[Mid-term safety and efficacy of high power thulium laser vaporization.] / Vaporización con láser tulio de alta potencia:eficacia y seguridad a medio plazo.

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the mediumterm (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%. The only statistically significant difference (p=0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate.

Vaporización con láser tulio de alta potencia: eficacia y seguridad a medio plazo / Mid-term safety and efficacy of high power thulium laser vaporization

OBJETIVO: La vaporización prostática con láser Tulio (VP-LT) se realiza desde hace 12 años aproximadamente, durante este tiempo los diferentes sistemas láser han ido evolucionado, particularmente los reportes de su uso en alta potencia (150-180W) son aún escasos. En este trabajo presentamos nuestra experiencia en cuanto a su eficacia y seguridad a medio plazo (seguimiento 42 meses). MÉTODOS: Desde Marzo de 2011 a Noviembre de 2013 se recogieron datos de 235 pacientes intervenidos con VP-LT. Las variables incluyen, tamaño prostático, características intraoperatorias, IPSS, Qmax, PSA entre otros. RESULTADOS: La edad media fue 69±9 años. La media del tamaño prostático fue 62±28 ml. Las medias de IPSS y Qmax preoperatorios fueron 18±6 puntos y 7,6±3,5 ml/seg respectivamente. La media del tiempo quirúrgico fue 45,31±16 min. La estancia hospitalaria media fue 24±17 horas y el tiempo medio de sondaje fue 38 horas. Sólo 26,1% sufrieron complicaciones perioperatorias, ninguna mayor de grado III de Clavien. Únicamente 1,7% requirieron reingreso. En el postoperatorio la media del Qmax a los 3 y 24 meses fue 19±6 ml/seg, y 17±8 ml/seg. El IPSS 5±5 puntos. El resultado se considero éxito en 81,3%. Un 15,7% persistió con síntomas obstructivos y 3% con patología funcional de llenado. La tasa de reintervención fue 5%. La única diferencia significativa (p = 0,008) entre resultado exitoso vs. no exitoso fue el tamaño prostático, 60 ml vs. 72 ml respectivamente. La tasa de reintervenciones aumenta significativamente a partir de un tamaño prostático de 70 ml (p = 0,001). CONCLUSIONES: La VP-LT de alta potencia es una alternativa segura, eficaz y eficiente con resultados funcionales subjetivos y objetivos comparables a la técnica "gold standard", ofrece un tiempo de estancia hospitalaria más corto y una menor tasa de complicaciones. Sin embargo su efectividad a mediano plazo disminuye en próstatas mayores de 70 ml aumentando las probabilidades de reintervención

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the medium-term (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%.The only statistically significant difference (p = 0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate

Estudio comparativo de eficacia y seguridad de la nefrolitotomía percutánea (NLPC) y la cirugía retrógrada intrarrenal (CRIR) para litiasis renales de 2-3, 5 cm / Comparative study for the efficacy and safety of percutaneous nefhrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of 2-3,5 cm kidney stones

OBJETIVO: Comparar la eficacia y seguridad de Nefrolitotomía Percutánea (NLPC) y de Cirugía Retrógrada Intrarrenal (CRIR) para el tratamiento de litiasis renales entre 2 y 3,5 cm. MÉTODOS: Revisión de 142 casos con litiasis renal entre 2 y 3,5 cm tratados en nuestro centro entre diciembre 2009 y diciembre 2011; 106 casos de CRIR y 36 casos de NLPC. Se evalúan y comparan edad, sexo, composición, localización, unidades Hunsfield (UHC) y tamaño litiásico, tiempo quirúrgico, complicaciones, días de ingreso y éxito de la técnica en el primer procedimiento y tras un segundo procedimiento. Análisis estadístico con T Student, U Mann-Whitney y Chi2 - V Cramer (p = 0,05). RESULTADOS: No hay diferencias en la edad, distribución de sexos, UHC, tamaño litiasico entre ambos brazos. El tiempo quirúrgico fue menor en el grupo NLPC (mediana 85 minutos vs 112 minutos; p:0,04) La estancia hospitalaria fue significativamente más corta en la CRIR (mediana=16 horas vs 93 horas; p = 0,001). En cuanto a la tasa de complicaciones globales, 94,8% de procedimientos libres de complicaciones para CRIR frente a un 80% de la NLPC (p 0,08). La NLPC obtuvo mejor porcentaje de éxito (80,6% frente al 73,6% de CRIR) aunque estas diferencias no son estadísticamente significativas (p = 0,40). Si comparamos el éxito con segundas maniobras, la NLPC presenta un porcentaje del 94,3% de los casos frente al 93,5% (p = 0,88). CONCLUSIONES: La CRIR se presenta como una opción segura, eficaz y con corta estancia hospitalaria. Puede ser considerada como alternativa a la NLPC en el tratamiento de litiasis renales de hasta 3,5 cm. Sin embargo hacen falta más publicaciones con estudios aleatorizados que confirmen esta hipótesis

OBJECTIVES: Retrograde intrarenal surgery (RIRS) has become an important alternative for the treatment of kidney stones due to its increased safety and efficiency. The purpose of this study is to compare efficacy and safety features of RIRS against percutaneous nephrolithotomy (PCNL) for the treatment of 2 - 3.5 cm kidney stones. METHODS: 142 cases (106 RIRS and 36 PCNL) encompassing 2 - 3.5 cm kidney stones that have been treated in our center between December 2009 and December 2011 have been considered. Demographic variables, stone characteristics, surgical stay and surgical time have been evaluated. Additionally, the complication rate and success rate after one and two procedures (retreatment) have also been assessed. Student`s T, Mann-Whitney U y Chi2 - V Cramer (p = 0.05) tests were used for statistical analysis. RESULTS: There are not statistically significant differences in demographic or stone variables. The calculated mean surgical time was lower for PCNL (85 min) than for RIRS (112 min). Mean hospital stay was statistically significantly shorter in RIRS (16 h vs. 98 h in RIRS, p = 0.001). PCNL exhibited a higher global complication rate of 19.4% vs. 6.6% for RIRS (p = 0.001). PCNL also showed a higher successful rate (80.6% vs. 73.6% for RIRS), although this difference was not statistically significant (p = 0.40). When comparing the success rate after a second procedure, PCNL results in 94.3% vs. 93.5% for RIRS (p = 0.88). CONCLUSION: RIRS was found to be a safe and efficient procedure with a short hospital stay. Overall, RIRS can be considered as an alternative to PCNL for the treatment of renal stones smaller than 3.5 cm

Retrograde intrarenal surgery (RIRS) in the treatment of calyceal diverticulum with lithiasis.

OBJECTIVES: To evaluate the result of retrograde intrarenal surgery (RIRS) assisted by flexible ureterorenoscopy (FURS) and Holmium laser in the treatment of lithiasis within calyceal diverticula as a minimally invasive therapeutic option. METHODS: We retrospectively evaluated 11 cases of symptomatic lithiasis within calyceal diverticula treated between January 2010 and December 2011. We defined treatment success as absence of residual stones and absence/disappearance of symptomatology over the course of follow-up. We describe the RIRS technique and maneuvers for locating the diverticulum, opening the neck, and fragmenting intradiverticular lithiasis. RESULTS: The most frequently experienced symptom was flank pain (72.7%). The size of the lithiasis treated ranged from 7-20 mm. The overall success rate of RIRS was approximately 73% (absence of lithiasis and disappearance of symptoms) with an average follow-up of 13.3 months. Three cases were not solved by RIRS (2 due to unsuccessful location of the neck, 1 due to persistence of lithiasis and symptoms) . Cases of unsuccessful location were treated with laparoscopic surgery. CONCLUSION: RIRS assisted by FURS and Holmium laser is an effective and minimally invasive procedure for the treatment of lithiasis in the interior of the calyceal diverticulum. This treatment's efficacy improves upon the results from ESWL (extracorporeal shock wave lithotripsy( and equals that of the percutaneous method, exhibiting a lower rate of complications.

Cirugía retrograda intrarenal en el tratamiento del divertículo calicial con litiasis / Retrograde intrarenal surgery (RIRS) in the treatment of calyceal diverticulum with lithiasis

OBJETIVO: Evaluar el resultado de la cirugía retrograda intrarenal (CRIR) con uso de ureterorrenoscopio flexible (URSF) y láser Holmium en el tratamiento de la litiasis en el interior del divertículo calicial como una opción terapéutica mínimamente invasiva. MÉTODOS: Evaluamos retrospectivamente 11 casos de litiasis sintomáticas en el interior de divertículo calicial tratadas entre enero de 2010 y Diciembre de 2011. Definimos éxito del tratamiento: ausencia de restos litiásicos residuales y ausencia/desaparición de la sintomatología a lo largo del seguimiento. Describimos la técnica de CRIR y maniobras para la localización del divertículo, apertura del cuello y fragmentación de litiasis intradiverticular. RESULTADOS: El síntoma de presentación más frecuente fue dolor en el flanco (72,/%). El tamaño de litiasis tratada osciló entre 7-20 mm, El éxito global de CRIR fue de un 73% (ausencia litiasis y desaparición síntomas) con media de seguimiento de 13,3 meses. En 3 casosla CRIR no fue resolutiva (2 por no localización del cuello, 1 por persistencia de litiasis y sintomatología). Los casos de no localización se trataron con cirugía laparoscópica. CONCLUSIÓN: La CRIR con uso de URSF y láser holmium es un procedimiento efectivo y mínimamente invasivo en el manejo de la litiasis en el interior del divertículo calicial

OBJECTIVES: To evaluate the result of retrograde intrarenal surgery (RIRS) assisted by flexible ureterorenoscopy (FURS) and Holmium laser in the treatment of lithiasis within calyceal diverticula as a minimally invasive therapeutic option. METHODS: We retrospectively evaluated 11 cases of symptomatic lithiasis within calyceal diverticula treated between January 2010 and December 2011. We defined treatment success as absence of residual stones and absence/disappearance of symptomatology over the course of follow-up. We describe the RIRS technique and maneuvers for locating the diverticulum, opening the neck, and fragmenting intradiverticular lithiasis. RESULTS: The most frequently experienced symptom was flank pain (72.7 %). The size of the lithiasis treated ranged from 7-20 mm. The overall success rate of RIRS was approximately 73% (absence of lithiasis and disappearance of symptoms) with an average follow-up of 13.3 months. Three cases were not solved by RIRS (2 due to unsuccessful location of the neck, 1 due to persistence of lithiasis and symptoms). Cases of unsuccessful location were treated with laparoscopic surgery. CONCLUSION: RIRS assisted by FURS and Holmium laser is an effective and minimally invasive procedure for the treatment of lithiasis in the interior of the calyceal diverticulum. This treatment’s efficacy improves upon the results from ESWL [extracorporeal shock wave lithotripsy] and equals that of the percutaneous method, exhibiting a lower rate of complications