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Kallidonis P, Peteinaris A, Veneziano D, Pietropaolo A, Pagonis K, Adamou C, Vagionis A, Al-Aown A, Liatsikos E, Somani B. Use of artificial stones in training and laboratory studies, have we found the right material? Outcomes of a systematic review from the European School of Urology. Urol Ann 2024; 16:43-51. [PMID: 38415239 PMCID: PMC10896332 DOI: 10.4103/ua.ua_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/12/2022] [Indexed: 02/29/2024] Open
Abstract
Objective In this review, we investigated the current literature to find out which artificial stones (AS) are available in endourology, and in which experimental and training schemes they are used. Materials and Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Twenty-one out of 346 studies met our inclusion criteria and are presented in the current review. The inclusion criteria were the existence of AS and their use for laboratory and training studies. Results There is a wide variety of materials used for the creation of AS. BegoStone powder (BEGO USA, Lincoln, Rhode Island) and plaster of Paris™ were used in most of the studies. In addition, Ultracal-30 (U. S. Gypsum, Chicago, IL) was also used. Other materials that were used as phantoms were AS created from plaster (Limbs and Things, UK), standardized artificial polygonal stone material (Chaton 1028, PP13, Jet 280; Swarovski), model stones consisting of spheres of activated aluminum (BASF SE, Ludwigshafen am Rhein, Deutschland), Orthoprint (Zhermack, Badia Polesine, Italy), and a combination of plaster of Paris, Portland cement, and Velmix (calcium sulfate powder). Many experimental settings have been conducted with the use of AS. Our research demonstrated nine studies regarding testing and comparison of holmium: yttrium-aluminum-garnet laser devices, techniques, and settings. Six studies were about extracorporeal shock wave lithotripsy testing and settings. Three experiments looked into treatment with percutaneous nephrolithotomy. Additionally, one study each investigated imaging perioperatively for endourological interventions, stone bacterial burden, and obstructive uropathy. Conclusion AS have been used in a plethora of laboratory experimental studies. Independent of their similarity to real urinary tract stones, they present a tremendous potential for testing and training for endourological interventions.
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Affiliation(s)
| | | | - Domenico Veneziano
- Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy
- School of Medicine, Hofstra Northwell University, New York, USA
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | | | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Rion, Patras, Greece
- Medical University of Vienna, Vienna, Austria
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Cauni VM, Tanase F, Mihai B, Gorecki GP, Ples L, Sima RM, Persu C. Single-Center Experience with Swiss LithoClast ® Trilogy for Kidney Stones. Diagnostics (Basel) 2023; 13:diagnostics13081372. [PMID: 37189473 DOI: 10.3390/diagnostics13081372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION PCNL remains the gold standard for larger kidney stones. Reducing the operating time of PCNL and its complication rate seems to be the next logical step in optimizing this classical technique. To achieve these objectives, some new methods of lithotripsy emerge. We present the data of a single, high-volume, academic center with combined ultrasonic and ballistic lithotripsy in PCNL using the Swiss LithoClast® Trilogy device. MATERIALS AND METHODS We designed a prospective, randomized study including patients who underwent PCNL or miniPerc with lithotripsy using the new EMS Lithoclast Trilogy or EMS Lithoclast Master. The procedure was carried out with all patients in prone position, by the same surgeon. The working channel size was 24 Fr-15.9 Fr. We evaluated the stones' features, operative time, fragmentation time, complications, stone clearance rate and stone-free rate. RESULTS Our study included 59 patients, 38 females and 31 males, of an average age of 54.5 years old. The Trilogy group included 28 patients and the comparator included 31 patients. Urine culture was positive in seven cases which required seven days of antibiotics. The mean stone diameter was 35.6 mm with a mean Hounsfield unit (HU) of 710.1. The average number of stones was 2.08 (6 complete staghorn stones and 12 partial staghorn stones). A total of 13 patients presented a JJ stent (46.4%). We found a very significant difference in all the parameters favoring the Trilogy device. The most important result in our opinion is the probe active time, which was almost six times shorter in the Trilogy group. The stone clearance rate was about double in the Trilogy group, leading to shorter overall and intra-renal operating times. The overall complication rate was 17.9% in the Trilogy group and 23% in the Lithoclast Master group. The mean hemoglobin drop was 2.1 g/dL with a mean creatinine rise of 0.26 mg/dL. CONCLUSIONS Swiss LithoClast® Trilogy, a device combining ultrasonic and ballistic energy, is a safe and efficient method of lithotripsy for PCNL, proving statistically significant benefits over its predecesor. It can achieve the goal of reducing complication rates and operative times for PCNL.
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Affiliation(s)
- Victor-Mihail Cauni
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Florin Tanase
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Mihai
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Bucur" Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Bucur" Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Cristian Persu
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
- Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Mykoniatis I, Pyrgidis N, Tzelves L, Pietropaolo A, Juliebø-Jones P, De Coninck V, Hameed BMZ, Chaloupka M, Schulz GB, Stief C, Kallidonis P, Somani BK, Skolarikos A. Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies. World J Urol 2023; 41:551-565. [PMID: 36656331 DOI: 10.1007/s00345-023-04278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis. METHODS We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631). RESULTS We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82 min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification. CONCLUSIONS SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.
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Affiliation(s)
- Ioannis Mykoniatis
- First Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.,University College of London Hospitals NHS Foundation Trust, London, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Amelia Pietropaolo
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Belthangady M Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Gerald Bastian Schulz
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | | | - Bhaskar K Somani
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.
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4
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Natsos A, Tsaturyan A, Peteinaris A, Adamou C, Pagonis K, Bravou V, Koumoundourou D, Vrettos T, Kagadis G, Giannitsas K, Kallidonis P, Liatsikos E. Clearance of Metal Particles After Percutaneous Nephrolithotomy with Trilogy Lithotripter. J Endourol 2023; 37:15-20. [PMID: 35972730 DOI: 10.1089/end.2022.0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: To evaluate the clearance of metal particles produced and released in the pelvicaliceal system (PCS) during percutaneous nephrolithotomy (PCNL) with the use of the Swiss Lithoclast® Trilogy dual-energy (EMS Urology, Nyon, Switzerland) lithotripter. Methods: An experimental in vivo study and a clinical investigation of case series were conducted. An in vivo porcine model with two pigs for lithotripsy (after inserting artificial stones into the collecting system) and two pigs for submucosal injection of metal particles (provided by the manufacturer of Trilogy) was conducted. Porcine kidney histology analysis for metal leftovers was conducted immediately or 2 weeks after the surgery. A prospective observational study design included 10 consecutive patients treated with conventional 30F PCNL or with 22F mini-PCNL technique. Only the patients with the confirmed metal particles in the PCS during the initial PCNL and the need for additional retrograde intrarenal surgery over a period of 2-4 weeks were selected. The presence of metal particles was evaluated during the second endoscopic surgery. Results: The generated metal particles during PCNL and the submucosally injected particles were not found macroscopically 2 weeks postoperatively in porcine models. No pathologic changes such as foreign body granuloma or inflammation were found. Similarly, no metal particles were observed during the second look endoscopy (n = 10). Conclusion: Metal particles observed endoscopically using the Trilogy lithotripter are cleared with no pathologic evidence of tissue damage from the metal particles 2 weeks after the procedure. Thus, the intraoperative release of any particle by the Trilogy lithotripter should not raise any safety concerns.
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Affiliation(s)
- Anastasios Natsos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | | | | | - Vasiliki Bravou
- Department of Pathology, University Hospital of Patras, Patras, Greece
| | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - George Kagadis
- Department of Medical Physics, University Hospital of Patras, Patras, Greece
| | | | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria
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5
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O'Connor CJ, Hogan D, Yap LC, Lyons L, Hennessey DB. An ex-vivo assessment of a new single probe triple modality (Trilogy) lithotripter. World J Urol 2022; 40:2561-2566. [PMID: 36001137 PMCID: PMC9512712 DOI: 10.1007/s00345-022-04127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and objectives This Swiss LithoClast® Trilogy lithotrite is a new lithotrite for percutaneous nephrolithotomy (PCNL). It has four modifiable settings; impact, frequency, ultrasound and suction. We aim to determine the optimal device settings for the fastest stone clearance. Materials and methods Kidney stone phantoms were made with Begostone in a powder to water ratio (15:3–15:6). Complete stone clearance (seconds) was calculated and impact and frequency were adjusted and repeated N = 3. Intra renal pressure (IRP) was then measured in a porcine kidney model. Results Stone phantoms with physical properties similar to struvite were cleared best with 100% impact and frequency of 12 Hz. Both uric acid stone phantoms and calcium phosphate stone phantoms were cleared most efficiently with an impact of 30% and a frequency of 4 Hz. The mean time to clear uric acid stone phantoms was 83 s versus 217 s for calcium phosphate stone phantoms. Similarly, for calcium oxalate stone phantoms, an impact of 30% and a frequency of 4 Hz was associated with the fastest clearance time, mean 204 s. However, the differences between 4, 8 and 12 Hz were not statistically significant. At a suction level of 60% or higher, IRP became negative. Conclusion These results indicate that stone phantoms of hard kidney stones are cleared more efficiently at lower impact and frequency settings. With regard to suction, a setting of ≤ 50% appears to be the optimal setting.
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Affiliation(s)
| | - Donnacha Hogan
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Lee Chien Yap
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Louise Lyons
- Department of Urology, Mercy University Hospital, Cork, Ireland
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6
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Lithotripsy devices for percutaneous nephrolithotomy (PNL) - new developments. Curr Opin Urol 2022; 32:405-410. [PMID: 35674683 DOI: 10.1097/mou.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PNL) is the mainstay of surgery for renal calculi>2 cm or complex multiple calculi and is a technique that has been around since 1976. We review recent literature surrounding novel lithotripsy devices and technology used in PNL. RECENT FINDINGS At present, the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is widely accepted as the gold standard laser lithotripsy for PNL. SwissLithoClast Trilogy offers a range of probes with a trifecta of electromagnetic, ultrasonic energy with surgeon-controlled suction. The Olympus Shockpulse-SE is a similar lithotripter that relies on continuous ultrasonic energy with pulsed ballistic energy to break stones. Thulium Fiber Laser (TFL) offers an alternative laser energy source to the Holmium laser, which has been shown to be very effective at producing small stone fragments and dust. The Moses technology is another addition in a long list of improvements to the Ho:YAG laser, forming vaporization bubble through which more effective energy can be applied to stones. SUMMARY Trilogy, Shockpulse, TFL and Moses pulse modulation technology for the Holmium laser all provide improvements compared with older lithotripsy devices. In particular, they convey a safer, efficient and more effective way to manage and clear stones.
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7
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Thakare N, Tanase F, Saeb-Parsy K, Atassi N, Endriss R, Kamphuis G, Pérez-Fentes D, Hasan M, Brehmer M, Osther P, Jung H, Turney B, Finch W, Burgess N, Irving S, Dragos L, Liatsikos E, Knoll T, Cauni V, Wiseman O. Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology. World J Urol 2021; 39:4247-4253. [PMID: 33991214 PMCID: PMC8122211 DOI: 10.1007/s00345-021-03710-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). Methods Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective). Results One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. Conclusions We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.
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Affiliation(s)
- N Thakare
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - F Tanase
- Department of Urology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19-21, Bucharest, Romania
| | - K Saeb-Parsy
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N Atassi
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - R Endriss
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - G Kamphuis
- Amsterdam UMC Locatie AMC, Department of Urology, Amsterdam University Medical Center, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands
| | - D Pérez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - M Hasan
- Department of Urology, Danderyd University Hospital, Stockholm, Sweden
| | - M Brehmer
- Department of Urology, Danderyd University Hospital, Stockholm, Sweden
| | - P Osther
- Lillebaelt Hospital, Department of Urology, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark
| | - H Jung
- Lillebaelt Hospital, Department of Urology, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark
| | - B Turney
- The Churchill Hospital, Oxford, OX3 7LJ, UK
| | - W Finch
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - N Burgess
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - S Irving
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - L Dragos
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - E Liatsikos
- Department of Urology, University Hospital, University of Patras, Rio, 26500, Patras, Greece
| | - T Knoll
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - V Cauni
- Department of Urology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19-21, Bucharest, Romania
| | - O Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Lattarulo M, Tsaturyan A, Adamou C, Pagonis K, Peteinaris A, Vagionis A, Liourdi D, Vrettos T, Simeone C, Liatsikos E, Kallidonis P. Comparative Evaluation Between One Ultrasonic and Two Single-Probe Dual-Energy Lithotripters: In Vitro and In Vivo Experiment in a Porcine Model. J Endourol 2021; 35:1229-1235. [PMID: 33573470 DOI: 10.1089/end.2020.1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To investigate the efficiency of three advanced lithotripters during the treatment of artificial stones (hard and soft) in an experimental in vitro and in vivo setting. Materials and Methods: An experimental configuration was created to treat artificial stones, made from BegoStone Plus in a weight ratio of 15:3 or 15:6 powder to water, replicating hard and soft urinary stones, respectively. Experimental data of three lithotripters, the Lithoclast Master, the Lithoclast Trilogy, and the ShockPulse-SE, were assessed. Experiments aimed at comparing the stone clearance times (SCTs) of the devices as well as different probe diameters, probe disposability, and hardness of the stones. The in vivo experiment was performed in a porcine model after the approval from the State Services. Before in vivo lithotripsy, stones had been placed through percutaneous access established by using the Bull's eye technique. The SCT between the Lithoclast Trilogy and the ShockPulse-SE was compared. Results: All the devices were statistically more efficient in the treatment of soft stones in both in vitro (p < 0.001) and in vivo settings (p < 0.008). The use of larger-diameter probes resulted in shorter SCT (p < 0.007). The disposable probes of the ShockPulse-SE showed higher performance than the multiple-use probes (p < 0.05). In the direct comparison between the devices, the Lithoclast Trilogy was found to be the fastest during all the in vitro (p < 0.001) and in vivo (p < 0.008) trials. Conclusion: Modern dual-energy lithotripters proved to possess high performance in the treatment of stones. Faster SCTs were observed by using the larger-diameter and disposable probes. The Lithoclast Trilogy was superior in terms of SCT over all the experimental settings compared with other lithotripters.
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Affiliation(s)
- Marco Lattarulo
- Department of Urology, University of Patras, Patras, Greece.,Urology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | | | | | | | - Despoina Liourdi
- Department of Urology, University of Patras, Patras, Greece.,Department of Internal Medicine, Agios Andreas General Hospital, Patras, Greece
| | - Theofanis Vrettos
- Department of Anaesthesiology and ICU, University of Patras, Patras, Greece
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria
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9
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Strittmatter F, Nagele U, Schachtner J, Bader MJ. Evaluation of intrarenal pressure stability at different lithotripter suction settings in a porcine kidney model. World J Urol 2021; 39:3665-3670. [PMID: 33774719 DOI: 10.1007/s00345-021-03679-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/20/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Using the Swiss LithoClast® Trilogy, urinary stones can be fragmented and removed simultaneously by suction at different selectable suction settings. The aim was to evaluate pressure stability at different settings and test stone fragmentation and suction at the optimal settings. METHODS In an ex vivo porcine kidney model, we recorded intrarenal pressure levels with different suction levels. Storz® Nephroscopes MIP-M and MIP-L and Swiss LithoClast® Trilogy probes were used. RESULTS Pressure stabilized at 19 cm H2O with the MIP-M at 1 m gravity irrigation with no instrument introduced. After inserting the 1.5 mm probe, the pressure dropped to 5 cm H2O. With a suction setting of 10%, the pressure stabilized at 3 cm H2O and remained stable for the maximum time of 120 s. After increasing the suction to 20, 30, 40, and 50%, we recorded the pressure drop time to 0 after 22, 14, 11, and 8 s. Using the MIP-L, pressure stabilized at 44 cm H2O and decreased to 8 cm H2O after inserting the 3.4 mm probe. With 10% suction, a pressure stabilization was measured at 2 cm H2O and remained stable for 120 s. At suction levels of 20 and 30%, the pressure drop time to 0 was 6 and 5 s. With a 10% suction, removing stones was efficient, and the kidney's filling volume was maintained. CONCLUSIONS When using the LithoClast® Trilogy, a suction setting of 10% seems to be optimal for the treatment of urinary calculi when applying suction continuously.
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Affiliation(s)
- Frank Strittmatter
- Department of Urology, University Hospital of Munich, Marchioninistr 15, 8137, Munich, Germany.
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Jörg Schachtner
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
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10
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Perkutane Nephrolithotomie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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