The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

UreteroPyeloVisClear catheter: a new frontier in ureteroscopic lithotripsy for ureteral stones

Conventional semirigid ureteroscopy for ureteral stones faces challenges such as stone retropulsion, poor intraoperative vision, and elevated intrarenal pressure. This study evaluates the safety and efficacy of a novel multi-channel negative pressure suction catheter (UreteroPyeloVisClear Catheter, VCC) in ureteroscopic lithotripsy. To compare the performance of VCC with conventional rigid ureteroscopy, this study evaluated operative time, stone clearance rates, and complication incidence between VCC and traditional semirigid ureteroscopy. A prospective cohort study included 42 patients with ureteral stones (diameter ≤ 2.0 cm), randomized into VCC (n = 21) and traditional (n = 21) groups. The VCC group utilized an integrated negative pressure suction and active water circulation system, while the traditional group used standard semirigid ureteroscopy. The primary outcome was operative time, with secondary outcomes including stone clearance rates, retropulsion incidence, basket utilization, and complication rates. The VCC group demonstrated significantly shorter operative time (39.95 ± 10.24 vs. 53.00 ± 26.95 min, p = 0.001) and reduced basket utilization (5% vs. 57%, p < 0.001). Stone retropulsion rates were lower in the VCC group (5% vs. 14%, p = 0.294), though not statistically significant. Both groups achieved 100% stone-free rates at 1 month. Postoperative pain scores (VCC: 0.90 ± 1.36 vs. traditional: 1.24 ± 1.49) and complication rates (0% vs. 5%) showed no significant differences. The VCC significantly reduces operative time and reliance on auxiliary instruments while maintaining safety and stone-free outcomes. Its innovative design addresses key limitations of traditional ureteroscopy, offering a promising advancement for ureteral stone management.

The role of suction devices in enhancing outcomes of retrograde intrarenal surgery: a narrative review by the YAU urolithiasis and section of EAU endourology

PURPOSE OF REVIEW

To provide a comprehensive overview of existing literature on suction-assisted ureteroscopy, evaluating its effectiveness and associated complications.

RECENT FINDINGS

A literature review was conducted in December 2024 using the MEDLINE, EMBASE and Scopus databases by two independent authors. To structure and address the clinical question, "Do suction devices improve outcomes in RIRS?", we employed the PICOS (Patient, Intervention, Comparison, Outcome, Study Type) model. Exclusion criteria included case reports, studies involving suction techniques outside the context of endocorporeal laser lithotripsy (ELL), non-English language articles and articles or clinical trials with fewer than 15 patients.

SUMMARY

Among the 36 included studies, 28 studies focused on SUAS, of which seven specifically investigated SUAS with pressure measurement, three studies examined DISS, three studies evaluated SURE and two comparative studies analyzed different suction techniques. The presented results show that advancements in suction technology seem very promising and likely to shift endourological practice.

Comparison of suction technique and non-suction technique in retrograde intrarenal stone surgery: a systematic review and meta-analysis

OBJECTIVE

To evaluate the clinical efficacy of retrograde intrarenal stone surgery (RIRS) using the vacuum suction technique for the treatment of upper urinary calculi.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Sino Med, CNKI, WANFANG DATA, and Cochrane. We included studies comparing vacuum suction RIRS with non-vacuum RIRS. Following the PRISMA guidelines, we performed a meta-analysis of the selected studies. Inclusion criteria were randomized controlled trials (RCTs), case-control studies, and retrospective studies evaluating the efficacy of these techniques. Key outcomes analyzed included operative time, hospitalization duration, stone-free rates, and complication rates. Statistical analyses were conducted using mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI).

RESULTS

Sixteen studies (6 RCTs, 1 case-control study, and 9 retrospective studies) involving a total of 2029 patients were included. Meta-analysis revealed that the vacuum suction technique significantly reduced operative time (MD = - 14.45 min, 95% CI [- 18.45; - 10.44], P < 0.00001) and hospital stay (MD = - 0.54 days, 95% CI [- 0.80; - 0.28], P < 0.00001). In addition, patients in the vacuum suction group had a higher stone-free rate (OR = 3.57, 95% CI [2.57; 4.95], P < 0.00001) and lower complication rates, particularly in reducing postoperative fever.

CONCLUSION

The application of the vacuum suction technique in RIRS significantly improves clinical outcomes by reducing operative time and hospitalization duration, enhancing stone-free rates, and lowering postoperative complication rates. This technique demonstrates a clear clinical advantage over non-vacuum RIRS and should be considered a preferred option for the management of upper urinary tract stones.

Vacuum suction catheter semi-rigid ureteroscopic laser lithotripsy for impacted upper ureteral stones: randomized controlled trial

PURPOSE

To evaluate the effectiveness and safety of an upgraded integrated vacuum suction catheter in semi-rigid ureteroscopic laser lithotripsy (VC-URSL) compared to traditional methods for treating impacted upper ureteral stones.

PATIENTS AND METHODS

This prospective, randomized controlled trial was conducted from September 2022 to March 2024 at a single center, enrolling 95 patients aged 18-70 years with a single radiopaque impacted upper ureteral stone. Participants were randomized into two groups: the VC-URSL group used an integrated vacuum suction catheter featuring a stainless steel stabilizing tube and a narrowed distal end to prevent obstruction, while the T-URSL group underwent standard ureteroscopic lithotripsy without vacuum assistance. Both groups utilized a holmium-YAG laser under general anesthesia. Primary outcomes included operative time, stone-free rates on the first postoperative day and after one month, and complication rates, specifically fever and stone retropulsion.

RESULTS

The VC-URSL group achieved significantly shorter operative times (37.60 ± 3.87 min vs. 46.21 ± 7.54 min, P < 0.001) and higher initial stone-free rates (91.7% vs. 74.5%, P = 0.025) compared to T-URSL. Additionally, the VC-URSL group had fewer complications, with lower rates of fever (2.1% vs. 17.0%, P = 0.015) and stone retropulsion (6.3% vs. 21.3%, P = 0.033).

CONCLUSIONS

VC-URSL offers a more effective, safer, and efficient alternative to T-URSL, enhancing outcomes while reducing complications. Further multicenter trials with larger populations are recommended for broader validation.

Suction use in ureterorenoscopy: A systematic review and meta-analysis of comparative studies

Objectives

Ureterorenoscopy is seeing a bloom of technological advances, one of which is incorporating suction. The objective of this study is to systematically review existing literature regarding suction use in rigid and flexible ureterorenoscopy and perform meta-analysis of studies comparing suction versus no suction ureteroscopy or mini percutaneous nephrolithotomy (PCNL).

Methods

A literature search was performed (November 2023) in MEDLINE, Embase and Cochrane CENTRAL. Study protocol was registered at PROSPERO (CRD42023482360). Comparative studies (observational and randomized) were eligible for inclusion if they compared suction versus no suction group and reported at least one primary outcome of interest (stone-free or complication rate).

Results

Sixteen studies (5 randomized and 11 observational), analysing 1086 and 1109 patients in standard and suction groups, respectively, were included. Final stone-free rates (SFRs), overall and infectious complications and length of hospital stay exhibited significant improvement when suction was used. When mini-PCNL was compared with flexible ureterorenoscopy with suction, no differences were found in terms of stone-free and infectious complications rates.

Conclusions

Ureterorenoscopy is a commonly performed endoscopic procedure for urolithiasis treatment, the success of which is defined by SFRs and complication rates. Application of suction via ureteral access sheaths, ureteral catheters or scopes may provide improved SFRs, reduced overall and infectious complication rates, along with a reduction in length of hospital stay. Further randomized studies are needed to validate these findings and standardize indications and protocols.

Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review

OBJECTIVE

To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones.

BASIC PROCEDURES

A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded.

MAIN FINDINGS

Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure.

CONCLUSION

Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

Evaluation of the efficacy of ureteroscopic lithotripsy for proximal impacted ureter stones based on a new scoring standard: a bicentric matched-pair analysis

OBJECTIVE

To evaluate the clinical efficacy of ureteroscopic lithotripsy (URSL) in the treatment of proximal impacted ureter stones (PIUS) based on a new scoring standard in two medical centers.

METHODS

The data of 45 patients with Complicated PIUS (total stone score ≥ 3) and 350 with Simple PIUS (total stone score < 3) who underwent URSL were collected in this retrospective study between January 2015 and June 2022. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was > 2 cm, stone density was > 1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the Complicated stone case was defined as a total stone score ≥ 3; the Simple stone case was defined as a total stone score < 3. During the same period, 45 patients were selected from the patients with Simple stone cases as the control group, matched at a 1:1 ratio to index Complicated stone cases with regard to age, sex, and BMI. Perioperative data were compared between the two groups.

RESULTS

All 90 operations were successfully completed. Compared to the Simple cases group, the surgical duration of the Complicated group was significantly longer (59.69 ± 28.06 min vs. 73.46 ± 27.12 min, p < 0.05), and stone-free rate (SFR) was significantly lower (88.89 vs. 68.9%, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in Complicated cases group vs. 8.9% in Simple cases group, p = 0.037). As for the length of the hospital stay and the total treatment cost, the two groups have no difference.

CONCLUSION

For Simple stone cases, URSL had a better SFR and higher surgical efficacy, whereas complicated stone cases had a high complication rate and long operation time. Thus, we suggest that URSL is the preferred choice for Simple stone cases rather than complicated stone cases.

Comparison of the Efficacy of Different Surgical Approaches for Complicated Impacted Proximal Ureteral Calculi Based on a New Scoring Standard: A Matched-Pair Analysis

Objective: To compare the clinical efficacy of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) in the treatment of complicated impacted proximal ureteral calculi using a new scoring standard. Methods: The data of 45 patients with complicated impacted proximal ureteral calculi (score ≥3 points) who underwent URSL were collected in this retrospective study between January 2015 and April 2021. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was >2 cm, stone density was >1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the complicated stone case was defined as a total stone score ≥3 points. During the same period, PCNL was used in 171 patients with complicated impacted proximal ureteral calculi. Forty-five patients were selected as the control group and matched at a 1:1 ratio to index URSL cases regarding age, sex, and body mass index. Perioperative data were compared between the two groups. Results: All 90 operations were completed effectively. Compared to the URSL group, the surgical duration of the PCNL group was significantly shorter (53.69 ± 25.07 vs 73.46 ± 27.12 minutes, p < 0.05), stone-free rate (SFR) was significantly higher (93.3% vs 68.9%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs US $3901.45 ± 1069.46, p < 0.05). Conversely, the URSL group had a shorter hospital stay (3.68 ± 2.70 vs 6.39 ± 3.34 days, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in URSL group vs 8.9% in PCNL group, p = 0.037). Conclusion: PCNL had a better SFR and higher surgical efficacy, whereas URSL had a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureteral calculi.

Development and validation of a predictive model for treatment outcome after emergency extracorporeal shockwave lithotripsy in patients with symptomatic ureteral stones during the COVID-19 pandemic: in a large prospective cohort

The predictors of treatment outcome after emergency extracorporeal shockwave lithotripsy (SWL) are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting treatment outcome after emergency SWL in patients with symptomatic ureteral stones. The development cohort included 358 patients with symptomatic ureteral stones who underwent emergency SWL between June 2020 and August 2021 in our hospital. One hundred and twenty-nine patients with symptomatic ureteral stones participated in the validation cohort from September 2021 to April 2022. The data were prospectively recorded. The backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 15.6% (56/358) of patients in the development cohort and 14.0% (18/129) of those in the validation cohort suffered from stone-free failure after emergency SWL. We identified four predictors for stone-free failure: stone size, stone density, skin to stone distance (SSD), and degree of hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic (AUROC) curves of 0.935 (0.899-0.971) and good calibration (P = 0.059). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that stone size, stone density, SSD, and degree of hydronephrosis were predictors of treatment outcome after emergency SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of patients may increase the success rate of emergency SWL during the COVID-19 pandemic.

The Evaluation of Clinical Status of Endoscopic Retrograde Cholangiography for the Placement of Metal and Plastic Stents in Cholangiocarcinoma Therapy

Objective

Cholangiocarcinoma is a common malignant tumor that occurs in the bile duct system, which can be treated by using the endoscopic retrograde cholangiography (ERCP). This study was aimed at exploring the therapeutic effect of ERCP with metal stent and plastic stent for cholangiocarcinoma.

Methods

The clinical data of 71 patients with cholangiocarcinoma treated by ERCP in our hospital from June 2020 to October 2021 were retrospectively analyzed. According to different stent types, the patients were divided into plastic stent group (n = 43) and metal stent group (n = 28). Patients in the plastic stent group and metal stent group were received with plastic stent and metal stent, respectively. The indexes of liver function (serum alkaline phosphatase (ALT), direct bilirubin (DBIL), glutamic oxaloacetic transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL)), postoperative complications, success rate of stent implantation, and survival time of patients in the two groups were determined. Logistic multivariate regression analysis was used to analyze the prognostic factors of postoperative cholangiocarcinoma.

Results

The liver function indexes of the two groups were significantly improved after treatment with the stent, in which the ameliorative effect in the metal stent group was better than that in the plastic stent group (P < 0.05). The incidence of postoperative complications in the plastic stent group and the metal stent group was 53.49% and 14.29%, respectively, and the success rate of stent placement was 60.47% and 96.43%, respectively. The incidence of complications in the metal stent group was lower than that in the plastic stent group, and the success rate of stent placement was higher than that in the plastic stent group (P < 0.05). The median survival time of patients in the plastic stent group and the metal stent group was 8.15 and 11.83 months, respectively. The survival time of patients in the metal stent group was longer than that of the plastic stent group. The median survival time of patients with types I, II, III, and IV was 12.73, 11.54, 10.57, and 9.36 months, respectively. The survival time of patients with stage I was significantly higher than that of patients with types II, III, and IV. There was an inverse relationship between the disease type and the survival time of patients. Logistic multivariate regression analysis showed that tumor diameter ≥ 5 cm, portal vein invasion, lymph node metastasis, and classification of hilar cholangiocarcinoma were the risk factors (P < 0.05) and metal stent type was the protective factor (P < 0.05).

Conclusion

In the clinical treatment of patients with cholangiocarcinoma, the placement of metal stent and plastic stent under ERCP plays an important role. The placement of the metal stent under ERCP has a higher success rate and better prognosis and can prolong the survival time of patients to a greater extent, but the price of the metal stent is relatively expensive. For patients with an expected survival period of more than 4-6 months, the metal stent should be considered; otherwise, the plastic stent can be used to maintain cost-effectiveness. Therefore, it is necessary to comprehensively analyze the patient's economic affordability, expected survival time, stent drainage time, and personal needs and then select an appropriate treatment method.

Comparison of Fragmentation and Dusting Modality Using Holmium YAG Laser during Ureteroscopy for the Treatment of Ureteral Stone: A Single-Center's Experience

Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies comparing the different energy and frequency settings for URSL in a single center. We compared these two laser modalities, which were simultaneously used in our medical center for the treatment of ureteral stones. Patients who underwent fragmentation or dusting laser URSL between September 2018 and June 2020 were retrospectively reviewed. We compared patients who underwent fragmentation and dusting laser and assessed the enhancing factors for stone free rate. There were a total of 421 patients with ureteral stones who met the study criteria. There was no significant difference between the characteristics of both groups. The fragmentation group had a better stone free rate and a lower retropulsion rate compared with the dusting group. Multivariate analysis revealed that stone basket use, no upper ureteral stone or pyuria significantly improved the stone free rate. Both laser modes were effective and safe for ureteral lithotripsy although the fragmentation system showed slightly higher effectiveness and lower complication rate.

Renal pelvis mucosal artery hemorrhage after percutaneous nephrolithotomy: a rare case report and literature review

BACKGROUND

Following a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure.

CASE PRESENTATION

This clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled.

CONCLUSIONS

This case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.

Clinical Observation of MRI Image in Floating Needle Therapy for Cervical Spondylosis of Cervical Type

In order to solve the problem of cervical spondylosis in the early stage of various cervical spondylosis, effective treatment can prevent the deterioration of the disease. This paper presents the results of a clinical trial examining magnetic resonance imaging in the treatment of cervical spondylosis with flotation therapy and selected 68 patients with cervical spondylosis. According to research commodity, using a rigorous randomized controlled trial, 34 cases were divided into a control group (acupuncture group). The needles were kept for 30 minutes once a day. The treatment group (acupuncture combined with floating acupuncture group) was treated with acupuncture on the 1st, 3rd, and 5th days and floating acupuncture on the 2nd, 4th, and 6th days, respectively. Both groups were treated for 6 consecutive days and rested for 1 day. After 2 weeks of treatment, the simplified McGill Pain Scale (MPQ), visual analogue scale (VAS), and neck pain scale (NPQ) were observed and recorded to compare the curative effects. Finally, Excel software is used to manage the data, and SPSS21.0 is used for statistical analysis. Measurements of gender, age, disease, VAS, simple MPQ, and NPQ of the two groups were compared in the two groups, P > 0.05, which was not significant and comparable. After treatment, VAS, simple MPQ, and NPQ of the two groups were compared in and between groups, the total P < 0.05, with the mean data. Topics. Acupuncture combined with float needle and acupuncture therapy can improve the pain and breathing of cervical spondylosis and improve the quality of life of patients, but acupuncture combined with needle float is more pronounced than acupuncture groups.