Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.10.007
F. Pauchard , N. Bhojani , B. Chew , E. Ventimiglia
Introduction
High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS.
Methods
A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed.
Results
A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement.
Conclusions
We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
{"title":"How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives","authors":"F. Pauchard , N. Bhojani , B. Chew , E. Ventimiglia","doi":"10.1016/j.acuroe.2023.10.007","DOIUrl":"10.1016/j.acuroe.2023.10.007","url":null,"abstract":"<div><h3>Introduction</h3><p>High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS.</p></div><div><h3>Methods</h3><p>A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed.</p></div><div><h3>Results</h3><p>A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement.</p></div><div><h3>Conclusions</h3><p>We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.08.003
A. Piana , G. Basile , S. Masih , G. Bignante , A. Uleri , A. Gallioli , T. Prudhomme , R. Boissier , A. Pecoraro , R. Campi , M. Di Dio , S. Alba , A. Breda , A. Territo , en representación del grupo de trabajo de trasplante renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU)
Introduction
Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment.
Evidence acquisition
A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss.
Evidence synthesis
A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29–53 years. Incidence of urolithiasis ranged from 0.1–6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%.
Conclusions
Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient’s characteristics and surgeon preferences.
{"title":"Kidney stones in renal transplant recipients: A systematic review","authors":"A. Piana , G. Basile , S. Masih , G. Bignante , A. Uleri , A. Gallioli , T. Prudhomme , R. Boissier , A. Pecoraro , R. Campi , M. Di Dio , S. Alba , A. Breda , A. Territo , en representación del grupo de trabajo de trasplante renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU)","doi":"10.1016/j.acuroe.2023.08.003","DOIUrl":"10.1016/j.acuroe.2023.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment.</p></div><div><h3>Evidence acquisition</h3><p>A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss.</p></div><div><h3>Evidence synthesis</h3><p>A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29–53 years. Incidence of urolithiasis ranged from 0.1–6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%.</p></div><div><h3>Conclusions</h3><p>Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient’s characteristics and surgeon preferences.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173578623001014/pdfft?md5=4af842280bde4575c8829fa419c381e4&pid=1-s2.0-S2173578623001014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10005460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.06.002
V. Massella , A. Pietropaolo , V. Gauhar , E. Emiliani , B.K. Somani , el Grupo de Trabajo de Urolitiasis de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU)
Introduction
Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the ‘As Low As Reasonably Achievable’ (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD.
Methods
A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines.
Results
Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p = 0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p = 0.9). The overall Clavien–Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n = 71) and 8.5% (n = 131), and 1.7% (n = 23) and 3% (n = 47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures.
Conclusion
The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases.
{"title":"Has fluoroless endourology (URS and PCNL) come of age? Evidence from a comprehensive literature review","authors":"V. Massella , A. Pietropaolo , V. Gauhar , E. Emiliani , B.K. Somani , el Grupo de Trabajo de Urolitiasis de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU)","doi":"10.1016/j.acuroe.2023.06.002","DOIUrl":"10.1016/j.acuroe.2023.06.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the ‘As Low As Reasonably Achievable’ (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD.</p></div><div><h3>Methods</h3><p>A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines.</p></div><div><h3>Results</h3><p>Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (<em>p</em> <!-->=<!--> <!-->0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (<em>p</em> <!-->=<!--> <!-->0.9). The overall Clavien–Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (<em>n</em> <!-->=<!--> <!-->71) and 8.5% (<em>n</em> <!-->=<!--> <!-->131), and 1.7% (<em>n</em> <!-->=<!--> <!-->23) and 3% (<em>n</em> <!-->=<!--> <!-->47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures.</p></div><div><h3>Conclusion</h3><p>The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173578623000628/pdfft?md5=1c02b387c684f48d801a7221d4b05ab0&pid=1-s2.0-S2173578623000628-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9694961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.11.008
M. Segall , A. Mousavi , B.H. Eisner , K. Scotland
Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.
{"title":"Pharmacologic treatment of kidney stones: Current medication and pH monitoring","authors":"M. Segall , A. Mousavi , B.H. Eisner , K. Scotland","doi":"10.1016/j.acuroe.2023.11.008","DOIUrl":"10.1016/j.acuroe.2023.11.008","url":null,"abstract":"<div><p><span><span><span>Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic </span>treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including </span>calcium oxalate<span>, calcium phosphate, </span></span>uric acid<span><span>, struvite, and </span>cystine<span> stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.</span></span></p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.06.001
C. Giulioni , D. Castellani , O. Traxer , N. Gadzhiev , G.M. Pirola , Y. Tanidir , R.D. da Silva , X. Glover , G. Giusti , S. Proietti , P.M. Mulawkar , V. De Stefano , A. Cormio , J.Y.-C. Teoh , A.B. Galosi , B.K. Somani , E. Emiliani , V. Gauhar
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.
{"title":"Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review","authors":"C. Giulioni , D. Castellani , O. Traxer , N. Gadzhiev , G.M. Pirola , Y. Tanidir , R.D. da Silva , X. Glover , G. Giusti , S. Proietti , P.M. Mulawkar , V. De Stefano , A. Cormio , J.Y.-C. Teoh , A.B. Galosi , B.K. Somani , E. Emiliani , V. Gauhar","doi":"10.1016/j.acuroe.2023.06.001","DOIUrl":"10.1016/j.acuroe.2023.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones.</p></div><div><h3>Basic procedures</h3><p>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.</p></div><div><h3>Main findings</h3><p><span>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 </span>postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10015342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.06.009
M. Corrales , F. Panthier , C. Solano , L. Candela , O. Traxer
Objective
To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the thulium fiber laser (TFL).
Methods
Narrative overview of the most relevant articles published in MEDLINE and Scopus databases about this subject.
Results
TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions.
Conclusion
The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy. In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL.
{"title":"Laser safety, warnings, and limits in retrograde intrarenal surgery","authors":"M. Corrales , F. Panthier , C. Solano , L. Candela , O. Traxer","doi":"10.1016/j.acuroe.2023.06.009","DOIUrl":"10.1016/j.acuroe.2023.06.009","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology<span><span>, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the </span>thulium fiber laser (TFL).</span></p></div><div><h3>Methods</h3><p>Narrative overview of the most relevant articles published in MEDLINE and Scopus databases about this subject.</p></div><div><h3>Results</h3><p>TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions.</p></div><div><h3>Conclusion</h3><p>The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy. In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9777652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.09.001
L. Mosquera Seoane , J.B. Ortiz Salvador , A. Budia Alba , D.A. Perez Fentes
Introduction
Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis.
Material and methods
A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML).
Results
The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels.
Conclusions
Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.
{"title":"Technological innovations in shock wave lithotripsy","authors":"L. Mosquera Seoane , J.B. Ortiz Salvador , A. Budia Alba , D.A. Perez Fentes","doi":"10.1016/j.acuroe.2023.09.001","DOIUrl":"10.1016/j.acuroe.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Since 1980, extracorporeal<span> shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, </span></span>SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis.</p></div><div><h3>Material and methods</h3><p>A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML).</p></div><div><h3>Results</h3><p>The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels.</p></div><div><h3>Conclusions</h3><p>Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.acuroe.2023.08.009
F. Panthier , S. Kutchukian , H. Ducousso , S. Doizi , C. Solano , L. Candela , M. Corrales , M. Chicaud , O. Traxer , S. Hautekeete , T. Tailly
Objective
Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy [URS], extracorporeal shockwave lithotripsy [ESWL] and percutaneous nephrolithotomy [PCNL]). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis treatment.
Material and methods
A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction.
Results
In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20 mm. This was not the case for PCNL and SWL.
Conclusions
Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume.
{"title":"How to estimate stone volume and its use in stone surgery: a comprehensive review","authors":"F. Panthier , S. Kutchukian , H. Ducousso , S. Doizi , C. Solano , L. Candela , M. Corrales , M. Chicaud , O. Traxer , S. Hautekeete , T. Tailly","doi":"10.1016/j.acuroe.2023.08.009","DOIUrl":"10.1016/j.acuroe.2023.08.009","url":null,"abstract":"<div><h3>Objective</h3><p>Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy [URS], extracorporeal shockwave lithotripsy<span><span> [ESWL] and percutaneous nephrolithotomy [PCNL]). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis </span>treatment.</span></p></div><div><h3>Material and methods</h3><p>A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction.</p></div><div><h3>Results</h3><p>In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20 mm. This was not the case for PCNL and SWL.</p></div><div><h3>Conclusions</h3><p>Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10140763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.acuroe.2023.07.001
I. Schwartzmann , S. García Barreras , M. D’Anna , V. Parejo , I. Torneo Ruiz , A.C. Tagalos Muñoz , A. Bravo-Balado , P. Diana , L. Peri , M. Domínguez Esteban , E. Fernández Guzmán
Aim
The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers.
Materials and Methods
This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed.
Results
A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, P = .178), or prostate volume (47.9 g and 41.4 g respectively, P = .147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time.
Conclusions
Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.
目的本研究的目的是评估西班牙大学医院采用水蒸气热疗法(WVTT)治疗良性前列腺增生(BPH)的初步经验,并描述各中心在技术和随访方面的差异。材料和方法本回顾性观察性多中心研究收集了1、3、6、12和24个月的基线特征、手术、术后和随访数据,包括有效问卷、流量变化、并发症以及术后药物或手术治疗的需要。分析了术后急性尿潴留(AUR)的可能诱因。结果共纳入105例患者。在置管时间(分别为5天和4.3天,P = 0.178)和前列腺体积(分别为47.9 g和41.4 g, P = 0.147)方面,有无AUR组之间无差异。在3、6、12和24个月时,峰值流量的平均改善分别为5.3、5.2、4.2和3.8 ml/s。至于射精,随访3个月后观察到改善,并保持了一段时间。结论WVTT微创治疗BPH随访24个月功能预后良好,无明显性功能损害,并发症发生率低。医院间差异较小,主要发生在术后即刻。
{"title":"Water vapor thermal therapy: Technical variations among spanish hospitals and efficacy at 2-year follow-up","authors":"I. Schwartzmann , S. García Barreras , M. D’Anna , V. Parejo , I. Torneo Ruiz , A.C. Tagalos Muñoz , A. Bravo-Balado , P. Diana , L. Peri , M. Domínguez Esteban , E. Fernández Guzmán","doi":"10.1016/j.acuroe.2023.07.001","DOIUrl":"10.1016/j.acuroe.2023.07.001","url":null,"abstract":"<div><h3>Aim</h3><p>The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers.</p></div><div><h3>Materials and Methods</h3><p>This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed.</p></div><div><h3>Results</h3><p><span>A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, </span><em>P</em> <!-->=<!--> <!-->.178), or prostate volume (47.9<!--> <!-->g and 41.4<!--> <!-->g respectively, <em>P</em> <!-->=<!--> <span>.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8</span> <!-->ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time.</p></div><div><h3>Conclusions</h3><p><span>Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate </span>postoperative period.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.acuroe.2023.04.011
A. Territo , B. Bañuelos Marco , A. Breda , J. Gómez Rivas , M.İ. Dönmez
{"title":"What would be the ideal pathway for a young urologist interested in kidney transplantation?","authors":"A. Territo , B. Bañuelos Marco , A. Breda , J. Gómez Rivas , M.İ. Dönmez","doi":"10.1016/j.acuroe.2023.04.011","DOIUrl":"10.1016/j.acuroe.2023.04.011","url":null,"abstract":"","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10116375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}