients with stone size > 10 mm, stone impaction was related to higher UWT, more stone number, and higher frequency of stones located in the lower ureter. ROC curve analysis revealed good power of UWT in discrimination of stone impaction in all patients [AUC (95% CI) 0.65 (0.55–0.74)] at a cut-off of 3.8 mm, in patients with stone size ≤ 10 mm [AUC (95% CI) 0.76 (0.61–0.91)] at a cut-off of 4.1 mm and in patients with stone size > 10 mm [AUC (95% CI) 0.72 (0.62–0.83)] at a cut-off of 3.0 mm.ConclusionsStratifying ureteric stones according to size would render UWT a more practical and clinically-oriented approach for the preoperative prediction of stone impaction.