To compare the stone ablation volume (AV) achieved by thulium fiber laser (TFL) and high-power Holmium: YAG (Ho: YAG) lasers with MOSES™, Virtual Basket™ (VB™), Vapor Tunnel™ (VT™), and Magneto pulse-modulation technologies in an artificial stone model. BegoStone phantoms (15:6 “powder-to-water” ratio) were used. A motorized arm applied the laser at a constant speed (0.7 mm/s). Laser settings included 1.5 J × 5 Hz, 1 J × 20 Hz, and 0.3 J × 50 Hz, with five 21-mm cuts per setting. AV was calculated from width and depth measurements using an optical microscope. ANOVA was performed. Among 750 measurements, TFL-200 μm achieved the highest AV in most settings. At 1.5 J x 5 Hz, TFL-200 μm (15.9 mm³) significantly outperformed MOSES™ (LP: 11 mm³, SP: 10.4 mm³, MD: 9.7 mm³) and Magneto (9.1 mm³) (p < 0.05). At 1 J × 20 Hz, TFL-200 μm (21.2 mm³) exceeded all technologies (p < 0.001). At 0.3 J x 50 Hz, TFL-200 μm (8.9 mm³) outperformed MOSES™ MD (3.8 mm³) and Magneto (4.9 mm³), p < 0.05. TFL-150 μm showed comparable AV to Ho: YAG lasers across settings, except at 1 J x 20 Hz, where it was lower than TFL-200 μm and CyberHo150 SP and VT™ (p < 0.05), primarily due to lower depth of fissure (DOF) while width of fissure (WOF) remained comparable. At 0.3 J × 50 Hz, TFL-150 μm (6.7 mm³) demonstrated lower AV than CyberHo150 SP (10.9 mm³; p = 0.003), but higher AV than MOSES™ MD (3.8 mm³; p = 0.034). TFL-200 μm achieved higher AV than Ho: YAG in most settings, but statistical significance was observed in one-third of comparisons. TFL-150 μm demonstrated similar AV to Ho: YAG, except in cases where Ho: YAG had higher DOF. TFL-150 μm has known advantages in terms of irrigation, visibility, ureteroscope tip deflection, and potential for miniaturization of flexible ureteroscopy devices and aspiration methods, supporting its potential applicability for dusting strategies while maintaining comparable AV.

OBJECTIVE:To compare stone ablation volume (AV) and ablation morphology between pulsed thulium:YAG (p-Tm:YAG) and high-power holmium:YAG (Ho:YAG) lasers with different pulse modulation technologies using an in vitro stone model. MATERIALS AND METHODS:BegoStone phantoms (15:6 powder-to-water ratio) were used. A motorized arm applied the laser on the phantoms at a constant speed (0.7 mm/s). Three laser settings were tested: 1.5 J × 5 Hz, 1 J × 20 Hz, and 0.3 J × 50 Hz. For p-Tm:YAG, short pulse (SP) and long pulse (LP) modes were evaluated; for Ho:YAG, SP, LP, Vapor Tunnel™ (VT™), and Virtual Basket™ (VB™) modes were tested. Five 21-mm fissures were created per setting. AV was calculated from fissure width (WOF) and depth (DOF) measured by optical microscopy. RESULTS:A total of 555 measurements were analyzed. At 1.5 J × 5 Hz, p-Tm:YAG (SP) produced the deepest fissures (DOF = 1000 µm vs 523.3-734.3 µm, p < 0.05) and was the only modality with a width-to-depth ratio <1, indicating deeper and narrower fissures. In contrast, p-Tm:YAG (LP) showed DOF and width-to-depth ratios comparable with Ho:YAG. At 1 J × 20 Hz, p-Tm:YAG (LP) generated wider, shallower fissures with a lower AV (11.9 mm³ vs 16.9-19.7 mm³, p < 0.05), whereas Ho:YAG (VB™) demonstrated a comparable AV. At 0.3 J × 50 Hz, p-Tm:YAG (LP) and Ho:YAG (VB™) exhibited similar width-to-depth ratios (1.3-1.4), whereas Ho:YAG (LP) and (VT™) achieved greater AV (7.4-8.0 vs 3.4 mm³; p < 0.05), driven by greater DOF. CONCLUSIONS:p-Tm:YAG and Ho:YAG lasers demonstrated distinct ablation morphologies depending on pulse modulation and laser settings. At intermediate and low-energy settings, p-Tm:YAG (LP) produced wider, shallower fissures, whereas several Ho:YAG modalities achieved greater AV through deeper fissures. Ho:YAG (VB™) showed the most similar ablation morphology to p-Tm:YAG (LP). Whether these differences translate into clinical performance remains to be determined.

Our aim was to compare hand radiation exposure using leaded vs. regular latex surgical gloves in endourological procedures. We conducted a single-center prospective comparative study between January 2017 and December 2020. Surgeon 1 wore leaded surgical gloves, while Surgeon 2 voluntarily wore regular latex surgical gloves. A ring badge and chest dosimeters were used to estimate hand and whole-body scattered radiation dose in all endourological stone procedures (ureteroscopy (URS), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL)). We found that Surgeon 1 and 2 performed a mean of 158 (SD 15.2) and 158 (SD 15.1) procedures/year, respectively, for a total of 1,092 between 2017 and 2020 between the two surgeons (696 URS/RIRS and 396 PCNL). The overall mean hand annual radiation exposure dose for Surgeon 1 and 2 was 2.87 mSv (SD 1.3) and 14.89 mSv (SD 7.87), respectively (p = 0.027), which corresponds to a mean of 0.02 (SD 0.02) and 0.1 mSv (SD 0.1) per procedure (p < 0.001). The estimated annual scattered radiation was 0.0012 and 0.0016, respectively (p = 0.63). We concluded that the use of leaded gloves in endourological stone procedures showed a significant reduction of radiation dose per year and per procedure compared to regular latex gloves; no increase in whole-body scattered radiation was detected with their use. We believe that the use of leaded gloves may be recommended, especially in urologists who dedicate most of their practice to endoscopic stone surgery. Further studies are needed to define whether these gloves could increase patient radiation exposure.

Purpose of ReviewUrinary pH is an important factor related to renal stone disease, and it plays an essential role in stone prevention. Monitoring of urinary pH by patients at home provides information that can help to assess the treatment needed by each patient. We conducted a systematic review is to assess the available evidence concerning urinary pH monitoring methods along with their accuracy, cost, and usefulness by patients with urolithiasis.Recent FindingsA total of 9 articles were included (1886 urinary pH measurements). They reported information about urinary dipsticks, portable electronic pH meters and electronic strip readers, amongst other methods. Accuracy was compared with a laboratory pH meter (gold standard). Urinary dipsticks were found to be not accurate enough to guide clinical decision making and portable electronic pH meters showed promising results.Urinary dipsticks are neither precise nor accurate enough. Portable electronic pH meters seem to be more accurate, easy to use, and cost-effective. They are a reliable source for patients to use at home in order to prevent future episodes of nephrolithiasis.

Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case reports but requires rapid diagnosis and treatment. Methods: A review of the literature from PubMed/Medline, Embase, Cochrane, and Web of Science databases was performed including studies reporting bowel perforation secondary to ESWL between January 1990 and June 2022. Results: We found 16 case reports of intestinal perforation in the literature. Although some patients had previously undergone abdominal surgery or had inflammatory intestinal disease, others were without comorbidities that could lead to complications. Abdominal pain was the main symptom and imaging was required to confirm the diagnosis, which usually necessitated a surgical intervention. As regards the ESWL technique, it appears that the combination of a high energy level and the prone position constitutes a risk factor for these rare complications. At the authors’ centre, only one case has been reported among 24,000 ESWL procedures over 20 years: A 59-year-old female who underwent ESWL for a distal right ureteral stone presented acute abdominal pain and free intraperitoneal pelvic fluid on ultrasound. A CT scan revealed a small bowel perforation requiring open laparotomy with primary closure. Conclusions: In conclusion, although bowel perforation after ESWL is rare, progressive abdominal pain with tenderness at physical examination requires proper imaging evaluation to exclude bowel perforation and prompt intervention if required.

The aim of the study was to compare standard high-power laser (with < 80 Hz) to extended frequency (> 100 Hz) lithotripsy during miniPCNL. 40 patients were randomized in to two groups undergoing MiniPCNL. For both groups, the Holmium Pulse laser Moses 2.0 (Lumenis) was used. For group A, standard high-power laser with < 80 Hz, with Moses distance was set using up to 3 J. For Group B, extended frequency (100–120 Hz) was used allowing up to 0.6 J. All patients underwent MiniPCNL using an 18 Fr balloon access. Demographics were comparable between groups. Mean stone diameter was 19 mm (14–23) with no differences between groups (p = 0.14). Mean operative time was 91 and 87 min for group A and B (p = 0.71), mean laser time was similar in both groups, 6.5 min and 7.5 min, respectively (p = 0.52) as well as the number of laser activations during the surgery (p = 0.43). Mean Watts used was 18 and 16 respectively being similar in both groups (p = 0.54) as well as the total KJoules (p = 0.29). Endoscopic vision was good in all surgeries. The endoscopic and radiologic stone free rate was achieved in all patients expect for two in both groups (p = 0.72). Two Clavien I complications were seen, a small bleeding for group A and a small pelvic perforation in group B. The use of high-power holmium laser with extended frequency and optimized Moses was effective and safe being comparable to standard high-power laser for MiniPCNL allowing more versatility with the setting range.

(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta's, 1 Dornier MedTech's, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.

Objective: To describe the epidemiological, clinical and laboratory characteristics of male patients diagnosed with Haemophilus spp. urethral infection and to compare them with the characteristics of male patients diagnosed with N. gonorrhoeae, C. trachomatis, M. genitalium and U. urealyticum urethral infection. Over the past 2 years, an increase in urethral infections due to Haemophilus spp. was observed. Materials and methods: All male patients who attended our Department of Sexually Transmitted Infections between January 2018 and February 2019 were retrospectively studied; they underwent conventional bacteriological and multiplex PCR studies in the urethra at the same time. Results: Of the 86 patients studied, a unique microorganism was detected in 76 cases, N. gonorrhoeae in 24, Haemophilus spp. in 21 (16 H. parainfluenzae and 5 H. influenzae), C. trachomatis in 19, M. genitalium in 8 and U. urealyticum in 4; 10 cases presented more than one microorganism. In case of multiple aetiological agents, sexual partnership was multiple. In the Haemophilus group, 81% reported only unprotected oral insertive sex; symptoms lasted for more than one week in 62% of the patients. Conclusions: Haemophilus is an aetiological agent of non-gonococcal urethritis whose incidence is clearly increasing; the main route of transmission is oral sex. The most common reason for consultation is dysuria and testicular pain, while urethral discharge was predominant for the other causes of urethral infection. Due to the high frequency of antibiotic resistance in the Haemophilus group, it is necessary to confirm eradication by performing a test of cure.

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP43)1 Apr 2020MP43-04 MEDICAL DIGITAL SOLUTION TO MONITOR AND CONTROL URINARY PH IN CYSTINURIC PATIENTS Oriol Angerri*, Ferran Rousaud, Silvia Gràcia, Esteban Emiliani, Andres K. Kanashiro, Francisco Sánchez-Martín, Félix Millán, Joan Palou, and Jordi Cuñé Oriol Angerri*Oriol Angerri* More articles by this author , Ferran RousaudFerran Rousaud More articles by this author , Silvia GràciaSilvia Gràcia More articles by this author , Esteban EmilianiEsteban Emiliani More articles by this author , Andres K. KanashiroAndres K. Kanashiro More articles by this author , Francisco Sánchez-MartínFrancisco Sánchez-Martín More articles by this author , Félix MillánFélix Millán More articles by this author , Joan PalouJoan Palou More articles by this author , and Jordi CuñéJordi Cuñé More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000898.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystinuria, is a congenital orphan disease that causes an excess of cystine excretion in urine. Urinary alkalinisation is a cornerstone of cystinuric patients: increase cystine solubility and making it difficult to crystallize. Hence the importance of urinary pH control to modulate the alkalizing treatments and maintain urine pH in alkaline range. Nowadays, urinary pH monitoring takes place with dipsticks, a subjective, non-standardized, semiquantitative colorimetric method (compare results with a scale). Some limitations in terms of diagnostic accuracy parameters were reported in them. The objective of the study is to know the acceptance of a new pHmeter, that has demonstrated superiority in terms of sensitivity, specificity, positive predictive value, negative predictive value and accuracy against dipsticks as a system to monitor the urinary pH by cystinuric patients. METHODS: A randomized, controlled, open trial in 28 cystinuric patients were performed in Puigvert Foundation after been approved by the ethical committee. Once the patient's eligibility is verified, those receiving alkalinizing therapy under routine clinical practice were randomized in 2 groups: those who measure the urinary pH twice a day with the medical device and those who do it with strips (standard method). The patients were randomized with a ratio 1:1 by blocks. Control visits were performed at baseline, 1, 3 and 6 months. Measures of urinary pH, urine density, number of crystal and mean size were monitored. Questions about the facility of use and adherence to pharmacological treatment and nutritional recommendations were also studied. RESULTS: The 28 patients (32.1% women and 67.9% men) had an average age of 51.82 ± 18.58 (mean± standard deviation). Regarding the facility of use, the pHmeter was easier to learn how to manage (p=0.021), easier to prepare (p=0.034) and easier to use (p=0.062) than strips. Regarding adherence to the pharmacological and dietary recommendations there were a tendency to be better in the pHmeter group. Regarding the acceptance, the pHmetre patients scored general satisfaction with a mean of 7.3 ± 2.2 (where 0 was the lowest score and 10 the highest). As expected, the measurement of urine pH, its density, number of crystals and its mean size did not show statistically significant differences versus strips. CONCLUSIONS: The pH meter studied is an accepted medical device to monitor cystinuric patients easier to use than strips. This 2.0 digital solution opens a way to work on empowerment of patients. Source of Funding: Devicare was the promoter of the study © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e648-e648 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oriol Angerri* More articles by this author Ferran Rousaud More articles by this author Silvia Gràcia More articles by this author Esteban Emiliani More articles by this author Andres K. Kanashiro More articles by this author Francisco Sánchez-Martín More articles by this author Félix Millán More articles by this author Joan Palou More articles by this author Jordi Cuñé More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Encrusted uropathy (EU) is a rare disease caused by urea-splitting bacteria, most commonly Corynebacterium urealyticum, whose incidence is increasing. Standard treatment is based on pathogen-directed antibiotic therapy, urinary diversion, bladder instillations, and surgical resection of urinary calcifications. Case Presentation: We present the case of a 60-year-old man with symptomatic bilateral encrusted pyelitis and cystitis with acute renal failure. We initially treated the patient with antibiotic therapy, urinary diversion, and oral acidification with acetohydroxamic acid, achieving negative urinary cultures. Because of the persistence of encrusted pyelitis, the patient was discharged on oral l-methionine 500 mg bid and 12 months later the encrustations had almost disappeared. Finally, we performed right retrograde intrarenal surgery to remove a persistent small calcification. Conclusion: Oral urinary acidification with l-methionine is a valid treatment for urinary encrustations in EU, with no complications reported. Complete resolution of the calcifications may be achieved without the need for invasive processes and unnecessary manipulation of the urinary system.

INTRODUCTION:The purpose of the present study was to clinically evaluate two new single-use Pusen ureteroscopes, one semirigid with a flexible tip (srURS) and one flexible (fURS).MATERIALS AND METHODS:During ten consecutive procedures (five srURS and five fURS), we subjectively evaluated on a scale from 0 (poor) to 10 (excellent), the scope's deflection, image quality, and maneuverability prior to, during and after the surgery. Patient demographics, complications with the devices, and troubleshooting were recorded.RESULTS:There were a total of ten patients, five of which were female while the other five were male. Mean age was 58.9 years. Seven patients had a single kidney stone with mean size of 9.6 mm (1.6-20 mm). Half of the patients were pre-stented. For the fURS, the preoperative image quality rating was 8.4 (8-10), compared with 6.8 (4-9) during surgery. The preoperative deflection rating was 9.6+ 0.9 (8-10), while during surgery this decreased to 8.0 (6-10) and to 6.0 (4-8) when using a laser fiber. The srURS had a preoperative image quality rating of 9.2 (8-10), which decreased to 7.6 (6-9) while using the scope. The deflection rating decreased from 9.4 (7-10) preoperatively to 7.0 (1-10) postoperatively, and a similar reduction was observed in the maneuverability rating, from 9.6 (8-10) to 7.4 (1-10). Ureteroscopy was considered as a standard in four of the fURS and three of the srURS procedures. The mean overall satisfaction rating was 6.CONCLUSIONS:The two new single-use ureteroscopes, one flexible and one semirigid, were considered to have allowed standard ureteroscopy in four and three out of the five procedures for each scope, respectively. The image quality, deflection, and maneuverability ratings decreased during the procedure for both scopes.

Introduction: There are currently 3 holmium laser, YAG (Ho:YAG) endolithotripsy procedures that are considered basic (fragmentation, pulverisation, "pop-corn" technique). We present the technique of fragmentation targeted at preferred discontinuities (FTPD), a new concept of endolithotripsy by Ho:YAG laser. Material and methods: The FTPD technique is based on the selective application of energy (targeting a specific preselected point) to an area that is visually prone to the formation of a fracture line or preferred discontinuity (conditioned by the anisotropy of the urolithiasis). The ideal energy regimen (setting) is a high range of working energy (2-3J) with a very low frequency range (5-8 Hz) and short pulse width. Between January 2015 to February 2017, the FTPD technique was used in 37 procedures (7 NLP, 16 RIRS, 12 URS, 2 cystolithotomies), with a Ho:YAG laser (Lumenis Pulse 120H (R), Tel-Aviv, Israel). Maximum power used: 24W (3J/8 Hz) with fibres of 365 mu, and 273 mu, (URS, RIRS), and 32W (4J/8 Hz) with fibres of 550 mu, (NLP, cystolithotomy). Results: Strategic improvement was achieved in all cases using the TFPD technique to continue the endolithotripsy or remove fragments. No complications were recorded after the use of this method. Conclusions: FTPD can be considered a complementary option in combination with the basic methods of fragmentation and pulverisation. In our experience, it constitutes significant progress in optimising the performance of Ho:YAG laser endolithotripsy. (C) 2018 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

PURPOSE:The holmium YAG (Ho:YAG) laser penetration depth (PD) of 0.4 mm has been widely described. Nonetheless, in physics, this concept refers to the tissue thickness at which 90% of the energy has been absorbed and not to the incision depth (ID) that the laser can achieve in tissue. The aim of this study is to evaluate the ablation efficiency of Ho:YAG laser on soft tissue. MATERIALS AND METHODS:With an automated robotic arm, systematic fissures were performed on flat veal kidney specimens. Broad setting spectrums from 2.5 to 80 W, short and long pulse, were tested with 272 and 365 μm laser fibers. Experiments were repeated three times. Two pathologists in a blinded manner measured the width, depth, and coagulation area with electronic microscopy. RESULTS:The overall mean ID was 2 mm (0.25-4.39) and the mean width was 1 mm (0.3-3.1). The mean coagulation thickness was 0.48 mm (0.25-1.73). The higher the frequency and energy, the deeper and wider was the incision p < 0.001. No differences were observed regarding the fiber diameter. The pulse length did not affect the ID, although the mean width was greater with short pulse p = 0.04. The outer mean coagulation was increased by increasing energy but not by increasing frequency p > 0.119. CONCLUSIONS:The overall mean ID was significantly higher than the theoretical 0.4 mm PD described for Ho:YAG laser. The energy, frequency, and pulse length had individual effects regarding ID, incision width, and coagulation. The ID should be specified in accordance with the laser's power output and should not be confused with the physics of PD concept.

IntroducciónEn la actualidad existen 3modalidades técnicas de endolitotricia con láser Holmium:YAG (Ho:YAG) consideradas básicas (fragmentación, pulverización, «pop-corn»). Presentamos la técnica de fragmentación dirigida por discontinuidades preferentes (FDDP), un nuevo concepto de endolitotricia con láser Ho:YAG.Material y métodosLa técnica de FDDP se basa en la aplicación selectiva (dirigida a un punto concreto preseleccionado) de la energía sobre una zona visualmente proclive a la formación de una línea de fractura o discontinuidad preferente (condicionada por la anisotropía de la urolitiasis). El régimen energético (setting) idóneo consiste en un elevado rango de energía de trabajo (2-3J) con un muy bajo rango de frecuencia (5-8Hz) y pulso de amplitud corta. Entre enero del 2015 y febrero del 2017 se ha realizado la técnica de FDDP en 37 procedimientos (7 NLP, 16 RIRS, 12 URS, 2 cistolitotomía), con un láser Ho:YAG (Lumenis Pulse 120H®, Tel-Aviv, Israel). Potencia máxima empleada: 24 W (3 J/8Hz) con fibras de 365 y 273μ (URS, RIRS), y 32 W (4 J/8Hz) con fibras de 550μ (NLP, cistolitotomía).ResultadosCon técnica de FDDP se obtuvo en todos los casos una mejora estratégica para continuar la endolitotricia o extraer fragmentos. No se registraron complicaciones derivadas de la aplicación de esta modalidad.ConclusionesLa FDDP puede ser considerada como una opción complementaria en combinación con las modalidades básicas de fragmentación y pulverización. En nuestra experiencia, significa un avance para optimizar el rendimiento de la endolitotricia con láser Ho:YAG.