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Evaluation of the Spies? modalities image quality
摘要： Introduction: The Spies? system (Karl-Storz?) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies? modalities (SM) to the standard white light in an in-vitro model. Materials and Methods: Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urology evaluated each video on a scale of 1 (very bad) to 5 (very good). Results: Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023)). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists. Conclusion: In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.
关键词： Lithotripsy,Diagnosis,Ureteroscopy,Technology
更新于2025-09-23 15:22:29
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Fluorescence in situ hybridization in 1?mL of selective urine for the detection of upper tract urothelial carcinoma: a feasibility study
摘要： Kidney-sparing surgery of upper tract urothelial carcinoma (UTUC) requires a stringent follow-up with frequent ureteroscopies. Triage testing could reduce the number of follow-up ureteroscopies and hence minimize the invasiveness of follow-up. The use of urine-based markers for triage seems appealing but should be feasible with selective urine from outpatient cystoscopy to maximize the reduction of invasiveness. In this study, the feasibility of UroVysion? fluorescence in?situ hybridization (FISH) for the detection of UTUC in 1?mL of selective urine is investigated. Ten consecutive patients with biopsy-proven UTUC and five patients with negative diagnostic ureteroscopy findings were included in this case-control study. During ureteroscopy, 1?mL of selective urine was collected passively with a ureteral splint for Urovysion? FISH. The FISH rater was blinded to any clinical information. The results of FISH were compared to the findings of concomitantly collected selective urine cytology and the patients’ UTUC status. FISH was feasible in all samples with a sensitivity of 90% and a specificity of 80% for UTUC. In comparison, selective cytology resulted in a diagnostic yield of 87% with a sensitivity of 80% and a specificity of 67%. In conclusion,?UTUC detection is feasible with FISH in 1?mL of passively collected selective urine. Thus from a technical point of view, FISH could be used as an outpatient triage test to decide if follow-up ureteroscopy is necessary after kidney-sparing surgery of UTUC. Evaluation of the diagnostic accuracy of FISH for the suggested pathway deserves further attention.
关键词： Ureteroscopy,Urothelial carcinoma,Cystoscopy,Fluorescence in?situ hybridization,Urine cytology,Upper tract urothelial carcinoma
更新于2025-09-23 15:21:21
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Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy
摘要： Introduction: Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use. Aim: To evaluate the risk factors for HLU failure. Material and methods: The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery. Results: Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred. Conclusions: Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.
关键词： lithotripsy,complication,ureteroscopy,ureteral stone
更新于2025-09-23 15:19:57
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Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser
摘要： The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
关键词： urolithiasis,flexible ureteroscopy,infection,Renal rupture,diabetes mellitus
更新于2025-09-19 17:13:59
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Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy
摘要： Objective: To compare Regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and methods: After obtaining ethics approval, a prospective double‐blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either Regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, peri‐ operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero‐no retropulsion to 3‐maximum retropulsion. Results: A total of 72 patients were included in the study (36 per each arm). Both groups were comparable in terms of age, and pre‐operative stone size (1.4 vs. 1.7 cm, p>0.05). When compared with the Regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 vs. 14.2 min; p=0.03) and procedural time (50.9 vs. 41.1 min, p=0.03). However, there were no significant differences in terms of lasing time (7.4 vs. 6.1 min, p>0.05) and total energy applied to the stones (11.1 vs. 10.8 KJ, p>0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs. 0.5, p=0.01). There were no significant differences between both modes in terms of intra‐operative complications (11.1% vs. 8.3%, p>0.05), with one patient requiring endo‐ureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs. 88.4%, p> 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
关键词： technology assessment,ureteroscopy,randomized clinical trial,holmium laser,Laser lithotripsy,outcomes assessment
更新于2025-09-19 17:13:59
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Pulse Modulation for Holmium Laser: Vapor Tunnela??Virtual Basketa??Bubble Blast
摘要： Introduction: New pulse modulations for holmium laser (vapor tunnel, virtual basket, and bubble blast) have been introduced, seeking energy optimization and better ef?ciency for stone lithotripsy. We aim to assess vapor tunnel, virtual basket, and bubble blast effects for stone lithotripsy during ureteroscopy and retrograde intra-renal surgery. Materials and Methods: Seven patients (10 stones) were treated using a 100 W holmium laser generator (Cyber Ho; Quanta System). Three, 272, 372, and 550 lm, ?bers were used. The settings used were 0.3–1.2 J/15–50 Hz, combined with short, medium, and long pulse length. Vapor tunnel, virtual basket, and bubble blast modulations were used during lithotripsy. Results: A smaller retropulsion and a more ef?cient ablation were observed with long pulse in combination with vapor tunnel and virtual basket effects, compared with regular mode fragmentation. No patient presented Clavien III/IV complications. The vapor tunnel technology consists in a long pulse, using the minimum peak power in accordance with selected output settings. The pulse creates a vapor tunnel, the remaining energy passes straight through the previously created tunnel, generating an elliptical shape bubble allowing less retropulsion. Virtual basket is composed of a double pulse emission. The time duration separating the two pulses is chosen so that the second pulse is emitted from the distal tip of the ?ber when the bubble size, and the corresponding amount of displaced ?uid, is at a maximum. The virtual basket emission mode combines a low retropulsion with a fragment suction effect. Bubble blast is a high-energy pulse resulting in the generation of a strong mechanical effect. The physical principle is that the ?rst pulse generates a spherical bubble, the second pulse is emitted after the complete collapse of the ?rst bubble generating a second bubble with bigger volume than the ?rst pulse. This translates theoretically into a frontal and lateral increasing of the shock wave effects on the target. Conclusion: New pulse modulations vapor tunnel, virtual basket, bubble blast lead to retropulsion reduction, lithotripsy optimization, and theoretically to a shorter stone ablation time. Large clinical trials are needed to con?rm their ef?ciency, advantages, and limitations.
关键词： virtual basket,ureteroscopy,bubble blast,vapor tunnel,holmium,laser lithotripsy
更新于2025-09-19 17:13:59
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Effect of ureteral calculus in outpatients receiving semirigid ureteroscope laser lithotripsy
摘要： The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.
关键词： laser,ureteroscopy,urolithiasis,outcome,injury,risk
更新于2025-09-19 17:13:59
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Longitudinal Assessment of Post-Ureteroscopic Laser Lithotripsy Pain and Opioid Consumption using Text Messaging
摘要： Introduction: We identi?ed patterns of postoperative pain and opioid consumption and associated factors following ureteroscopy for kidney stones by acquiring real-time data through automated text messages. Methods: Adult patients undergoing ureteroscopy for kidney stones were prospectively enrolled to receive postoperative pain assessments and opioid consumption inquiries through daily automated text messages. Patients were prompted for pain levels (0 to 10) twice daily and opioid consumption nightly. Univariable and multivariable analyses were performed to identify factors associated with decreased time to pain resolution and increased opioid consumption. Results: Of 62 patients enrolled 46 (74%) completed the study. Median time to pain resolution was 7 days and 75% of patients reported pain of 4 or less by postoperative day 3. Median opioid consumption was 10 pills, 25% of patients consumed no pills and 63% of pills went unused. Higher pain immediately preceding surgery (HR 0.7, p <0.001) and preoperative opioid consumption (HR 0.36, p?0.004) were predictive of increased time to pain resolution. Increased postoperative opioid consumption was associated with increased pain immediately preceding surgery (p <0.001), consumption of opioids at the time of surgery (p?0.001) and increased quantity of opioid consumption at the time of surgery (p <0.001). Preoperative renal drainage was associated with faster pain resolution (HR 2.29, p?0.017) and decreased opioid use (p?0.018). Conclusions: Pain following ureteroscopy peaks on postoperative day 0 and decreases to zero by postoperative day 7, with patients taking a median of 10 opioids in the postoperative period. Preoperative identi?cation of at-risk populations allows for patient speci?c dose escalation of opioids, which may limit future opioid overprescription.
关键词： text messaging,ureteroscopy,pain, postoperative,kidney calculi,analgesics, opioid
更新于2025-09-16 10:30:52
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Identification of Factors Associated with Postoperative Urosepsis after Ureteroscopy with Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy
摘要： Objective: To report the incidence and risk factors of urosepsis after ureteroscopic lithotripsy (URSL). Patients and Methods: We retrospectively reviewed 1,421 patients who underwent URSL for ureteral calculi between July 2015 and June 2018 at our department to identify factors predicting postoperative urosepsis. Demographic characteristics, clinical data, operative information, and complications were compared, and risk factors of postoperative urosepsis were identified and analyzed. Results: Of the 1,421 patients treated with URSL using holmium: yttrium-aluminum-garnet laser, 12 (0.8%) developed a urosepsis after operation. The positive preoperative multidrug resistance (MDR) urine culture and operative duration were statistically different between those who did and did not develop a urosepsis (4.61 vs. 25%, p = 0.017; 70 vs. 62 min, p < 0.001). However, patient age, sex, body mass index, diabetes mellitus, history of urolithiasis, positive preoperative urine cultures, stone size and location, degree of hydronephrosis, and prior stent placement were similar in 2 groups. Multivariate analysis revealed that positive preoperative MDR urine culture and long operation duration significantly increased the risk of postoperative urosepsis (OR 5.090, 95% CI 1.312–19.751, p = 0.019; OR 1.034, 95% CI 1.004–1.063; p = 0.024). Matched-pair analysis demonstrated that positive preoperative MDR urine culture and operation duration were significantly associated with postoperative urosepsis (OR 15.77, 95% CI 1.033–240.7, p = 0.047; OR 1.087, 95% CI 1.011–1.169, p = 0.025). Conclusions: Patients with positive preoperative MDR urine culture or long operation duration had a higher risk of developing urosepsis after URSL. When treating patients who present with positive preoperative MDR urine culture or long operation duration, urologists should be vigilant and aware of the potential risk of urosepsis.
关键词： Ureteroscopy,Urosepsis,Lithotripsy,Complication,Risk factors
更新于2025-09-16 10:30:52
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Defining thermally safe laser lithotripsy power and irrigation parameters: in vitro model
摘要： Introduction: High-power laser settings are commonly employed for stone dusting techniques. Previous in vitro and in vivo studies have demonstrated that a toxic thermal dose can result from treatment within a renal calyx without adequate irrigation. Hence, both laser power and irrigation rate must be considered together to determine safe laser lithotripsy parameters. The objective of this in vitro study was to map parameter safety boundaries and create guidelines for selection of safe laser and irrigation settings. Methods: The experimental system consisted of in vitro models simulating ureter, renal calyx, and renal pelvis placed in a water bath maintained at 37°C. Temperature was recorded during ureteroscopy with laser activation for 60 seconds. Trials were conducted at strategically selected power levels and irrigation rates. Thermal dose for each trial was calculated based on Dewey and Sapareto t43 methodology with thermal dose > 120 equivalent minutes considered to result in thermal tissue injury. A parameter safety boundary was established by plotting the maximal safe power level for each irrigation rate. Results: The parameter safety boundary was found to be linear for each scenario with the renal pelvis able to tolerate the highest laser power and the renal calyx the least power without injury. Conclusion: This study describes methodology to determine parameter safety boundaries that can be used to guide proper selection of thermally safe laser settings and irrigation rates during ureteroscopy with laser lithotripsy. This work provides a framework to assess the effectiveness of various strategies to control and mitigate thermal dose.
关键词： Ureteroscopy,Holmium Laser,Temperature,Laser Lithotripsy
更新于2025-09-12 10:27:22