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Comparison of the effectiveness of crushing concrements in the urinary tract with the use of holmium laser and sonotrode.

Jakóbczyk B, Wrona M, Lipiński M, Różański W - Cent European J Urol (2011)

Bottom Line: The total effectiveness of the procedure reached 92% (90 out of 98 procedures).In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures).The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication.

View Article: PubMed Central - PubMed

Affiliation: 2 Clinic of Urology, Department of Urology, Medical University, Łódź, Poland.

ABSTRACT

Introduction: Holmium lasers and ultrasound probes are widely used in urinary stone lithotripsy. The authors present a comparison of both methods in urinary stones lithotripsy.

Materials and methods: We analyzed 164-patients who underwent endoscopic lithotripsy. Ninety-eight of them (group I) were treated with the holmium laser Omni-Pulse Max 80 and were compared to the other 66-patients (group II) who were operated on with an ultrasound probe (sonotrode). Prior to the procedures, all patients were exposed to urological ultrasound and radiological imaging in order to localize the stone. The state where the stones were invisible in the radiological and renal ultrasound imaging that was performed after the operation was considered to be effective. Patients were operated under intravenous general or subepidural anesthesia.

Results: The effectiveness of laser lithotripsy in the bladder amounted to 100% (25 of 25 patients). In the case of stones localized in the ureter it reached 89%. The total effectiveness of the procedure reached 92% (90 out of 98 procedures). In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures). In group I, two cases the inflammatory changes of the ureter made the endoscopy impossible. These two patients were operated with open surgery. In one case, the laser lithotripsy was complicated with a perforation of the ureter.

Conclusion: The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication. It might surpass sonotrode and become its alternative. Both methods have both advantages and disadvantages.

No MeSH data available.


Related in: MedlinePlus

Procedure effectiveness.
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Figure 0002: Procedure effectiveness.

Mentions: In the case of procedures performed with the use of holmium laser, the effectiveness of crushing stones in the bladder amounted to 100% (25 out of 25 cases). The effectiveness of crushing concrements in ureters reached 89%. Total effectiveness of procedures (stone-free rate) with the use of holmium laser amounted to 92% (90 out of 98 procedures), which correlates with other authors’ reports [9–14]. Ilker et al. describes an effectiveness of 95.1% in a group of 205 patients. Devarajan, analyzing 300 procedures with the use of holmium laser, achieved effectiveness on the level of 90%. In their study, Scarpa et al. obtained 92.6% effectiveness. In the case of the sonotrode, the effectiveness amounted to: 85% (12 out of 14 procedures) in the bladder and 76% (40 out of 52 procedures) in the ureter, which resulted in total effectiveness (stone-free rate) of 79% (52 out of 66 procedures). Juxtaposition of the given results showed statistical significance (p <0.05) (Fig. 2). All patients who were not stone-free after first ureterorenoscopy underwent ESWL procedure. There were no indications for second URS. The composition of the stones was not identified and was not taken under consideration. The average duration of the procedure with the use of holmium laser is 42 minutes (17-135 min), whereas in the case of sonotrode – 56 minutes (20-120 min), which is statistically significant (p <0.05) (Fig. 3). In the case of 75 (76%) patients, total disintegration of concrement was observed, after using holmium laser. After using sonotrode, total disintegration of concrement was achieved in the case of 33 (50%) patients. In cases of four (6%) patients the uncrushed concrements were dislocated into the renal pelvis and in cases of three (4%) a piece of crushed concrement was dislocated into the renal pelvis. In cases of four (6%) patients the stones turned out to be utterly resistant to the operation of sonotrode. These concrements were successfully crushed with the use of a holmium laser during the same procedure. No concrements were observed to be utterly resistant to the influence of the holmium laser light. In cases of two patients (2%) operated on with the use of holmium laser, reaching the concrement proved to be impossible, because of significant constriction of the ureter. These patients were subject to an open surgery, which resulted in successful concrement removal. In case of 1 (1%) patient, ureter multi-focal perforation occurred as a result of direct influence of the laser beam on the ureter wall. Because of massive urinary leakage in the retroperitoneum and severe abdominal pain the patient underwent an emergency surgery. After supplying the perforation spot, the catheter D-J was left in the ureter for a period of 3-weeks. This complication occurred at the initial stage of using the laser. The complications prevalence rate in the examined group of patients amounts to 6% (6 patients). The average duration of patients’ stay in the Clinic after the laser procedure is 2.55 days and after the sonotrode procedure 3.55 days (p <0.05). The ureter catheter was left in cases of 13 (13%) patients after the laser procedure and in cases of 12 (18%) patients after the sonotrode procedure (p >0.05). The average energy dose in the case of bladder lithotripsy amounted to 23.5 J, whereas in the case of ureter 1.8 J. In cases of all patients, directly after the surgery, preventive antibiotherapy was instituted (ciprofloxacin).


Comparison of the effectiveness of crushing concrements in the urinary tract with the use of holmium laser and sonotrode.

Jakóbczyk B, Wrona M, Lipiński M, Różański W - Cent European J Urol (2011)

Procedure effectiveness.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921703&req=5

Figure 0002: Procedure effectiveness.
Mentions: In the case of procedures performed with the use of holmium laser, the effectiveness of crushing stones in the bladder amounted to 100% (25 out of 25 cases). The effectiveness of crushing concrements in ureters reached 89%. Total effectiveness of procedures (stone-free rate) with the use of holmium laser amounted to 92% (90 out of 98 procedures), which correlates with other authors’ reports [9–14]. Ilker et al. describes an effectiveness of 95.1% in a group of 205 patients. Devarajan, analyzing 300 procedures with the use of holmium laser, achieved effectiveness on the level of 90%. In their study, Scarpa et al. obtained 92.6% effectiveness. In the case of the sonotrode, the effectiveness amounted to: 85% (12 out of 14 procedures) in the bladder and 76% (40 out of 52 procedures) in the ureter, which resulted in total effectiveness (stone-free rate) of 79% (52 out of 66 procedures). Juxtaposition of the given results showed statistical significance (p <0.05) (Fig. 2). All patients who were not stone-free after first ureterorenoscopy underwent ESWL procedure. There were no indications for second URS. The composition of the stones was not identified and was not taken under consideration. The average duration of the procedure with the use of holmium laser is 42 minutes (17-135 min), whereas in the case of sonotrode – 56 minutes (20-120 min), which is statistically significant (p <0.05) (Fig. 3). In the case of 75 (76%) patients, total disintegration of concrement was observed, after using holmium laser. After using sonotrode, total disintegration of concrement was achieved in the case of 33 (50%) patients. In cases of four (6%) patients the uncrushed concrements were dislocated into the renal pelvis and in cases of three (4%) a piece of crushed concrement was dislocated into the renal pelvis. In cases of four (6%) patients the stones turned out to be utterly resistant to the operation of sonotrode. These concrements were successfully crushed with the use of a holmium laser during the same procedure. No concrements were observed to be utterly resistant to the influence of the holmium laser light. In cases of two patients (2%) operated on with the use of holmium laser, reaching the concrement proved to be impossible, because of significant constriction of the ureter. These patients were subject to an open surgery, which resulted in successful concrement removal. In case of 1 (1%) patient, ureter multi-focal perforation occurred as a result of direct influence of the laser beam on the ureter wall. Because of massive urinary leakage in the retroperitoneum and severe abdominal pain the patient underwent an emergency surgery. After supplying the perforation spot, the catheter D-J was left in the ureter for a period of 3-weeks. This complication occurred at the initial stage of using the laser. The complications prevalence rate in the examined group of patients amounts to 6% (6 patients). The average duration of patients’ stay in the Clinic after the laser procedure is 2.55 days and after the sonotrode procedure 3.55 days (p <0.05). The ureter catheter was left in cases of 13 (13%) patients after the laser procedure and in cases of 12 (18%) patients after the sonotrode procedure (p >0.05). The average energy dose in the case of bladder lithotripsy amounted to 23.5 J, whereas in the case of ureter 1.8 J. In cases of all patients, directly after the surgery, preventive antibiotherapy was instituted (ciprofloxacin).

Bottom Line: The total effectiveness of the procedure reached 92% (90 out of 98 procedures).In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures).The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication.

View Article: PubMed Central - PubMed

Affiliation: 2 Clinic of Urology, Department of Urology, Medical University, Łódź, Poland.

ABSTRACT

Introduction: Holmium lasers and ultrasound probes are widely used in urinary stone lithotripsy. The authors present a comparison of both methods in urinary stones lithotripsy.

Materials and methods: We analyzed 164-patients who underwent endoscopic lithotripsy. Ninety-eight of them (group I) were treated with the holmium laser Omni-Pulse Max 80 and were compared to the other 66-patients (group II) who were operated on with an ultrasound probe (sonotrode). Prior to the procedures, all patients were exposed to urological ultrasound and radiological imaging in order to localize the stone. The state where the stones were invisible in the radiological and renal ultrasound imaging that was performed after the operation was considered to be effective. Patients were operated under intravenous general or subepidural anesthesia.

Results: The effectiveness of laser lithotripsy in the bladder amounted to 100% (25 of 25 patients). In the case of stones localized in the ureter it reached 89%. The total effectiveness of the procedure reached 92% (90 out of 98 procedures). In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures). In group I, two cases the inflammatory changes of the ureter made the endoscopy impossible. These two patients were operated with open surgery. In one case, the laser lithotripsy was complicated with a perforation of the ureter.

Conclusion: The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication. It might surpass sonotrode and become its alternative. Both methods have both advantages and disadvantages.

No MeSH data available.


Related in: MedlinePlus