Effect of positioning on ureteric stone retropulsion: ‘gravity works’

Walia, Arman; Grohs, Evan; Okhunov, Zhamshid; Landman, Jaime; Clayman, Ralph V.

doi:10.1111/bju.14510

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…However, in most in vitro studies, retropulsion is investigated via indirect methods which include pendulums [5,6], angled glass channels and flat glass setups [1,3,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], and vertical set-ups [22,23]. Through these indirect methods, there are several factors potentially influencing the results such as fluid dynamics, the impact's exact location, and the test body's irregular surface and composition.…”

Section: Introductionmentioning

confidence: 99%

Retropulsion force in laser lithotripsy—an in vitro study comparing a Holmium device to a novel pulsed solid-state Thulium laser

2021

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Purpose To investigate retropulsion forces generated by two laser lithotripsy devices, a standard Ho:YAG and a new pulsed solid-state Thulium laser device. Materials and methods Two different Dornier laser devices were assessed: a Medilas H Solvo 35 and a pulsed solid-state Thulium laser evaluation model (Dornier MedTech Laser GmbH, Wessling, Germany). We used a 37 °C water bath; temperature was monitored with a thermocouple/data-logger. Representative sets of settings were examined for both devices, including short and long pulse lengths where applicable. For each setting, ten force values were recorded by a low-force precision piezo sensor whereby the laser fibre was either brought into contact with the sensor or placed at a 3 mm distance. Results The mean retropulsion forces resulting from the new Tm:YAG device were significantly lower than those of the Ho:YAG device under all pulse energy and frequency settings, ranging between 0.92 and 19.60 N for Thulium and 8.09–39.67 N for Holmium. The contact setups yielded lower forces than the distance setups. The forces increased with increasing pulse energy settings while shorter pulse lengths led to 12–44% higher retropulsive force in the 2.0 J/5 Hz comparisons. Conclusion The Tm:YAG device not only significantly generated lower retropulsion forces in all comparisons to Holmium at corresponding settings but also offers adjustment options to achieve lower energy pulses and longer pulse durations to produce even lower retropulsion. These advantages are a promising add-on to laser lithotripsy procedures and may be highly relevant for improving laser lithotripsy performance.

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Section: Introductionmentioning

confidence: 99%

Retropulsion force in laser lithotripsy—an in vitro study comparing a Holmium device to a novel pulsed solid-state Thulium laser

2021

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“…In an experimental study, Patel et al showed that the inclination of the patient on the operating table can preclude the development of push-ups during ureteroscopy. 11 Zehri et al reported that gel instillation to the proximal part of the stone increased stonefree rates. 12 Dretler demonstrated that a ureteral balloon advanced over a guidewire to the proximal part of the stone is useful in averting push-up.…”

Section: Discussionmentioning

confidence: 99%

Where Is It Logical to Break-Up A Ureter Stone with Endoscopic Surgery?

Caniklioğlu

Selmï

SARI

et al. 2021

Preprint

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Aims: Today, we have technology to break up a ureter stone in ureter as well as in renal pelvis during ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices in order not to let the stone migrate through renal pelvis. However, we still do not know whether it is advantageous to dust a stone in ureter where it is impacted or in a wider area such as renal pelvis. This study was carried out to clarify whether it is advantageous to breaking an upper ureter stone up where it is enclaved or in a wider area such as renal pelvis. Study Design: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included in our study and analyzed retrospectively. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: non-push-up group, Group 2: push-up group). Results: Laboratory findings were changed significantly in both groups before and after surgery. However, this change was not significant between the groups. Operation times were statistically similar in both groups in contrast with the literature. Stone-free rates were significantly higher in srURS than in flexible ureterorenoscopy (fURS) (p<0,05). Complication rates were also found similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back in order to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.

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“…To address this problem, various manipulations and antiretropulsion devices or techniques were developed. In an experimental study, Patel et al [11] showed that the inclination of the patient on the operating table can preclude the development of push-ups during ureteroscopy. Zehri et al [12] reported that gel instillation to the proximal part of the stone increased stone-free rates.…”

Section: Discussionmentioning

confidence: 99%