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1.
Urologiia ; (2): 21-26, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-33960152

RESUMO

INTRODUCTION: The length of the operation to remove urinary concernments has a marked effect on the occurrence of postoperative complications in the time of the postoperative patients in the hospital. A significant factor contributing to the increase in time is the clouding of the fragmentation region, which increases the operation time and the number of complications. PURPOSE: to develop a method of reducing the time of additional costs in contact lithotripsy with a holmium laser in order to reduce the risk of postoperative complications. MATERIALS AND METHODS: The paper presents the own results of in vivo measurements of time intervals spent on fragmentation of stone. Fragmentation of stones in kidney was carried out by a holmium lithotripter of Triple type with the help of semirigid and flexible ureteroscopes. In the case of severe clouding of the fragmentation region, the author s technique of percutaneous micro-drainage of the kidney was used. The evaluation of the duration of the fragmentation procedure is based on statistical processing of the obtained measurement data using Excell Data Analysis tools. RESULTS: In the process of analysis of literary sources and results of own studies it was revealed that with increase in duration of contact laser lithotripsy the number of postoperative complications significantly increases. In order to reduce the time of transurethral contact holmium lithotripsy, the author s technique of percutaneous micro-drainage has been developed. By in vivo measurements and statistical processing of the data, it was found that by using the micro-drainage technique, the average additional washing time of the fragmentation region was reduced by an average of 4 times compared to the conventional technique. CONCLUSION: By further washing the fragmentation region, it is possible to reduce the time of additional crushing costs by at least 4 times and reduce the number of postoperative complications.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Drenagem , Humanos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia
2.
Arch Esp Urol ; 74(3): 343-349, 2021 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33818431

RESUMO

OBJECTIVES: With the spread of more powerful lasers and the advent of new technologies, endoscopic interventions for urolithiasis are continuously evolving. The aim of this study is to present our experience and technique regarding Low Energy (LE)/High Frequency (HF) lithotripsy by using a 120-W Holmium laser (Lumenis®). METHODS: We retrospectively analysed our prospectively maintained Retrograde Intra Renal Surgery (RIRS) database. Lithotripsy was performed using LE/HF settings with a Long Pulse Width (LPW) and consisted of the following steps: 1) contact Laser lithotripsy (LE/HF/LPW dusting - 0,5 J/50 Hz or 02 J/70 Hz); 2) extraction ofmain fragments; 3) non-contact Laser lithotripsy (LE/HF/Short Pulse Width Pop Dusting - 0,5 J /80Hz). Pre-operativeand peri-operative outcomes were collected. Post-operative complications were recorded according to Clavien-Dindo Grading System. Finally, all patients under went a CT scan at three months after RIRS to assess the success of procedure, defined as stone-free or presence of ≤4 mm fragments (Clinical Insignificant Residual Fragments - CIRF). RESULTS: Overall, 104 LE/HF/LPW RIRS from December 2017 to January 2019 were performed. Mean operative time was 59 (SD ±23) minutes, median post-operative stay was two days (IQR 2-3). The post-operative complication rate was 4,8%: one patient had nausea and vomiting (Clavien-Dindo I) and four patients developed urosepsis (Clavien-Dindo II). The success rate was 88,5% (71,2% stone-free and 17,3% CIRF). CONCLUSIONS: LE/HF/LPW RIRS seems to be safe and effective in terms of positive success rate, safety and standard operative time. However, randomized clinical trials are needed to compare this technique to standard RIRS.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Humanos , Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia
3.
Urologiia ; (1): 28-32, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818931

RESUMO

INTRODUCTION: surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS). AIM: to improve the performance of RIRS using the 1.94m superpulsed thulium fiber laser. MATERIALS AND METHODS: a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done. RESULTS: The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT. CONCLUSION: A superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Cálculos Urinários , Humanos , Túlio , Cálculos Urinários/cirurgia
4.
Arch. esp. urol. (Ed. impr.) ; 74(1): 171-182, ene.-feb. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-199448

RESUMO

OBJECTIVE: The objective of this study is to present the content of existing Guidelines on medical management of urinary stone disease. MATERIALS AND METHODS: A search for current Guidelines from national and international urological Associations was performed in Societe International d'Urologie and American Urological Association websites, along with a search in Pubmed/MEDLINE until 30/06/2020. Two authors performed an independent search and data extraction regarding medical management of acute renal colic, medical expulsive treatment, dietary modifications and pharmaceutical interventions for prevention of stone disease recurrence. Quality of Guidelines was assessed by the two reviewers using the AGREE II instrument. RESULTS: Literature search revealed 82 Associations, while eight of them provide recommendations/Guidelines on medical management of stone disease. Non-steroidal anti-inflammatory drugs or paracetamol are the most common 1st line treatment proposed for acute pain management, with opiates following next. Use of a-blockers is also indicated by most Guidelines for facilitating expulsion of distal ureteral stones 5-10 mm, after shockwave or laser lithotripsy or for alleviating stent-related symptoms. Adequate fluid intake, normal dietary calcium consumption and sodium restriction with varying daily limits, are universal dietary modifications from urological Associations on prevention of stone disease. Thiazides and alkaline citrates are proposed usually for calcium oxalate stone formers with differences in grading of the recommendations, while urinary alkalization with allopurinol or febuxostat as a second line treatment is a common treatment algorithm for urate stones, but with differences in target urine pH. European and American Urological Association Guidelines, along with National Institute for Health and Care Excellence recommendations were the most highly rated based on AGREE II. CONCLUSIONS: Despite methodological heterogeneity and subjective rating of recommendations, an acceptable degree of consensus was noted on Guidelines regarding medical management of stone disease


OBJETIVO: El objetivo de este estudio es presentar el contenido de las guías clínicas existentes en el manejo médico de las litiasis urinarias MATERIALES Y MÉTODOS: Una búsqueda de las guías clínicas actuales de las asociaciones nacionales e internaciones se realizó en la página web de la Societe International d'Urologie y la American Urological Association, junto con una búsqueda en Pubmed/Medline hasta el 30 junio 2020. Dos autores realizaron una búsqueda independiente y la extracción de datos en relación al manejo médico del cólico renal agudo, tratamiento médico expulsivo, modificaciones en la dieta e intervenciones farmacológicas para la prevención de la recurrencia en la litiasis. La calidad de las guías se determinó por dos revisores externos utilizando el instrumento AGREE II. RESULTADOS: La búsqueda en la literatura demostró 82 asociaciones, mientras que ocho de estas promueven recomendaciones/guías en el manejo médico de la litiasis. Antiinflamatorios no-esteroideos o paracetamol son los tratamientos de primera línea más comunes para el manejo del dolor agudo, siendo los opioides el siguiente. El uso de alfa-bloqueantes esta también indicado por la mayoría de las guías para facilitar la expulsión de litiasis del uréter distal de 5 a 10 mm, después de litotricia o después de lasertricia o para aliviar los síntomas relacionados con los catéteres. La ingesta de fluidos adecuada, consumo normal de calcio en la dieta y restricción de sodio con limites variables, son las recomendaciones dietéticas universales de las asociaciones urológicas en la prevención de las litiasis. Tiazidas y citratos alcalinos se proponen para los formadores de litiasis de oxalato cálcico con diferencias en el grado de las recomendaciones, mientras la alcalinización de la orina con alopurinol o febuxostat es la segunda línea de tratamiento en el algoritmo de las litiasis de urato, pero con diferencias en el pH urinario final. Las guías europeas y americanas, junto con las guías del instituto nacional de salud y las recomendaciones care excellence fueron las mejor reportadas en relación a AGREE II. CONCLUSIÓN: A pesar de todo y con la heterogeneidad metodológica y las recomendaciones subjetivas, hay un grado aceptable de consenso en las guías clínicas en relación al manejo médico de la enfermedad litiásica


Assuntos
Humanos , Litotripsia a Laser/métodos , Cálculos Ureterais , Cálculos Urinários , Urolitíase/diagnóstico , Urolitíase/terapia , Recidiva
5.
Arch Esp Urol ; 74(1): 171-182, 2021 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33459633

RESUMO

OBJECTIVE: The objective of this study isto present the content of existing Guidelines on medical management of urinary stone disease. MATERIALS AND METHODS: A search for current Guidelines from national and international urological Associations was performed in Societe International d'Urologie and American Urological Association websites, along with a search in Pubmed/MEDLINE until 30/06/2020. Two authors performed an independent search and data extraction regarding medical management of acute renal colic, medical expulsive treatment, dietary modifications and pharmaceutical interventions for prevention of stone disease recurrence. Quality of Guidelines was assessed by the two reviewers using the AGREE II instrument. RESULTS: Literature search revealed 82 Associations, while eight of them provide recommendations/Guidelines on medical management of stone disease. Non-steroidalanti-inflammatory drugs or paracetamol are the most common 1st line treatment proposed for acute pain management, with opiates following next. Use of a-blockers is also indicated by most Guidelines for facilitating expulsion of distal ureteral stones 5-10 mm, after shockwave or laser lithotripsy or for alleviating stent-related symptoms. Adequate fluid in take, normal dietary calcium consumption and sodium restriction with varying daily limits, are universal dietary modifications from urological Associations on prevention of stone disease. Thiazidesand alkaline citrates are proposed usually for calciumoxalate stone formers with differences in grading of the recommendations, while urinary alkalization with allopurinol or febuxostat as a second line treatment is acommon treatment algorithm for urate stones, but with differences in target urine pH. European and American Urological Association Guidelines, along with National Institute for Health and Care Excellence recommendations were the most highly rated based on AGREE II. CONCLUSIONS: Despite methodological heterogeneity and subjective rating of recommendations, an acceptable degree of consensus was noted on Guidelines regarding medical management of stone disease.


Assuntos
Litotripsia a Laser , Cálculos Ureterais , Cálculos Urinários , Urolitíase , Humanos , Recidiva , Urolitíase/diagnóstico , Urolitíase/terapia
6.
Vasc Endovascular Surg ; 55(4): 415-418, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33334245

RESUMO

Uretero-arterial fistula (UAF) is a rare complication of either aneurysmal disease primarily or pelvic inflammation secondary to urologic, oncologic, or vascular interventions. Diagnosis can be difficult to confirm and treatment may need to proceed on high index of suspicion alone. We present the case of a 56-year-old woman suffering from intermittent hematuria after laser lithotripsy leading to UAF between her left ureter and left Dacron aortobifemoral bypass limb. The fistula was successfully treated with endovascular intervention.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular , Artéria Femoral/cirurgia , Litotripsia a Laser/efeitos adversos , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Fístula Vascular/etiologia , Procedimentos Endovasculares , Feminino , Hematúria/etiologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/cirurgia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
7.
Urologe A ; 60(1): 19-26, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33315134

RESUMO

Management of urolithiasis has undergone fundamental changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureterorenoscopic techniques in the 1980s. Since then, these minimally invasive techniques have been continuously optimized and specific laser techniques for stone disintegration have emerged. Besides the established holmium laser, other types of lasers are also emerging. Especially the thulium fiber laser is the subject of promising research due to its variable adjustment options. In terms of patient safety, both holmium and thulium techniques seem to be similar . While serious direct physical lesions are rare, there is increasing evidence of clinically relevant secondary thermal injury due to increased temperatures in the upper urinary tract during treatment. Our research group has recently demonstrated in both in vitro and in vivo (porcine animal model) experiments that monitoring the fluorescence spectra of calculi allows precise target differentiation between stone, tissue, and endoscope components. Consequently, pulse emissions were only emitted when stone material was detected. We believe that target monitoring will minimize the risk of laser-induced urothelial damage and decrease energy release into the upper urinary tract allowing adequate temperature management.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Urolitíase , Animais , Humanos , Lasers de Estado Sólido/uso terapêutico , Segurança do Paciente , Suínos , Ureteroscopia/efeitos adversos , Urolitíase/terapia
8.
Zhonghua Nan Ke Xue ; 26(1): 48-53, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33345477

RESUMO

Objective: To investigate the impact of two different ureteral stents on the quality of life and erectile function of young and middle-aged men after ureteral laser lithotripsy. METHODS: A total of 118 male patients aged 22-45 years underwent ureteral laser lithotripsy followed by indwelling of the traditional double-J stent (the DJS group, n = 60) or Polaris loop stent (the PLS group, n = 58). We obtained the general information, intra- and post-operative clinical data, and scores on QOL, IPSS, Visual Analogue Scale (VAS) and IIEF, and compared them between the two groups of patients. RESULTS: There were no statistically significant differences in the body mass index, height, stone diameter, hydronephrosis degree, operation time, intra-operative adverse events, or post-operative stenting time between the two groups of patients. The PLS outperformed the DJS group in such clinical indexes as inflammation markers, lower urinary tract symptoms (LUTS), backache at urination, and QOL, IPSS and VAS scores during stenting at 4 weeks after operation(P < 0.05). The IIEF scores of the PLS and DJS groups were 8.44 ± 2.10 vs 12.50 ± 1.78 (P = 0.003) at 2 weeks, 8.65 ± 1.90 vs 13.42 ± 1.88 (P = 0.002) at 4 weeks, and 13.57 ± 1.01 vs 17.38 ± 2.47 (P = 0.003) at 6 weeks after operation, with no statistically significant difference between the two groups at 8 weeks. CONCLUSIONS: Ureteral stenting affects the quality of life and erectile function of young and middle-aged male patients after ureteral laser lithotripsy. The Polaris loop stent affects less the quality of life and erectile function of the patients than the traditional double-J stent during postoperative stenting.


Assuntos
Disfunção Erétil , Litotripsia a Laser , Qualidade de Vida , Stents , Adulto , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents/classificação , Ureteroscopia , Adulto Jovem
9.
Zhonghua Yi Xue Za Zhi ; 100(40): 3161-3163, 2020 Nov 03.
Artigo em Chinês | MEDLINE | ID: mdl-33142399

RESUMO

Objective: To investigate the clinical efficacy and safety of one-time percutaneous transhepatic establishment of intrahepatic bile duct sinus, choledochoscope combined with holmium laser lithotripsy in elderly patients with hepatolithiasis combined with benign stricture. Methods: The clinical data of 56 elderly patients diagnosed with intrahepatic bile duct stones combined with stricture in our hospital from January 2018 to January 2019 were collected. All patients underwent PTCD puncture and drainage, and simultaneously expanded the punctured sinus channels step by step, intrahepatic bile duct stones lithotripsy and lithotomy were performed under choledochoscope combined with holmium laser. The intraoperative operation and postoperative complications were analyzed. Results: The sinus tract was established in 53 patients, the stones were removed, and the stenosis was relieved. Two cases of puncture bleeding and 1 case of bleeding when the stenosis was relieved by holmium laser and the surgery was timely transferred. The patients received 4(2-8) times of laser lithotripsy, and it took 30(28-32) min for each treatment. The T tubules were removed when colour Doppler ultrasound and choledochography were rechecked well. The patients were followed-up for an average of 6 months with the liver function and cholerythrin recovered. Conclusion: The one-time establishment of sinus tract combined with choledochoscope holmium laser provides a new therapeutic approach for the elderly patients with hepatolithiasis and benign stricture who cannot tolerate surgery.


Assuntos
Coledocolitíase , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Idoso , Constrição Patológica , Hólmio , Humanos , Resultado do Tratamento
10.
Arch Esp Urol ; 73(8): 682-688, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025913

RESUMO

Thulium lasers operate at wavelengths between1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiberlaser.  This technique delivers the laser energy through anactive fiber with an absorption maximum in water at awavelength of 1940 µm. Preclinical studies showed asignificantly higher stone fragmentation rate in differentex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Litotripsia a Laser , Hiperplasia Prostática , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Túlio
11.
Arch Esp Urol ; 73(8): 735-744, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025918

RESUMO

OBJECTIVE: To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed. RESULTS: Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 µm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones. CONCLUSIONS: HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come.


Assuntos
Cálculos , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Humanos , Lasers de Estado Sólido/uso terapêutico , Túlio
12.
Arch Esp Urol ; 73(8): 767-776, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025921

RESUMO

The SuperPulsed Thulium fiber laser has recently become available to the urologist. It can be safely and efficiently applied to humans for the purposes of laser lithotripsy. Particularly, this innovative technology overcomes the main limitations of Holmium:YAG lasers, which had been the principal source of energy for lithotripsy over the past decades. The SuperPulsed Thulium fiber laser allows a broader range of pulse energy (0.025 to 6.0 J), pulse frequency (up to 2000 Hz) and pulse duration (0.05 to 12 ms), as well as smaller operating laser fibers (50-150 µm core), compared to Holmium:YAG lasers. The laser emission at 1940 nm leads to a four-fold higher energy absorption in water, which ensures precise lithotripsy and a high degree of safety. Multiple comparative in vitro studies suggest a 1.5 to 4 times faster stone ablation rate in favor of the SuperPulsed Thulium fiber laser, when compared to Holmium:YAG lasers. It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization. The SuperPulsed Thulium fiber laser, like the Holmium:YAG laser, has been repeatedly reported thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintaining throughout the lithotripsy process. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting, and open paths that were not been amenable to the Holmium:YAG laser.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Litotripsia a Laser , Cálculos Urinários , Humanos , Túlio , Cálculos Urinários/cirurgia
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5045-5048, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019120

RESUMO

The Thulium fiber laser (TFL) is being explored as a potential alternative to the gold standard Holmium:YAG laser for infrared laser ablation of kidney stones. Laser-induced vapor bubbles contribute to both the ablation mechanism and stone retropulsion. In this preliminary study, a biocompatible surfactant with concentrations of 1-5% was used to enhance the vapor bubble dimensions during the laser pulse. Bubble dimensions using surfactant increased on average by 25% compared with water only (control). With further development, introduction of the surfactant into the saline irrigation flow typically delivered through the working channel of the ureteroscope during laser lithotripsy, may contribute to more efficient stone ablation.Clinical Relevance-This preliminary study demonstrates that the dimensions of laser-induced vapor bubbles created during infrared laser lithotripsy can be enhanced by up to 25%, for potential clinical translation into more efficient lithotripsy and use in the "popcorn" ablation method.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Surfactantes Pulmonares , Tensoativos , Túlio
14.
Medicine (Baltimore) ; 99(43): e22704, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120764

RESUMO

With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Cálculos Renais/patologia , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
15.
Arch. esp. urol. (Ed. impr.) ; 73(8): 682-688, oct. 2020.
Artigo em Inglês | IBECS | ID: ibc-197467

RESUMO

Thulium lasers operate at wavelengths between 1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiber laser. This technique delivers the laser energy through an active fiber with an absorption maximum in water at a wavelength of 1940 μm. Preclinical studies showed a significantly higher stone fragmentation rate in different ex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification


El láser de tulio opera entre 1940 y 2013 nm en onda continua o pulsada. Esto permite incisiones sencillas y una vaporización rápida o una litotricia láser para el tratamiento de las litiasis urinarias. La enucleación con láser tulio es mínimamente invasiva e independiente del tamaño de la hiperplasia benigna de próstata con excelentes resultados a largo plazo. Desde su introducción, varias modificaciones en la tecnología y en la técnica quirúrgica se han propuesto como la vaporesección, la vaporización y la enucleación. El desarrollo reciente de la tecnología del láser tulio incluye la introducción de una fibra de láser de superpulsación. Esta técnica administra la energía del láser a través de una fibra activa con una absorción máxima a 1940 nm. Estudios preclínicos han demostrado una mejor fragmentación de las litiasis en diferentes modelos ex vivo en comparación con láser Ho:YAG. Otra innovación del laser tulio es que funciona como un láser híbrido, pero aun no se ha testado clínicamente. Con la introducción de nuevas tecnologías en láser, el conjunto de técnicas en endourología y enucleación incrementa. En este resumen presentamos los diferentes lásers tulio y las técnicas quirúrgicas que son posibles de realizar con cada aparato, incluyendo el racional y las ventajas para cada modificación


Assuntos
Humanos , Litotripsia a Laser/tendências , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Ressecção Transuretral da Próstata/métodos , Ressecção Transuretral da Próstata/tendências , Hiperplasia Prostática/cirurgia
16.
Arch. esp. urol. (Ed. impr.) ; 73(8): 735-744, oct. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-197472

RESUMO

OBJECTIVE: To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed. RESULTS: Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 μm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones. CONCLUSIONS: HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come


OBJETIVO: El láser Holmio:YAG (Ho:YAG) es el de elección para litotricia en cirugía retrógrada intrarenal (RIRS). Los equipos láser de alto poder (HPL) y bajo poder (LPL) tienen diferentes características, por lo tanto, pueden tener diferente desempeño. En el presente trabajo tuvimos el objetivo de revisar evidencia sobre el uso de HPL y LPL en RIRS. MATERIAL Y MÉTODOS: Se realizó una búsqueda en PubMed/Embase y la información reciente y relevante sobre HPL y/o LPL en RIRS fue evaluada para una revisión monográfica. RESULTADOS: Los HPL y algunos LPL más recientes permiten al cirujano ajustar la duración del pulso, por lo tanto, al configurar un pulso largo, alta frecuencia y baja energía, se puede lograr una verdadera pulverización. Los LPL no pueden alcanzar la misma emisión de energía que los HPL. La retropulsión aumenta si la energía de pulso es mayor, entonces, se previene la retropulsión al incrementar la emisión total de energía mediante el incremento de la frecuencia. El costo de adquisión de los HPL es considerablemente mayor que el de los LPL, sin embargo, el costo a largo plazo pudiera ser similar pues los procedimientos pueden abaratarse al disminuir el uso de insumos para recuperar los litos, preservar la punta de las fibras reutilizables y disminuir el tiempo quirúrgico. CONCLUSIONES: La evidencia no favorece la efectividad de los HPL o LPL de modo abrumador. Ambos dispositivos son efectivos y seguros. No cabe duda de que los HPL alcanzan mayor emisión de energía que los LPL, pero los dispositivos de 50-80 Watts, tienen emisiones de energía que rara vez se alcanzan para litotricia y por lo tanto pudiera considerarse demasiada energía. A medida que nuevas tecnologías han surgido, la brecha entre LPL y HPL se amplía, dejando espacio para una clasificación de poder intermedio (36-55 Watts) y la comparación entre estos dispositivos sería más justa. Asimismo, los HPL aún necesitan ser contrastados en el escenario clínico, con las nuevas tecnologías disponibles, tal como la fibra de laser tulio


Assuntos
Humanos , Litotripsia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Cálculos Renais/cirurgia , Litotripsia a Laser/instrumentação , Fatores de Tempo
17.
Arch. esp. urol. (Ed. impr.) ; 73(8): 753-766, oct. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-197473

RESUMO

Holmium laser has been established as the gold-standard for the ureteroscopic management of urinary stone disease. However the role of laser in percutaneous nephrolithotomy (PCNL) varies, as multiple energy sources and lithotripters are available. Currently, lasers are becoming more relevant with the development of several miniaturized PCNL techniques. The purpose of this article is to review the role of laser in percutaneous renal surgery, and whether or not it is the best option for this approach. Discussion points include: the history and background of lasers in urologic surgery, PCNL and its outcomes in the literature, the positives and negatives of lasers versus other lithotripters in several different PCNL techniques, emerging laser technology such as thulium fiber laser, the use of lasers in establishing percutaneous renal access, and laser's role in non-stone percutaneous renal surgery


El láser holmium está establecido como gold-standard en el manejo de la litiasis con ureteroscopio. El papel del láser en la nefrolitotomía percutánea varía ya que existen varios tipos de láser. El objetivo de este artículo es revisar el papel del láser en la cirugía percutánea renal para determinar si es una buena opción terapéutica. Discutiremos la historia del láser en urología, nefrolitotomía percutánea y sus resultados en la literatura, los pros y contras de los láseres vs otros litotriptores como el tulio, el uso del láser para establecer el acceso percutáneo; el papel del láser en la cirugía percutánea no-litiásica


Assuntos
Humanos , Nefrolitotomia Percutânea/métodos , Lasers de Estado Sólido/uso terapêutico , Cálculos Renais/cirurgia , Litotripsia a Laser/métodos , Nefrolitotomia Percutânea/instrumentação , Rim/cirurgia , Litotripsia a Laser/instrumentação
18.
Arch. esp. urol. (Ed. impr.) ; 73(8): 767-776, oct. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-197474

RESUMO

The SuperPulsed Thulium fiber laser has recently become available to the urologist. It can be safely and efficiently applied to humans for the purposes of laser lithotripsy. Particularly, this innovative technology overcomes the main limitations of Holmium:YAG lasers, which had been the principal source of energy for lithotripsy over the past decades. The SuperPulsed Thulium fiber laser allows a broader range of pulse energy (0.025 to 6.0 J), pulse frequency (up to 2000 Hz) and pulse duration (0.05 to 12 ms), as well as smaller operating laser fibers (50-150 μm core), compared to Holmium:YAG lasers. The laser emission at 1940 nm leads to a four-fold higher energy absorption in water, which ensures precise lithotripsy and a high degree of safety. Multiple comparative in vitro studies suggest a 1.5 to 4 times faster stone ablation rate in favor of the SuperPulsed Thulium fiber laser, when compared to Holmium:YAG lasers. It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization. The SuperPulsed Thulium fiber laser, like the Holmium:YAG laser, has been repeatedly reported thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintaining throughout the lithotripsy process. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting, and open paths that were not been amenable to the Holmium:YAG laser


El tulio superpulsado ha salido al mercado recientemente. Se puede usar en humanos para la litotricia. En concreto, esta nueva tecnología mejora las limitaciones del laser holmium, usado hasta ahora. Las fibras de laser tulio permite un pulso de energía (0.025 a 6 J), frecuencia de pulso (hasta 2000 Hz) y duración de este pulso (0.05 a 12 ms) así como diámetros menores (50-150 nm) en comparación con el holmium. La emisión de laser a 1940 nm permite una mejoría hasta 4 veces en la absorción de agua, lo que permite una litotricia mas eficiente y segura. Múltiples estudios comparativos in vitro sugieren que la litotricia es entre 1,5 y 4 veces mas rápida con el tulio superpulsado. Además produce un polvo secundario a litotricia mas fino y el pulso electrónico modulado permite una mejor estabilización de la litiasis. Las fibras de tulio superpulsado, como las de holmium, son térmicamente seguras teniendo en cuenta que la irrigación mínima continua (10-15 ml/min) y el bajo voltaje (menos de 25 W) se mantienen durante el tratamiento de litotricia. Estos nuevos estándares confieren particular ventaja en la litotricia ureteroscopica y permitirán una mejor aceptación que el laser homium


Assuntos
Humanos , Litotripsia a Laser/métodos , Túlio/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Ondas de Choque de Alta Energia , Urolitíase/cirurgia , Ureteroscopia/métodos
19.
Urologiia ; (4): 18-20, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897009

RESUMO

Over the past several decades, there has been a significant increase in the prevalence of nephrolithiasis in the general population. Ureteroscopy has become the treatment of choice for a growing number of urologic conditions; ureteroscopy is still relatively new procedure and continue to undergo significant advancement. The recent technical development of small caliber semi rigid and flexible deflectable ureteroscopes and the development of diminutive intra-corporeal lithotripsy probes have made the retrograde access to urinary calculi throughout the entire ureter a more feasible and low-risk technique. The study aims to identify the need for use of laser lithotripsy and/or other ureteroscopic ancillary equipment (ureteric stent, ureteric catheter, forceps and dormia basket) in patient undergoing ureteroscopy for ureteric stone management. A prospective observational study from 2013 to 2015. The study conducted in urosurgical theater in Al-Jumhoori Teaching Hospital. 200 patient with ureteric stone in the study treated by ureteroscopy. The mean age of the patient is 36 years. Ureteroscopy had done in the right side in 98 patients, left side in 83 patients, and bilateral ureteroscopy in 19 patients. Ureteric stones found in upper ureter in 86 patients, middle ureteric stone seen in 40 patients, and lower ureteric stone founded in 108 patients, whereas 16 patients had stones at more than one location. Ureteric catheter used in 33 patients, and had been removed after 48-72 hours, while Double J stent had been used in 175 patients and had been removed after 2 to 8 weeks.


Assuntos
Cálculos Renais , Litotripsia a Laser , Litotripsia , Cálculos Ureterais/terapia , Adulto , Humanos , Resultado do Tratamento , Ureteroscopia
20.
PLoS One ; 15(8): e0237068, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760154

RESUMO

OBJECTIVE: To evaluate four predictive scores for stone-free rate (SFR) after flexible ureterorenoscopy (f-URS) with holmium-YAG laser fragmentation of renal and ureteral lithiasis. METHODS: We carried out a retrospective analysis of 800 f-URS procedures performed in our institution between January 2009 and December 2016. For each procedure, a single surgeon calculated the following scores: S.T.O.N.E score; Resorlu Unsal Stone Score (RUSS); modified Seoul National University Renal Complexity (S-ReSC) score; and Ito's score. RESULTS: Overall SFR was 74.1%. Univariate analysis demonstrated that stone size (p<0.0001), stone volume (p<0.0001), stone number (p = 0.004), narrow lower pole infundibulopelvic angle (IPA) (p = 0.003) and lower pole location + IPA <45° (p = 0.011) were significantly associated with SFR. All scores differed between the stone-free and non-stone-free groups. Area under the curve of the receiving operator characteristics curve was calculated for each score: 0.617 [95%CI: 0.575-0.660] for the S.T.O.N.E score; 0.644 [95%CI: 0.609-0.680] for the RUSS; 0.651 [95%CI: 0.606-0.697] for the S-ReSC score; and 0.735 [95%CI: 0.692-0.777] for Ito's nomogram. CONCLUSION: All four scores were predictive of SFR after f-URS. Ito's score was the most sensitive. However, the performance of all scores in this analysis was lower than in developmental studies.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser , Cálculos Ureterais/terapia , Ureteroscopia , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/química , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/química
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