Controlled Fragmentation of Urinary Stones as a Method of Preventing Inflammatory Infections in the Treatment of Urolithiasis (Experience in Successful Clinical Use)

Abstract

The introduction of technologically advanced methods of lithotripsy into medical practice changes the nature of postoperative complications. Among them, the main complications are inflammatory infections. This largely determines the search for new, improved methods of stone fragmentation avoiding small stone fragments and dissemination of the pelvicalyceal system of the kidney with stoneassociated infection. The authors have developed a method for controlled stone fragmentation using a continuous-wave diode laser with a hot-spot effect at the optical fiber end.The aim of the study was to evaluate the efficacy of controlled urinary stone fragmentation using a continuous-wave diode laser with a highly heated distal end of the optical fiber light guide as a method of preventing inflammatory infections in clinical practice.Materials and Methods. We analyzed 1666 case histories of urolithiasis patients who underwent percutaneous nephrolithotripsy/ nephrolithoextraction and contact ureterolithotripsy/ureteroextraction, we also performed a prospective analysis of complications based on the Clavien-Dindo classification in 90 patients who underwent fine fragmentation of stones with various lithotripters: ultrasonic, pneumatic, and holmium laser. The method of controlled stone fragmentation by a diode laser with a hot-spot effect was tested on postoperative samples of 26 renal calculi. For the first time in clinical practice, this method was tested in the bladder cavity (n=10).Results. In the percutaneous nephrolithotripsy group, postoperative infectious and inflammatory complications occurred in 34.1% of cases, in the percutaneous nephrolithoextraction group -in 24.6%, in the contact ureterolithotripsy group -in 7.8%, in the ureterolithoextraction group -in 2.5%. The analysis made it possible to identify factors promoting the development of infectious and inflammatory complications. For the first time in clinical practice, there were successfully performed ten operations of stone fragmentation using a continuous-wave diode laser with a hot-spot effect. Controlled coarse fragmentation of stones providing the possibility to reduce the number of infectious and inflammatory complications was performed in the bladder as a model for testing the method.Conclusion. The method of laser-induced controlled coarse fragmentation of stones with a hot-spot effect, developed and tested in clinical practice, is promising for the prevention of infectious and inflammatory complications in patients with potentially infected stones since their fine fragmentation and, consequently, spread of stone-associated toxins and microflora within the urinary system is avoided.

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

“… 24 Additionally, it has been shown that the prevalence of common infectious complications in patients following urinary stone surgery, including fever and systemic inflammatory response syndrome (SIRI), could be as high as 27.4%. 25 Given the above clinical characteristics of urinary stone, we deem older patients undergoing urinary calculi surgery might be at high risk for POD, and it is crucial to identify its associated risk factors for preventing POD. Nevertheless, to our knowledge, the POD incidence and potential risk factors among older adults after urinary calculi surgery have not been investigated so far.…”

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

“…A complex of metaphylactic measures, such as lifestyle changes, hyperhydration, dietary modifications, correction of concomitant diseases and hormonal disorders, is considered extremely important to prevent relapses after surgical treatment. In addition, the prevention of postoperative recurrence depends on minimizing intraoperative trauma, reducing the risk of infectious complications, and avoiding residual fragments that can act as initial nucleus of stone formation (6). It is important to note that the recommendations for stone treatment have been changed in the context of the pandemic.…”