Accessory instrumentation in flexible ureteroscopy: Evidence-based recommendation

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Abstract

Instrumentation is the key to success in endourology. Indeed, endourology could be redefined as “enginurology” as the marriage between engineering and urology to develop instrumentation to improve patient outcomes is the key facilitator in the advancement of minimally invasive techniques. This review article will identify the evidence-base that supports our current recommendations for equipment used during ureteroscopy.

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Most cited references 21

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Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy.

J M Teichman, G J Vassar, J Bishoff … (1997)

The mechanism of lithotripsy differs among electrohydraulic lithotripsy, mechanical lithotripsy, pulsed dye lasers and holmium:YAG lithotripsy. It is postulated that fragment size from each of these lithotrites might also differ. This study tests the hypothesis that holmium:YAG lithotripsy yields the smallest fragments among these lithotrites. We tested 3F electrohydraulic lithotripsy, 2 mm. mechanical lithotripsy, 320 microns pulsed dye lasers and 365 microns. holmium:YAG fiber on stones composed of calcium hydrogen phosphate dihydrate, calcium oxalate monohydrate, cystine, magnesium ammonium phosphate and uric acid. Fragments were dessicated and sorted by size. Fragment size distribution was compared among lithotrites for each composition. Holmium:YAG fragments were significantly smaller on average than fragments from the other lithotrites for all compositions. There were no holmium:YAG fragments greater than 4 mm., whereas there were for the other lithotrites. Holmium:YAG had significantly greater weight of fragments less than 1 mm. compared to the other lithotrites. Holmium:YAG yields smaller fragments compared to electrohydraulic lithotripsy, mechanical lithotripsy or pulsed dye lasers. These findings imply that fragments from holmium:YAG lithotripsy are more likely to pass without problem compared to the other lithotrites. Furthermore, the significant difference in fragment size adds evidence that holmium:YAG lithotripsy involves vaporization.

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The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience.

Mahesh R. Desai, Sanjiv B Patel, Mihir Desai … (2002)

Retrograde stone migration during ureteroscopic lithotripsy occurs in 5% to 40% of proximal and distal ureteral stone cases. This migration increases morbidity and the need for auxiliary procedures. The Dretler stone cone (Medsource, Norwell, Massachusetts) is a novel device to prevent proximal stone migration and facilitate fragment extraction during ureteroscopic lithotripsy. We assessed the safety and efficacy of the Dretler stone cone in the clinical setting and compared it prospectively with a conventional flat wire basket during ureteroscopy for ureteral calculi. To our knowledge we report the initial clinical use of the Dretler stone cone in 50 consecutive patients with ureteral calculi undergoing ureteroscopic extraction. Calculi were situated above the sacroiliac joint in 24 cases, over the sacroiliac joint in 15 and below the sacroiliac joint in 11. Pneumatic lithotripsy was done in 42 cases. In the remaining 8 cases ureteroscopic (3) or fluoroscopic (5) intact stone extraction was performed. The later 23 cases using the Dretler stone cone were prospectively compared with 20 of ureteroscopic intracorporeal lithotripsy using a standard flat wire basket. The Dretler stone cone was successfully placed in all 50 cases. In 41 patients it was placed via cystoscopy under fluoroscopic guidance, while 9 impacted stones required ureteroscopic placement. Six patients in whom the Dretler stone cone was used had residual fragments less than 3 mm. No patient required auxiliary procedures. In the prospective trial no patients in Dretler stone cone group had residual fragments greater than 3 mm. or required auxiliary procedures. However, in the flat wire basket group residual stones greater than 3 mm. were present in 6 cases (30%, p <0.001), while auxiliary procedures were required in 4 (20%, p <0.01). The Dretler stone cone represents a new generation of basketry that minimizes proximal ureteral stone migration and allows safe extraction of fragments during ureteroscopic lithotripsy. In our experience it is associated with a lower incidence of significant residual fragments and fewer auxiliary procedures than conventional flat wire baskets.

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Randomized evaluation of Ureteral Stents using validated Symptom Questionnaire.

Manoj Monga, Neil Skemp, Courtney Lee … (2005)

Ureteral stents are associated with significant pain and urinary symptoms. Manufacturers have altered stent designs and materials in an attempt to minimize this morbidity. This study evaluated the impact of these modifications. Stent manufacturers were asked to provide the 6F ureteral stent they believed would be associated with the least patient discomfort. Patients undergoing uncomplicated ureteroscopy were randomized to the Bard Inlay, Cook Endo-Sof, Microvasive Contour, Applied Medical Vertex, or Surgitek Classic Double-Pigtail stent. The Ureteric Stent Symptom Questionnaire (USSQ) was administered on days 1, 3, and 5, and the patients maintained a narcotic diary. The data were analyzed using ANOVA and nonparametric methods. A total of 44 patients (73%) completed all USSQ questionnaires. Urinary symptom scores were significantly lower for the Inlay stent on day 3 than for the Vertex (P = 0.01), Contour (P = 0.05), Endo-Sof (P = 0.03), and Classic (P = 0.02) stents. No significant differences were noted in pain and general symptom scores or narcotic use. The Bard Inlay stent is associated with less-severe urinary symptoms than other ureteral stents. The USSQ is a sensitive tool to measure differences between stents.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Urol

Journal ID (publisher-id): IJU

Title: Indian Journal of Urology : IJU : Journal of the Urological Society of India

Publisher: Medknow Publications (India )

ISSN (Print): 0970-1591

ISSN (Electronic): 1998-3824

Publication date (Print): Oct-Dec 2008

Volume: 24

Issue: 4

Pages: 510-512

Affiliations

Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455, USA

Author notes

For correspondence: Dr. Manoj Monga, Department of Urologic Surgery, 420 Delaware St SE (MMC 394), Minneapolis, MN 55455, USA. E-mail: endourol@ 123456yahoo.com

Article

Publisher ID: IJU-24-510

DOI: 10.4103/0970-1591.39548

PMC ID: 2684413

PubMed ID: 19468508

SO-VID: 4c84555c-55e5-4a8a-9a1c-66ea9ca3f40b

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Accessory instrumentation in flexible ureteroscopy: Evidence-based recommendation

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Abstract

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Most cited references 21

Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy.

The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience.

Randomized evaluation of Ureteral Stents using validated Symptom Questionnaire.

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