Comparison of flexible ureteroscopy damage rates for lower pole renal stones by laser fiber type

Forbes, Connor M.; Rebullar, Karla; Teichman, Joel M.H.

doi:10.1002/lsm.22822

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. The studies consisted of four randomized controlled trial 9,11,38,56 , three multicenter trials 17,30,33 , 40 case series 5,8,10,12,13,15,16,[25][26][27][28][29]31,32,[34][35][36][37]39,41,42,[44][45][46][47][48][49][50][51][52]54,55,[57][58][59][60][61][62][63]66 , one cadaveric feasibility study 18 , one animal feasibility study 19 , and ten bench top studies…”

Section: Resultsmentioning

confidence: 99%

“…Reusable scopes included were fiber optic Olympus URF-P3 14,26,30,39,43,48,55,56,62,66 , fiber optic Olympus URF-P5 5,9,18,19,33,44,46,54,61 , fiber optic Olympus URF-P6 10,13,49 , fiber optic Karl Storz Flex-X 14,[30][31][32][39][40][41]50,59 , fiber optic Karl Storz Flex-X 2 11,28,35,45,47,57,58,60,61 , fiber optic ACMI DUR-8 and DUR-8 elite 14,29,30,33,36,37,39,59 , fiber optic Richard Wolf 7330/1 14,26,30,39,63,64 , fiber optic Richard Wolf Cobra 20,24 , fiber optic Richard Wolf Viper 33 , fiber optic ACMI AUR-7 …”

Section: Resultsmentioning

confidence: 99%

“…However, there are no well-designed prospective randomized trials to provide strong evidence that the durability of the deflection unit of the flexible ureteroscope is preserved using this technique and this should be further investigated. On the other hand, previous studies strongly suggest that there is increased damage to the flexible scope if the patient has a urothelial tumor in the lower pole, a staghorn stone, a stone in the lower pole with more than 10mm, if the lower pole infundibulum is narrow, and if the infundibulopelvic angle is lower than <30 to 50 o48, [50][51][52] . In those situations, a single-use device could be more cost-effective than using a reusable scope.…”

Section: Discussionmentioning

confidence: 98%

“…In forced deflections where the laser fiber is unable to maintain total internal reflection, the photons may refract into the cladding and jacket rather than reflect back into the core fiber, with resultant fiber failure and ureteroscope damage 30,33 . Forbes et al 50 retrospectively analyzed laser fiber logs during flexible ureteroscopy for stone treatment and found that malfunction occurred in 8 of 142 cases (5.6%), all with the Innova Quartz fiber and none with the Boston Flexiva fiber. Importantly, all 8 cases were in procedures for lower pole stones (8 of 79; 10.1%) and resulted in flexible ureteroscope damage.…”

Section: Impact Of Stone Burden and Surgical Instrumentation On Uretementioning

confidence: 99%

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Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Marchini

Torricelli

Batagello

et al. 2018

Rev. Med. (São Paulo)

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Purpose: The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies. The purpose of this study was to critically evaluate all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. Two separate urologists (GSM and FCT) performed the online search and reviewed all papers considered suitable and relevant for this analysis. Because of the paucity of high quality publications, not only prospective assessments but also case control and case series studies were included in the final analysis. All factors potentially affecting surgical costs or clinical outcomes were considered in the analysis. Results: 741 studies with the previously elected terms were found. Of those, 18 were duplicated and 77 were not related to urology procedures and were excluded. Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. In special, urinary tract infection rate following flexible ureteroscopy is not inferior if a single-use device is used instead of a reusable scope. Operative time was in average 20% shorter if a digital scope was used, single-use or not. There is a suggestion that the learning curve is shorter with single-use devices but this is not consistent in the literature. Surgeon expertise impacts the longevity of the flexible scope. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last three to four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Both sterilization method and cleaning process impact scope longevity, the best results being achieved with Cidex and a dedicated nurse to take care of the sterilization process. The main factors that negatively impact device longevity regarding patient and disease are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects that must be considered when deciding whether to choose between a single-use and a reusable ureterorenoscope. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls significantly.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Impact Of Stone Burden and Surgical Instrumentation On Uretementioning

confidence: 99%

See 2 more Smart Citations

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Marchini

Torricelli

Batagello

et al. 2018

Rev. Med. (São Paulo)

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“…Besides correct fiber positioning, also the fiber itself plays a fundamental role in the lithotripsy procedure: Its diameter, the preparation or shape of its tip, and the fiber degradation, affect the direct ablation of the calculi and the intervening instruments, for example, the ureterorenoscopes . Monitoring the integrity of transmission fibers in an optical system has already, been the subject of several inventions in other medical/non‐medical fields (see e.g., Doi and colleagues ).…”

Section: Introductionmentioning

confidence: 99%

Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence

2019

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Background and Objectives In Holmium laser lithotripsy, usually, the surgeon is guided by a visible beam superimposing the infrared (IR) treatment radiation. It has been shown that a green aiming beam excites stone autofluorescence. This fluorescence signal can be used for calculi detection to check the correct fiber position before triggering the IR laser, thus preventing damage to soft tissue and application devices. However, also the directly reflected green light from the fiber tip gives valuable information on fiber position and its surface condition. Materials and Methods An external fiber‐fiber‐coupling‐box (fiber core diameter 365 µm) for pulsed holmium laser radiation (2.1 µm) was set up containing a green diode laser module (520 nm, average power on the sample <0.5 mW) and optics and detectors for measuring the reflected light of this aiming beam as well as the fluorescence excited with it. Measurements were done via a lock‐in technique with more than 20 human calculi samples and porcine calix in vitro. After the implementation of automatic data storage signals during ongoing in vitro lithotripsy procedures were recorded with the fiber positioned on tissue, stone, or in/on medical equipment (working channel of an endoscope, stone retrieval basket). Results Stone fluorescence signals measured were a factor of 7 to >100 higher than those of tissue. Stone fluorescence was detectable in “non‐contact mode” with a linear signal decrease over a distance up to ~1 mm in front of the fiber tip (core diameter 365 µm) and with severely damaged fibers (max. decrease: 75% with pinched off fiber). Reflection signals of the fiber tip surface in air and water surrounding decreased significantly when the fiber was damaged; measured ratios of intact to damaged fiber found in the air were (5–17):1 and in water (1.6–3.7):1. Surfaces in front of the fiber aggravated the evaluation of fiber condition due to reflections but enabled to detect, for example, the working channel of a flexible endoscope in combination with the (missing) fluorescence signal. Conclusions Autofluorescence induced by a green aiming beam can be exploited for stone detection in laser lithotripsy. A reflection measurement can give further information on fiber condition and position. Implementing this kind of safety features for an automatic block of IR laser emission in case of weak or missing fluorescence and un‐normal reflections can assist the surgeon by avoiding tissue perforation, and damage to medical devices such as endoscopes. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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A clinical study of choledochoscopic holmium laser lithotripsy for multiple intrahepatic calculi within ERAS programs

Wang

et al. 2018

Lasers Surg Med

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Holmium laser lithotripsy is feasible and efficient for treating multiple intrahepatic calculi within ERAS programs, which could reduce the liver resection rate and render refractory hepatic calculi easy to eliminate. In addition, holmium laser lithotripsy could be well coupled to the ERAS program to relieve surgical stress and accelerate postoperative recovery. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

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Comparison of flexible ureteroscopy damage rates for lower pole renal stones by laser fiber type

Cited by 12 publications

References 23 publications

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence

A clinical study of choledochoscopic holmium laser lithotripsy for multiple intrahepatic calculi within ERAS programs

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