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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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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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Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
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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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Does combined lithotripter show superior stone-success rate than ultrasonic or pneumatic device alone during percutaneous nephrolithotrotomy? A meta-analysis. Int J Surg 2022; 98:106223. [PMID: 34990832 DOI: 10.1016/j.ijsu.2021.106223] [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: 07/28/2021] [Revised: 11/02/2021] [Accepted: 12/31/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare the stone clearance rate and stone-success rate among lithotripter with ultrasonic lithotripter alone, pneumatic lithotripter alone and combined mechanisms. METHODS Up till 2021 May, we conducted a literature search among several widely used database around the world, including Pubmed, Embase (Ovid Version), Medline (Ovid Version) and Cochrane Central Register of Controlled Trials. Only English literature was considered. Pediatric patients were excluded. Reviews and protocols without any published data were excluded. Conference abstracts and articles with unrelated contents were also excluded. RESULTS Fifteen articles were included in our final meta-analysis, with 9 RCTs and 6 cohort studies. In Lithoclast combined with ultrasonic device vs pneumatic device subgroup, overall stone-success rate yielded insignificant difference. As for subgroup of Shock Pulse vs pneumatic device, pooled analysis yielded a higher 1-month stone-success rate for Shock Pulse (RR = 1.10, 95% CI: 1.01-1.19). In Lithoclast combined with ultrasonic device vs ultrasonic device subgroup and Cyberwand vs ultrasonic device subgroup, both overall stone-success rate did not differ from one another. We found Lithoclast with ultrasonic device was more efficient in stone clearance rate than pneumatic device (mean difference = 8.23, 95% CI: 4.99-11.47). The same situation was applied to the comparison between Lithoclast with ultrasonic device and ultrasonic device (mean difference = 13.02, 95% CI: 4.57-21.46). CONCLUSIONS Combined lithotripter was more efficient in clearing stones than pneumatic or ultrasonic device alone. However, when it came to stone-success rate, no obvious superiority was seen in combined one.
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Large T, Nottingham C, Brinkman E, Agarwal D, Ferrero A, Sourial M, Stern K, Rivera M, Knudsen B, Humphreys M, Krambeck A. Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs Trilogy Trial. J Endourol 2021; 35:1326-1332. [PMID: 33843245 PMCID: PMC8558064 DOI: 10.1089/end.2020.1097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters: Trilogy and ShockPulse-SE. Materials and Methods: This is a prospective multi-institutional randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020. The study assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rates, and complications. Device assessment was provided through immediate postoperative survey by primary surgeons. Results: There were 100 standard PCNLs completed using either a Trilogy or ShockPulse-SE lithotrite. Using quantitative Stone Analysis Software to estimate stone volume, the mean stone volume was calculated at 4.18 ± 4.79 and 3.86 ± 3.43 cm3 for the Trilogy and ShockPulse-SE groups, respectively. Stone clearance rates were found to be 1.22 ± 1.67 and 0.77 ± 0.68 cm3/min for Trilogy vs ShockPulse-SE (p = 0.0542). When comparing Trilogy to ShockPulse-SE in a multivariate analysis, total operative room time (104.4 ± 48.2 minutes vs 121.1 ± 59.2 minutes p = 0.126), rates of secondary procedures (17.65% vs 40.81%, p = 0.005), and device malfunctions (1.96% vs 34.69%, p < 0.001) were less, respectively. There was no difference in final stone-free rates between devices. Conclusion: Both the Trilogy and ShockPulse-SE lithotripters are highly efficient at removing large renal stones. In this study, we noted differences between the two devices including fewer device malfunctions when Trilogy device was utilized. Clinical Trial ID number: NCT03959683.
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Affiliation(s)
- Tim Large
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | | | - Ethan Brinkman
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | - Deepak Agarwal
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | - Andrea Ferrero
- Department of Radiology, Mayo Clinic—Rochester, Rochester, Minnesota, USA
| | - Michael Sourial
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Karen Stern
- Department of Urology, Mayo Clinic—Scottsdale, Scottsdale, Arizona, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | - Bodo Knudsen
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Mitchel Humphreys
- Department of Urology, Mayo Clinic—Scottsdale, Scottsdale, Arizona, USA
| | - Amy Krambeck
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Tan C, Jiang Y, Song S, Li X, Zhou C. Therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi: a randomized controlled trial. Wideochir Inne Tech Maloinwazyjne 2021; 16:536-542. [PMID: 34691303 PMCID: PMC8512516 DOI: 10.5114/wiitm.2021.106425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Upper urinary tract calculus is a common disease of the urinary system. AIM To compare the therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi. MATERIAL AND METHODS A total of 146 patients were randomly divided into control and experimental groups (n = 73). The control group received flexible ureteroscopy lithotripsy, and the experimental group underwent the same but combined with external physical vibration. The rate of finding stones in the urine on the day after treatment, clearance rate, components of stones, levels of renal function indices blood urea nitrogen (BUN) and serum creatinine (Scr), and incidence of complications were compared. The stone-free rate during 1-year follow-up was analysed by Kaplan-Meier method. RESULTS The rate of finding stones in the urine on the day after treatment was higher in the experimental group (100%) than that in the control group (29.73%) (p < 0.05). The clearance rates on the day, at 1 week, and at 2 weeks after treatment in the experimental group were 71.23%, 87.67%, and 95.89%, respectively, which surpassed those of the control group at corresponding time points (p < 0.05). BUN and Scr levels decreased after treatment in both groups, especially in the experimental group (p < 0.05). The stone-free rate during 1-year follow-up in the experimental group (n = 71 (97.26%)) exceeded that of the control group (n = 61 (83.56%)) (p < 0.05). CONCLUSIONS External physical vibration combined with flexible ureteroscopy lithotripsy significantly increased the rate of finding stones in the urine the day after treatment, the clearance rate of upper urinary tract calculi, and the ameliorated renal function and reduced the stone re-formation rate.
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Affiliation(s)
- Cheng Tan
- Medical Examination Centre, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Yongbao Jiang
- Medical Examination Centre, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Shanshan Song
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Xiaoge Li
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Chunliang Zhou
- Ningbo University of Finance and Economics, Ningbo, Zhejiang Province, China
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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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Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A, Liatsikos E, Pal SK, Lahme S, Durutovic O, Farahat Y, Khadgi S, Desai M, Chi T, Smith D, Hoznek A, Papatsoris A, Desai J, Mazzon G, Somani B, Eisner B, Scoffone CM, Nguyen D, Ferretti S, Giusti G, Saltirov I, Maroccolo MV, Gökce MI, Straub M, Bernardo N, Lantin PL, Saulat S, Gamal W, Denstedt J, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus 2021; 8:588-597. [PMID: 33741299 DOI: 10.1016/j.euf.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital, London, UK
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | | | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, CA, USA
| | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
| | - Andras Hoznek
- Department of Urology, Mondor Hospital, Créteil, France
| | | | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Brian Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | | | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Sherjeel Saulat
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
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Axelsson TA, Cracco C, Desai M, Hasan MN, Knoll T, Montanari E, Pérez-Fentes D, Straub M, Thomas K, Williams JC, Brehmer M, Osther PJS. Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy. World J Urol 2020; 39:1663-1670. [PMID: 32728884 PMCID: PMC8217030 DOI: 10.1007/s00345-020-03383-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the balance between existing evidence and expert opinions on the safety and efficacy of new technological improvements in lithotripsy techniques for percutaneous nephrolithotomy (PCNL). METHODS A scoping review approach was applied to search literature in Pubmed, Embase, and Web of Science. Consensus by key opinion leaders was reached at a 2-day meeting entitled "Consultation on Kidney Stones: Aspects of Intracorporeal Lithotripsy" held in Copenhagen, Denmark, in September 2019. RESULTS New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS). CONCLUSION Recent technological improvements in PCNL techniques are promising, but there is a lack of high-level evidence on safety and efficacy. Different techniques suit different types of stones and patients. The evolution of diverse methods has given urologists the possibility of a personalized stone approach, in other words, the right approach for the right patient.
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Affiliation(s)
- Tomas Andri Axelsson
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Cecilia Cracco
- Department of Urology, Cottolengo Hospital of Torino, Turin, Italy
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mudhar Nazar Hasan
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tübingen, Sindelfingen, Germany
| | - Emanuele Montanari
- Urological Dept. at Fondazione Ca Granda-Ospedale Maggiore Policlinico of Milan, University of Milan, Milan, Italy
| | - Daniel Pérez-Fentes
- Department of Urology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Michael Straub
- Department of Urology, University Hospital Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Williams
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solna, Sweden
| | - Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
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11
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Timm B, Farag M, Davis NF, Webb D, Angus D, Troy A, Bolton D, Jack GS. Stone clearance times with mini-percutaneous nephrolithotomy: Comparison of a 1.5 mm ballistic/ultrasonic mini-probe vs. laser. Can Urol Assoc J 2020; 15:E17-E21. [PMID: 32701444 DOI: 10.5489/cuaj.6513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION A limitation of mini-percutaneous nephrolithotomy (mPCNL) is the narrow working channel of mini-nephroscopes, typically restricting instrumentation to 5 French (F) or smaller. We evaluated the efficacy of the 1.5 mm Swiss LithoClast ® Trilogy (Trilogy) rigid probe and compared the results to consecutive cases performed with a 30 W Holmium:YAG (Ho:YAG) laser. METHODS A retrospective review of 30 consecutive mPCNL cases using the Trilogy and 30 W Holmium laser was performed. A 12 F MIPS nephroscope with a 16.5 F access sheath and 6.7 F working channel was used for all mPCNL cases. The Trilogy was used with a disposable 1.5 mm × 440 mm probe with dual ultrasonic and ballistic energy. The Ho:YAG laser was used with a 550 micron fibre and a maximum of 30 W. Stone clearance time (SCT) was defined by the total time interval between activation of the lithotripter until insertion of the nephrostomy tube and measured in mm2/minutes. SCT included time for fragment retrieval, equipment adjustments, and rigid and flexible nephroscopy during and after lithotripsy. RESULTS Eleven cases using a 1.5 mm Trilogy probe and 16 cases using a Ho:YAG laser met final inclusion criteria. Three cases using the Trilogy were excluded from final analysis due to conversion to alternative energy sources - two of those were upsized to standard PCNL and one was converted to laser. Mean stone diameter and density in the final Trilogy cohort was 26.7 mm and 1193 Hounsfield units (HU). Mean diameter and density in the laser cohort was 25.2 mm and 1049 HU. The mean stone area clearance time for Trilogy was 4.7±1.8 mm2/minute vs. 3.4±0.7 mm2/minute with Ho:YAG laser (p=0.21). For hard stones, defined as density >1000 HU, the Trilogy averaged 3.7±1.6 mm2/minutes, while the laser averaged 3.1±1.3 mm2/minutes (p=0.786). For soft stones, defined as <1000 HU, the Trilogy averaged 8.9±1.0 mm2/minutes compared to the Ho:YAG, which averaged 3.6±1.8mm2/minutes (p=0.019). No device-related complications occurred in either cohort. CONCLUSIONS The 1.5 mm mPCNL Trilogy probe was comparable to 30 W Ho:YAG laser for clearing hard stones. The Trilogy performed better than laser on soft stones with a HU density <1000 HU.
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Affiliation(s)
- Brennan Timm
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Matthew Farag
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Niall F Davis
- Department of Urology, Beaumont and Connolly Hospitals, Dublin, Ireland
| | - David Webb
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - David Angus
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Andrew Troy
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Gregory S Jack
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
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12
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Comparison of stone elimination capacity and drilling speed of endoscopic clearance lithotripsy devices. World J Urol 2020; 39:563-569. [PMID: 32277277 DOI: 10.1007/s00345-020-03184-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the fragmentation capacity, clearance time, and drilling speed of combined ultrasonic with impact dual-energy and single energy ultrasonic lithotripter devices. METHODS Stone fragmentation and clearance tests were performed under direct view in an underwater layered hemisphere by four different operators using artificial stones (n = 10/operator). Time for complete clearance was measured. Drilling tests were performed using an underwater setup, consisting of a mounting rack for fixing the lithotripter handpiece with the probe in vertical position and in contact with the stone phantom placed on one side of a balance for defined and constant contact application pressure equivalent to 450 g load. Time until complete perforation or in case of no perforation, the penetration depth after 60 s into the stone sample was recorded. Four devices, one single energy device (SED), one dual-energy dual probe (DEDP), two dual-energy single probe (DESP-1, DESP-2), with different parameters were tested. RESULTS Stone fragmentation and clearance speed were significantly faster for dual-energy device DESP-1 compared to all other devices (p < 0.001). Using DESP-1, the clearance time needed was 26.0 ± 5.0 s followed by DESP-2, SED and DEDP requiring 38.4 ± 5.8 s, 40.1 ± 6.3 s and 46.3 ± 11.6 s, respectively. Regarding the drilling speed, DESP-1 was faster compared to all other devices used (p < 0.05). While the drilling speed of DESP-1 was 0.69 ± 0.19 mm/s, compared to 0.49 ± 0.18 mm/s of DESP-2, 0.47 ± 0.09 mm/s of DEDP, and 0.19 ± 0.03 mm/s of SED. CONCLUSIONS The dual-energy/single-probe device combining ultrasonic vibrations with electromechanical impact was significantly faster in fragmentation and clearing stone phantoms as well as in drilling speed compared to all other devices.
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13
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Nottingham CU, Large T, Cobb K, Sur RL, Canvasser NE, Stoughton CL, Krambeck AE. Initial Clinical Experience with Swiss LithoClast Trilogy During Percutaneous Nephrolithotomy. J Endourol 2019; 34:151-155. [PMID: 31588790 DOI: 10.1089/end.2019.0561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective: Current available lithotrites have clinical stone clearance rates averaging 24 to 32 mm2/minute. The objective of this study was to critically evaluate the initial experience with the Swiss LithoClast® Trilogy lithotrite during percutaneous nephrolithotomy (PCNL). Methods: We prospectively enrolled patients with a minimum of 15 mm of stone in axial diameter at three locations (Indiana University, University of California Davis, and University of California San Diego) scheduled to undergo PCNL for nephrolithiasis over a 60-day trial period. We assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rate, and complications. Each surgeon also evaluated subjective parameters from each case related to the use of Trilogy on a 1 to 10 scale (10 = extremely effective), and compared it with their usual lithotrite on a 1 to 5 scale (5 = much better). Results: We included 43 patients and had 7 bilateral (16.3%) cases, for a total of 50 renal units. One case was a mini-PCNL. Two cases experienced device malfunctions requiring troubleshooting but no transition to another lithotrite. The mean stone clearance rate was 68.9 mm2/minute. The stone-free rate on postoperative imaging was 67.6% (25 of 37 patients with available imaging). The lowest subjective rating was the ergonomic score of 6.7, and the highest subjective rating was the ease of managing settings score of 9.2. The surgeon impressions of ultrasound (7.3), ballistics (8.1), combination of ultrasound and ballistics (8.7), and suction (8.4) were high. One patient experienced an intraoperative renal pelvis perforation, one patient required a blood transfusion, one patient had a pneumothorax requiring chest tube placement, and one patient had a renal artery pseudoaneurysm requiring endovascular embolization. Conclusions: This multi-institutional study evaluated a new and efficient combination lithotrite that was perceived by surgeons to be highly satisfactory, with an excellent safety and durability profile.
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Affiliation(s)
- Charles U Nottingham
- Department of Urology, Indiana University School of Medicine/IU Health Physicians, Indianapolis, Indiana
| | - Tim Large
- Department of Urology, Indiana University School of Medicine/IU Health Physicians, Indianapolis, Indiana
| | - Kaitlan Cobb
- University of California San Diego School of Medicine, San Diego, California
| | - Roger L Sur
- University of California San Diego School of Medicine, San Diego, California.,Department of Urology, UC San Diego Health, San Diego, California
| | - Noah E Canvasser
- Department of Urology, University of California Davis School of Medicine, Sacramento, California
| | - Christa L Stoughton
- Department of Urology, Indiana University School of Medicine/IU Health Physicians, Indianapolis, Indiana
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine/IU Health Physicians, Indianapolis, Indiana
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14
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EMS Lithoclast Trilogy™: an effective single-probe dual-energy lithotripter for mini and standard PCNL. World J Urol 2019; 38:1043-1050. [PMID: 31177306 DOI: 10.1007/s00345-019-02843-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Several energy sources are available to clear stones during PCNL. Required improvements are faster stone clearance, optimized suction and ease of use while maintaining high patient safety standard. EMS LithoClast® Trilogy, is the first device combining electromagnetic impactor with ultrasonic energy and suction, all-in-one probe. Animal studies and in vitro phantom stone studies have proven safety and efficacy of this device. We aim to study safety and clinical efficacy of Trilogy in our patients. METHODS 31 patients with renal stones were included. Amplatz sheath sizes/Trilogy probe size was 22-28 Fr/10.2 Fr for standard PNL (n = 20) and 15 Fr./5.7 Fr for mini PNL access (n = 11). Analysis was done with respect to demography, stone characteristics, operation duration (total time and lithotripter activation time), post op Hb drop, clearance rate and adverse events. Stone area/volume was calculated based on CT using 3D doctor. Efficacy was determined by stone volume clearance rate (mm3/min). RESULTS Male:female ratio was 6:5 and 16:4 for mini (MPNL)/standard PNL (SPNL). Stone densities were 1229 ± 206 vs. 1168 ± 344 HU (MPNL vs. SPNL). Mean stone volumes were 3776.1 ± 2132 mm3 for MPNL and 7096 ± 6441 for SPNL. Mean stone volume clearance ratios were 370.5 ± 171 mm3/min and 590.7 ± 250mm3/min for MPNL and SPNL, respectively. Hb drop was 1.24 ± 0.64 g/dL (MPNL) and 1.23 ± 0.89gm/dL (SPNL). Total procedure time/lithotripter activation time was 53.4 ± 23.8/14.7 ± 12.4 min for MPNL and 65.2 ± 23.5/12.0 ± 8.9 for SPNL. Immediate post-operative/1 month stone clearance rates were 93%/96% with one clinically insignificant residual fragment (< 3 mm) and no necessity for auxiliary procedures. No device failure occured and three Clavien grade I and one grade II complications were observed. CONCLUSION Swiss LithoClast® Trilogy provides fast stone clearance in standard/mini-PCNL procedures. Ease of use, high tissue safety and optimized suction that avoids fragment blockings are other key features.
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15
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Khoder W, Strittmatter F, Alghamdi A, Seitz M, Stief C, Bader MJ. Comparative evaluation of tissue damage induced by ultrasound and impact dual-mode endoscopic lithotripsy versus conventional single-mode ultrasound lithotripsy. World J Urol 2019; 38:1051-1058. [PMID: 31144092 DOI: 10.1007/s00345-019-02747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of our study was to perform comparative investigation of the tissue safety of three different endoscopic lithotripter devices including a new single-probe/dual-energy lithotripter in an in vivo animal model. The Swiss LithoClast Trilogy was compared to the Storz Calcuson and the Swiss LithoClast Vario. The safety test simulated the accidental direct contact between lithotripter probes and the urothelium, which can occur when sliding off a stone or drilling through a calculus during lithotripsy. The safety test included a smallest (1.5 mm) and largest (3.3/3.4 mm) probe diameter per device. METHODS Testing was performed in nine pigs (three animals per device). The bladder tissue was exposed to direct lithotripter probe contact at maximum power for 10 s to produce visible tissue lesions. Acute tissue trauma was evaluated using a simplified scoring model describing the expected bladder wall injuries for histological examination. After 7 days, all animals were killed, necropsied and examined post mortem. For between-group comparisons regarding microscopic histopathologic features, a Chi-square test was used. A p value < 0.05 was considered to be statistically significant. RESULTS Irrespective of the lithotripter used, no systemic signs of toxicity were observed. Histologically, signs of normal ongoing healing were observed on the bladder mucosa. There were no significant differences in histological findings taking changes of the epithelium (p = 0.360), the leucocyte infiltration (p = 0.123), the vascular congestion (p = 0.929) and the edema (p = 1.0) between the groups into account. CONCLUSIONS The results of this study demonstrated a comparable safety between all lithotripsy devices.
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Affiliation(s)
- Wael Khoder
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Frank Strittmatter
- Department of Urology, University Hospital of Munich Campus Großhadern, Munich, Germany
| | - Abdulmajeed Alghamdi
- Department of Urology, University Hospital of Munich Campus Großhadern, Munich, Germany
| | - Michael Seitz
- Department of Urology, University Hospital of Munich Campus Großhadern, Munich, Germany
- UroClinic München, Residenzstraße 18, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital of Munich Campus Großhadern, Munich, Germany
| | - Markus Juergen Bader
- Department of Urology, University Hospital of Munich Campus Großhadern, Munich, Germany.
- UroClinic München, Residenzstraße 18, Munich, Germany.
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17
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Sabler IM, Katafigiotis I, Gofrit ON, Duvdevani M. Present indications and techniques of percutaneous nephrolithotomy: What the future holds? Asian J Urol 2018; 5:287-294. [PMID: 30364501 PMCID: PMC6197369 DOI: 10.1016/j.ajur.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022] Open
Abstract
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy (PCNL) procedure in terms of indications and evolving techniques, and to identify the advantages and disadvantages of each modality. The data for this review were collected after a thorough PubMed search in core clinical journals in English language. The key words included “PCNL” and “PNL” in combination with “indications”, “techniques”, “review” and “miniaturized PCNL”. Publications relevant to the subject were retrieved and critically reviewed. Current European and American Urology Association Nephrolithiasis Guidelines were included as well. The indications for standard PCNL have been changed through the past decade. Despite evolution of the procedure, innovations and the development of new technical approaches, the indications for miniaturized PCNL have not been standardized yet. There is a need for well-constructed randomized trials to explore the indications, complications and results for each evolving approach. A continuous reduction of tract size is not the only revolution of the last years. There is constant ongoing interest in developing new efficient miniature instruments, intracorporeal lithotripters and sophisticated tract creation methods. We can summarize that, PCNL represents a valuable well-known tool in the field of endourology. We should be open minded to future changes in surgical approaches and technological improvements.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
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Radfar MH, Shakiba B. Re: Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy (From: York T, Borofsky MS, Chew BH, et al. J Endourol 2017;31:1145-1151). J Endourol 2018; 32:264. [PMID: 29310460 DOI: 10.1089/end.2017.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammad Hadi Radfar
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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Gómez-Núñez JG. Editorial Comment on: Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction by Matlaga et al. J Endourol 2018; 32:7-9. [DOI: 10.1089/end.2017.0814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joel Gustavo Gómez-Núñez
- Departamento de Urología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, México
- Urólogo/Endourólogo, Hospital General Regional (HGR) 180, Instituto Mexicano del Seguro Social (IMSS) Delegación Jalisco, Tlajomulco de Zúñiga, Jalisco, México
- Departamento de Urología, Urólogo/Endourólogo, Instituto Jalisciense de Cancerología, Secretaría de Salud Jalisco, Guadalajara, Jalisco, México
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20
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Grasso M. Editorial Comment on: Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy by York et al. (From: York NE, Borofsky MS, Chew BH, et al. J Endourol 2017;31:1145-1151). J Endourol 2017; 32:75. [PMID: 29161895 DOI: 10.1089/end.2017.0755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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