These elements should be included in future classification reassessment to efficiently determine the time for surgery in grade IV renal traumas, generally leading to nephrectomy.

INTRODUCTION AND OBJECTIVES: During the last years there has been an effort in miniaturizing the endoscopic devices.The video presents an alternative for the management of distal ureteral stone, using a ureteral access of 4.85Fr and 27cm of length, previously described as micro-ureteroscopy.METHODS: This procedure was performed through a 3-part allseeing needle, consisting of micro-optics 0.9mm in diameter with a 120degree angle of view, an irrigation channel and an integrated light.RESULTS: Seven year-old boy, with history of preterm birth (29 weeks) was referred to our consultation complaining of left back pain and an elevation of serum creatinine.The renal ultrasound revealed a left ureterohydronephrosis, caused by a 10mm stone located 13mm from the ureterovesical junction.The patient underwent a micro-ureteroscopy with laser lithotripsy. The stone was fragmented with an average energy of 0.5J with 12Hz of frequency. The total energy spent was 12514J. At the end of the procedure, a double J stent was placed.The procedure lasted 45 minutes and was uneventful. The patient was discharged 24h after the procedure without complaints and remained stone free.CONCLUSIONS: Micro-ureteroscopy is a safe and effective technique in distal ureteral lithiasis treatment in children. The small dimensions of the equipment increase the safety of the procedure making this a good option for the treatment of ureteral stones in children.

Penetrating pelvic trauma (PPT) is defined as a wound extending within the bony confines of the pelvis to involve the vascular, intestinal or urinary pelvic organs. The gravity of PPT is related to initial hemorrhage and the high risk of late infection. If the patient is hemodynamically unstable and in hemorrhagic shock, the urgent treatment goal is rapid achievement of hemostasis. Initial strategy relies on insertion of an intra-aortic occlusion balloon and/or extraperitoneal pelvic packing, performed while damage control resuscitation is ongoing before proceeding to arteriography. If hemodynamic instability persists, a laparotomy for hemostasis is performed without delay. In a hemodynamically stable patient, contrast-enhanced CT is systematically performed to obtain a comprehensive assessment of the lesions prior to surgery. At surgery, damage control principles should be applied to all involved systems (digestive, vascular, urinary and bone), with exteriorization of digestive and urinary channels, arterial revascularization, and wide drainage of peri-rectal and pelvic soft tissues. When immediate definitive surgery is performed, management must address the frequent associated lesions in order to reduce the risk of postoperative sepsis and fistula.

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Objectives: To compare the risk of laser fiber fracture between Ho:YAG laser and Thulium Fiber Laser (TFL) with different laser fiber diameters, laser settings, and fiber bending radii. METHODS: Lengths of 200, 272, and 365 μm single use fibers were used with a 30 W Ho:YAG laser and a 50 W Super Pulsed TFL. Laser fibers of 150 µm length were also tested with the TFL only. Five different increasingly smaller bend radii were tested: 1, 0.9, 0.75, 0.6, and 0.45 cm. A total of 13 different laser settings were tested for the Ho:YAG laser: six fragmentation settings with a short pulse duration, and seven dusting settings with a long pulse duration. A total of 33 different laser settings were tested for the TFL. Three laser settings were common two both lasers: 0.5 J × 12 Hz, 0.8 J × 8 Hz, 2 J × 3 Hz. The laser was activated for 5 min or until fiber fracture. Each measurement was performed ten times. Results: While fiber failures occurred with all fiber diameters with Ho:YAG laser, none were reported with TFL. Identified risk factors of fiber fracture with the Ho:YAG laser were short pulse and high energy for the 365 µm fibers (p = 0.041), but not for the 200 and 272 µm fibers (p = 1 and p = 0.43, respectively). High frequency was not a risk factor of fiber fracture. Fiber diameter also seemed to be a risk factor of fracture. The 200 µm fibers broke more frequently than the 272 and 365 µm ones (p = 0.039). There was a trend for a higher number of fractures with the 365 µm fibers compared to the 272 µm ones, these occurring at a larger bend radius, but this difference was not significant. Conclusion: TFL appears to be a safer laser regarding the risk of fiber fracture than Ho:YAG when used with fibers in a deflected position.

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The results are summarized in Table 1. CONCLUSIONS: The retropulsion effect evaluated by the initial speed and 1 second displacement for SP TFL was w4 times lower than for Ho:YAG laser in SP mode, and w1.8 times lower than for LP and MP modes. The retropulsion effect was similar for LP and MP modes of Ho:YAG laser. The average ablation volume for SP TFL was 2.2, 2.0, and 1.6 times higher than for Ho:YAG laser in SP, LP and MP modes, respectively. Thus, a small retropulsion and high efficiency of SP TFL may decrease the operating time compared to the Ho:YAG laser with Moses Technology in all modes of operationh.

Purpose To evaluate how variable working distances between the laser fiber and the stone influence ablation volume. Methods A laser fiber was fixed on a robotic arm perpendicular to an artificial stone. A single laser pulse was triggered at different working distances (0-2.0 mm in 0.2 mm increments) between the distal fiber tip and the stone. To achieve a measurable impact, pulse energy was set to 2 and 3 J, with either short or long pulse duration. Ablation volume was calculated with an optical microscope. Experiments were repeated five times for each setting. Results Highest ablation volume was observed with a long pulse of 3 J at a working distance of 0.4 mm between the laser fiber and the stone surface (p value < 0.05). At 2 J, the highest ablation volume was noticed with a short pulse in contact mode. However, ablation volume of the latter was not significantly greater than with a long pulse of 2 J at a working distance of 0.4 mm (p value > 0.05). Compared to lithotripsy in contact mode, triggering a single long pulse at 0.4 mm increased ablation volume by 81% (p value = 0.016) at 2 J and by 89% (p value = 0.034) at 3 J. Conclusions For Ho:YAG laser lithotripsy, ablation volume may be higher in non-contact mode using long pulses, rather than in direct contact to the stone. Findings of the current study support the need of further studies of lithotripsy in noncontact mode.