Ureteroscopic lithotripsy in the Trendelenburg position for extracting obstructive upper ureteral obstruction stones: a prospective, randomized, comparative trial

Zhou, Ru; Han, Conghui; Hao, Lin; Chen, Bin; Zang, Guanghui; Fan, Tao; Zhou, Jing; Dong, Yang; Ma, Weiming; Pang, Kun

doi:10.1080/21681805.2018.1492966

Cited by 13 publications

(12 citation statements)

References 20 publications

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“…For stones > 1 cm in size, complete clearance was obtained in 100% of cases by relocation versus 29% of cases in situ (p = 0.005); the difference between the two groups was not significant for stones of < 1 cm. Placing the patient in Trendelenburg position during surgery can facilitate stone relocation to the upper pole from other sites by creating a dependent upper pole; two randomized trials have demonstrated that this method results in shorter OR time, better SFR, less flexible ureteroscope manipulation, and less stone migration into the lower pole [34,35]. If the stone cannot be relocated due to size or anatomy, or if lithotripsy in situ is preferred, a ball-tip laser fibre can be safely introduced through a deflected scope.…”

Section: Technical Aspects Of Laser Lithotripsy and Stone Clearance During Fursmentioning

confidence: 99%

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

et al. 2020

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Purpose To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety. Methods A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark. Results and conclusions Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.

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Section: Technical Aspects Of Laser Lithotripsy and Stone Clearance During Fursmentioning

confidence: 99%

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

et al. 2020

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“…18,25 In addition, methods such as putting patients in the Trendelenburg position or applying gel to the proximal part of the stone have been employed to increase stone-free rates. 6,12,26 As the surgical technology and technique of fURS improves, it seems likely that pushup cases that develop during srURS will be able to be treated more easily, and there will no longer be a need for antiretropulsion techniques or devices. However, there are scarcely any studies in the literature comparing the stone-free rates of srURS with antiretropulsion and fURS.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Different techniques and devices have been used to mitigate the push-up problem. 6,7 However, it is not clear if these methods are truly necessary with today's technology. To go a step further and dust the stone after pushing it into the kidney instead of dusting it in a narrow area in the ureter might be more advantageous.…”

Section: Introductionmentioning

confidence: 99%

Where Is It Logical to Break-Up A Ureter Stone with Endoscopic Surgery?

Caniklioğlu

Selmï

SARI

et al. 2021

Preprint

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Aims: Today, we have technology to break up a ureter stone in ureter as well as in renal pelvis during ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices in order not to let the stone migrate through renal pelvis. However, we still do not know whether it is advantageous to dust a stone in ureter where it is impacted or in a wider area such as renal pelvis. This study was carried out to clarify whether it is advantageous to breaking an upper ureter stone up where it is enclaved or in a wider area such as renal pelvis. Study Design: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included in our study and analyzed retrospectively. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: non-push-up group, Group 2: push-up group). Results: Laboratory findings were changed significantly in both groups before and after surgery. However, this change was not significant between the groups. Operation times were statistically similar in both groups in contrast with the literature. Stone-free rates were significantly higher in srURS than in flexible ureterorenoscopy (fURS) (p<0,05). Complication rates were also found similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back in order to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.

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“…Researchers developed antiretropulsion devices to prevent stone push-up [18,25]. In addition, methods such as putting patients in the Trendelenburg position or applying gel to the proximal part of the stone were employed to increase stonefree rates [6,12,26]. As the surgical technology and technique of RIRS improves, it seems likely that push-up developing during srURS will be treated more easily, and there will no longer be a need for antiretropulsion techniques or devices.…”

Section: Discussionmentioning

confidence: 99%

“…Different techniques and devices have been used to mitigate the push-up problem [6,7]. However, it is not clear whether these methods are truly necessary with today's technology.…”

Section: Introductionmentioning

confidence: 99%