The future of laser technology in kidney stones

Kallidonis, Panagiotis; Vagionis, Athanasios

doi:10.1097/mou.0000000000001006

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…The pooled effect estimates from our meta-analysis have shown that TFL is likely to result in a shorter OT, LUT, and stone ablation rate. This was consistent with several previously reported preclinical studies that described higher efficacy of TFL compared to Ho:YAG in dusting urolithiasis [2,3,33,34,37]. Furthermore, when treating ureteric stones using URS with better pulse control, the degree of retropulsion was significantly lesser for TFL compared to Ho:YAG without a MOSES setting.…”

Section: Meta-analysis Findings Compared To Preclinical Studies and P...supporting

confidence: 91%

Thulium fibre laser vs holmium: yttrium‐aluminium‐garnet laser lithotripsy for urolithiasis: meta‐analysis of clinical studies

et al. 2022

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To compare and assess the clinical outcomes between thulium fibre laser (TFL) and holmium: yttrium-aluminium-garnet (Ho:YAG) laser endoscopic lithotripsy of urolithiasis through a meta-analysis of comparative clinical studies. MethodsA systematic literature search was performed in May 2022, grey literature search in July 2022. Comparative clinical studies were evaluated according to Cochrane recommendations. Assessed outcomes include the stone-free rate (SFR), complication rate, operative time (OT), laser utilisation time (LUT), ablation rate (stone volume/laser time), ablation efficiency (energy use/stone volume), total energy usage, degree of retropulsion, and hospital stay. Risk ratios (RRs) and standardised mean differences (SMDs) were extrapolated. Subgroup analyses, heterogeneity, publication bias, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment were performed. International Prospective Register of Systematic Reviews (PROSPERO) registration: CRD42022300788. ResultsA total of 15 studies with 1698 cases were included in this review. The outcome of SFR showed no significant betweengroup difference (RR 1.09, 95% confidence interval [CI] 0.99-1.20). However, subgroup analysis of TFL vs Ho:YAG with no pulse modulation showed a SFR favouring TFL (RR 1.11, 95% CI 1.01-1.23). The composite postoperative complication rate was comparable between the two intervention groups (RR 0.97, 95% CI 0.66-1.43). OT, LUT and ablation rate were significantly better for TFL than Ho:YAG (SMD À1.19, 95% CI À1.85 to À0.52; SMD À1.67, 95% CI À2.62 to À0.72; SMD 0.59, 95% CI 0.15-1.03; respectively). The degree of retropulsion was significantly lower for TFL than Ho:YAG without pulse modulation (SMD À1.23, 95% CI À1.74 to À0.71). Ablation efficiency, total energy usage, and hospital stay were all comparable. Based on GRADE criteria, the evidence certainty was determined to be very low. ConclusionOverall, there was no between-group difference for the SFR. However, compared to Ho:YAG with no pulse modulation, TFL rendered a better SFR. Shorter OT and LUT, a lesser degree of retropulsion, and a better ablation rate were noted in favour of the TFL. There was no overall between-group difference for composite postoperative complication rate, ablation efficiency, total energy usage, and hospital stay. Currently, the available clinical evidence was assessed to be of very low certainty.

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Section: Meta-analysis Findings Compared To Preclinical Studies and P...supporting

confidence: 91%

Thulium fibre laser vs holmium: yttrium‐aluminium‐garnet laser lithotripsy for urolithiasis: meta‐analysis of clinical studies

et al. 2022

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“…Therefore, for efficient tumor resection, the Ho: YAG laser may be used to resect coagulated tissues after ablation with the neodymium: yttrium aluminum garnet (Nd: YAG) or the continuous wave thulium: yttrium aluminum garnet (CW Tm: YAG) laser 20,24,25,45 . This laser has several ablation modes, including pulse duration‐adjusted mode (short/middle/long), Moses mode, and virtual basket mode; however, the effect of these modes on EM has not been elucidated 77 …”

Section: Surgical Setting Device and Techniquementioning

confidence: 99%

Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma

et al. 2023

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Current guidelines recommend endoscopic management (EM) for patients with low‐risk upper urinary tract urothelial carcinoma, as well as those with an imperative indication. However, regardless of the tumor risk, radical nephroureterectomy is still mainly performed worldwide despite the benefits of EM, such as renal function maintenance, no hemodialysis requirement, and treatment cost reduction. This might be explained by the association of EM with a high risk of local recurrence and progression. Furthermore, the need for rigorous patient selection and close surveillance following EM may be relevant. Nevertheless, recent developments in diagnostic modalities, pathological evaluation, surgical devices and techniques, and intracavitary regimens have been reported, which may contribute to improved risk stratification and treatments with superior oncological outcomes. In this review, considering recent advances in endourology and oncology, we propose novel treatment strategies for optimal EM.

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“…In addition, extracorporeal shock wave lithotripsy (ESWL) and minimally invasive approaches such as percutaneous nephrolithotomy and retrograde intrarenal surgery are considered as the mainstay for the treatment of kidney stones. More recently, laser devices have been used for lithotripsy during these procedures [ 11 ]. Although surgical treatment of stone disease has greatly advanced, there have been no improvements in the prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Astragalus membranaceus Extract Prevents Calcium Oxalate Crystallization and Extends Lifespan in a Drosophila Urolithiasis Model

Chen

Dalanbaatar

Chen

et al. 2022

Life

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Approximately 1 in 20 people develops kidney stones at some point in their life. Although the surgical removal of stones is common, the recurrence rate remains high and it is therefore important to prevent the occurrence of kidney stones. We chose Astragalus membranaceus (AM), which is a traditional Chinese medicine, to study the prevention of urolithiasis using a Drosophila model based on our previous screening of traditional Chinese herbs. Wild-type Drosophila melanogaster Canton-S adult fruit flies were used in this study. Ethylene glycol (EG, 0.5%) was added to food as a lithogenic agent. The positive control agent (2% potassium citrate (K-citrate)) was then compared with AM (2, 8, and 16 mg/mL). After 21 days, the fruit flies were sacrificed under carbon dioxide narcotization, and the Malpighian tubules were dissected, removed, and processed for polarized light microscopy examination to observe calcium oxalate (CaOx) crystallization. Then, the ex vivo dissolution of crystals in the Malpighian tubules was compared between K-citrate and AM. Survival analysis of the EG, K-citrate, and AM groups was also performed. Both 2% K-citrate and AM (16 mg/mL) significantly inhibited EG-induced CaOx crystal formation. Mean lifespan was significantly reduced by the administration of EG, and the results were significantly reversed in the AM (8 and 16 mg/mL) groups. However, AM extract did not directly dissolve CaOx crystals in Drosophila Malpighian tubules ex vivo. In conclusion, AM extract decreased the ratio of CaOx crystallization in the Malpighian tubules and significantly ameliorated EG-induced reduction of lifespan. AM prevented CaOx crystal formation in the Drosophila model.

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The future of laser technology in kidney stones

Cited by 11 publications

References 26 publications

Thulium fibre laser vs holmium: yttrium‐aluminium‐garnet laser lithotripsy for urolithiasis: meta‐analysis of clinical studies

Thulium fibre laser vs holmium: yttrium‐aluminium‐garnet laser lithotripsy for urolithiasis: meta‐analysis of clinical studies

Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma

Astragalus membranaceus Extract Prevents Calcium Oxalate Crystallization and Extends Lifespan in a Drosophila Urolithiasis Model

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