significant difference of change on kidney functions between two groups.CONCLUSIONS: 5-10 mm kidney stones on infants that doesn't cause >G2 hydronephrosis or febrile UTIs can safely be followed without any intervention or extensive metabolic evaluation during the infancy period.
were calculated to see association with categorical variables and the groups.RESULTS: A total of 172 adult patients with ureteric stones >1cm were included in this study. 87 patients in the TFL group with a mean age of 37.9þ-8.8 and 85 in the Ho:YAG group with a mean age of 39.4þ-10.5 (p[0.34). There was no difference regarding BMI (26þ-3.6 vs 26þ-3.7)(p[0.96), Co-morbidity (16% vs 24% with multiple comorbidities)(p[0.49), anaesthesia type using general or spinal (57% vs 55%) (p[0.77), stone volume (1.6þ-0.5 vs 1.5þ-0.5)(p[0.41), or basket use (15% vs 15%)(p[0.95). Interestingly, the TFL group took longer to perform, with higher operative time than the Ho:YAG group (81.7þ-42.2 vs 67þ-35.1 (p[0.016)). This was likely due to the fact the TFL group did have more multiple stones requiring lithotripsy than the Ho:YAG group, however this was not statistically significant, but clearly, clinically significant whereby there was a 27% vs 19% multiple stones rate (p[0.23). There was no difference in the SFR (95% vs 96% (p[0.72)), second look ureteroscopy (14% vs 8%) (p[0.25)) or early or late complication rates, 1% vs 4% (p[0.3) and 0% vs. 1% (p[0.31), respectively. All patients were stone and complication free on follow up.CONCLUSIONS: TFL has proven its efficacy and safety with high SFR and low early and late complication rates. TFL ureteroscopic lithotripsy took longer to perform than Ho:YAG, probably due to having a higher stone burden, however statistically not significant.
two platforms are fundamentally different in their pulse profile and energy (Ep) delivery. Clinical TFL platforms have an energy range of 0.025J-6J and a frequency (F) range of 1Hz-2400Hz. With the seemingly endless combination of settings and lack of scientific evidence to support one over the other, we aim to provide guidance to the practicing urologists and assess the efficiency of the TFL platform in an automated in vitro "dusting model".METHODS: All tests were conducted using an IPG Photonics TLR-50W TFL system and a 200mm fiber on "soft" (5:2) Begostone phantoms. We selected the most popular dusting settings (Figure 1) among endourologists familiar with TFL 1 and tested each combination of Ep and F settings at four different standoff distances (SD) (0.2mm, 0.5mm 1mm, 2mm) and at clinically significant scanning speeds of 1mm/sec or 2mm/sec, under the same total laser energy delivered to the stone (i.e., 40 J). All pulses were adjusted to maximum peak power and the corresponding pulse duration. The laser fiber was scanned in a 15mm straight line with a 3D positioning system across a polished and submerged Begostone surface. Ablation volumes were quantified by optical coherence tomography (OCT).RESULTS: The maximum stone ablation was achieved at the combination of high energy and low frequency settings (p<0.005). Overall, the settings that produced the greatest ablation volume were 1J/ 10Hz (2.51mm3) and 1J/20Hz (2.55mm3). For the rectangular pulse profile typically used in TFL, as SD increased ablation volume decreased.CONCLUSIONS: The most efficient dusting settings for dusting using the current TFL occur at high energy, low frequency, and at a short SD of 0.2mm. Further studies are warranted to compare dusting efficiency produced by these settings using human kidney stones.
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