Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

Lildal, Søren Kissow; Andreassen, Kim Hovgaard; Baard, Joyce; Brehmer, Marianne; Bultitude, Matthew; Eriksson, Ylva; Ghani, Khurshid R.; Jung, Helene; Kamphuis, Guido; Kronenberg, Peter; Turney, Ben; Traxer, Olivier; Ulvik, Øyvind; Osther, Palle Jørn Sloth

doi:10.1007/s00345-020-03481-9

Cited by 17 publications

(12 citation statements)

References 84 publications

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“…Among the 26 included patients, we found similar demographic characteristics to those in the available data [25,26]. We also present a complication rate similar to that reported in the available literature [27]. Whereas two-thirds of our population presented with a single stone, multiple calculi were found in 9 patients, possibly increasing the difference in ExDL-EfDL for two reasons: First, with "stop-and-start" laser emission, multiple stone cases and irrigation flow have increased.…”

Section: Clinical Evaluationsupporting

confidence: 85%

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

et al. 2021

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Introduction Kidney Stone Calculator (KSC) is a free, three-dimensional (3D) planning software for flexible ureteroscopy(fURS) with Holmium:YAG(Ho:YAG) endocorporeal lithotripsy (EL). KSC provides the stone volume (SV) and expected duration of lithotripsy (ExDL) estimations based on non-enhanced-CT scan (NECT) DICOM series. We aimed to provide a preclinical and clinical evaluation of KSC. Patients and methods A preclinical evaluation measured the SV by three operators (resident, endourology expert and research engineer) among 17 NECT cases. Between January and March 2020, a multicentric, prospective, observational double-blind clinical evaluation was conducted in patients presenting with renal stones treated with Ho:YAG-EL during fURS and preoperative NECT. Demographic and surgical data were collected. The primary endpoint was a significant median difference between ExDL and EffectiveDL (EfDL). Second, efficiency (J/mm 3 ) and efficacy (mm 3 /min) ratios were calculated. Results The preclinical evaluation showed no significant difference in the SV measurements among operators ( p > 0.05). Pearson and Kendall coefficients of 0.99 and 0.98, respectively, were found. Twenty-six patients were included in the clinical evaluation, with a median age of 55 years. In 66% of cases, there was a single stone located in the lower pole, with a density > 1000 Hounsfield Unit observed in 42% and 85% of cases. A 14% [Q1–Q3 (5.4–24.8); p = 0.36] median difference between ExDL and EfDL was noted, which was greater in the case of lower pole stones with no possible relocation ( p = 0.008). Median values of 17.6 J/mm 3 and 0.4 (0.32–0.56) mm 3 /s EL were also noted. Conclusions Kidney Stone Calculator is a reproducible and accurate software that allows for an estimation of the stone burden and provides an ExDL for URSf. Defining the influencing factors of EL will improve its ExDL. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03671-z.

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Section: Clinical Evaluationsupporting

confidence: 85%

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

et al. 2021

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“…In this study, IRB was investigated at pressure levels of 10–50 mm Hg within 70 minutes of continuous irrigation. The pressure levels and time settings were chosen based on former human studies determining the average IRP during ureteroscopic procedures and on the basis of an assumption that the maximum duration of a ureteroscopic procedure is 70–90 minutes [ 4 , 5 , 19 ]. IRP may be much higher than 50 mmHg as documented by for example Jung and Osther and Wilson [ 5 , 4 ], but IRB was evident in all kidneys within the range of 16–25 mmHg, and consequently we found no indication to examine higher pressure levels in this primary investigation.…”

Section: Discussionmentioning

confidence: 99%

Gadolinium-enhanced MRI visualizing backflow at increasing intra-renal pressure in a porcine model

et al. 2023

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Introduction Intrarenal backflow (IRB) is known to occur at increased intrarenal pressure (IRP). Irrigation during ureteroscopy increases IRP. Complications such as sepsis is more frequent after prolonged high-pressure ureteroscopy. We evaluated a new method to document and visualize intrarenal backflow as a function of IRP and time in a pig model. Methods Studies were performed on five female pigs. A ureteral catheter was placed in the renal pelvis and connected to a Gadolinium/ saline solution 3 ml/L for irrigation. An occlusion balloon-catheter was left inflated at the uretero-pelvic junction and connected to a pressure monitor. Irrigation was successively regulated to maintain steady IRP levels at 10, 20, 30, 40 and 50 mmHg. MRI of the kidneys was performed at 5-minute intervals. PCR and immunoassay analyses were executed on the harvested kidneys to detect potential changes in inflammatory markers. Results MRI showed backflow of Gadolinium into the kidney cortex in all cases. The mean time to first visual damage was 15 minutes and the mean registered pressure at first visual damage was 21 mmHg. On the final MRI the mean percentage of IRB affected kidney was 66% after irrigation with a mean maximum pressure of 43 mmHg for a mean duration of 70 minutes. Immunoassay analyses showed increased MCP-1 mRNA expression in the treated kidneys compared to contralateral control kidneys. Conclusions Gadolinium enhanced MRI provided detailed information about IRB that has not previously been documented. IRB occurs at even very low pressures, and these findings are in conflict with the general consensus that keeping IRP below 30–35 mmHg eliminates the risk of post-operative infection and sepsis. Moreover, the level of IRB was documented to be a function of both IRP and time. The results of this study emphasize the importance of keeping IRP and OR time low during ureteroscopy.

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“…With the development of the medical techniques and services, the current exible ureteroscope has the excellent operation track, the water inlet and outlet system and active and passive bending exural system, which has blossomed into the main weapon that play a signi cant role in surgery for upper urinary tract diseases [11,12]. According to the study report, the stone removal rate of middle and upper calyx stones with a diameter of less than 2cm is 97%, and that of lower calyx stones is 71.4% [13]. At the moment, the capability of exible ureteroscope has made signi cant breakthroughs, and also the surgical indications have further expanded.…”

Section: Discussionmentioning

confidence: 99%

The effects and clinical outcomes of inflammation-related factors in the middle and upper calyceal renal calculi without ureteral stent after flexible ureterorenoscopy

Wang

et al. 2022

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Objective To investigate the inflammatory factors and clinical outcomes of the middle and upper calyceal renal calculi after flexible ureterorenoscopy without the usage of the ureteral stent. Data and Methods: 150 patients were randomly divided into three groups: Group A, Group B and Group C. In Group A, double-J stent was implanted preoperatively, but not postoperatively. In Group C, Double-J stent was implanted postoperatively, but not preoperatively. In Group B, double-J stent were implanted preoperatively and postoperatively. Finally, the inflammatory factors and clinical effects of the 3 groups were compared. Results There is a significant difference in operation time among the 3 groups with group A having the shortest time (P < 0.05). There have been no significant differences in stone clearance rate (P > 0.05). Additionally, it is observed that the incidence of postoperative hematuria and bladder irritation in group A has been comparatively lower than those in groups B and C (P < 0.01). At 24 hours after the operation among the 3 groups, and the incidence of fever between groups A and B observed has been considerably lower than that of group C (P < 0.05). Lastly, CRP and WBC in group A and B were lower than those in group C after operation(P < 0.05). Conclusion For the patients with middle and upper calyceal renal calculi, by prepositioning double-J stent before the operation along with the absence of ureteral stent after the flexible ureterorenoscopy, it has been presented that the operation time can be effectively reduced. At the same time, it will not affect the postoperative clearance rate, significantly reduce the incidence of postoperative complications, and will also not increase the postoperative-related inflammatory factors.

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Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

Cited by 17 publications

References 84 publications

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

Gadolinium-enhanced MRI visualizing backflow at increasing intra-renal pressure in a porcine model

The effects and clinical outcomes of inflammation-related factors in the middle and upper calyceal renal calculi without ureteral stent after flexible ureterorenoscopy

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