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MP55-08 HOLMIUM LASER LITHOTRIPSY FOR URETERAL AND RENAL STONES: IS DUSTING EQUIVALENT TO FRAGMENTING?

2018; Lippincott Williams & Wilkins; Volume: 199; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2018.02.1779

1527-3792

Thomas Knoll, Mira Sieg, Jan Peter Jessen, Gunnar Wendt‐Nordahl, Thorsten Bach,

Kidney Stones and Urolithiasis Treatments

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2018MP55-08 HOLMIUM LASER LITHOTRIPSY FOR URETERAL AND RENAL STONES: IS DUSTING EQUIVALENT TO FRAGMENTING? Thomas Knoll, Mira Sieg, Jan Jessen, Gunnar Wendt-Nordahl, and Thorsten Bach Thomas KnollThomas Knoll More articles by this author , Mira SiegMira Sieg More articles by this author , Jan JessenJan Jessen More articles by this author , Gunnar Wendt-NordahlGunnar Wendt-Nordahl More articles by this author , and Thorsten BachThorsten Bach More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1779AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopy became the treatment option of first choice for upper tract stones, even for larger stone sizes. This development led to an increasing interest in optimizing the settings of the holmium laser. Factors as frequency, energy, pulse length or shape do substantially influence the effect of the laser on the stone. Aim of our prospective study was to evaluate the outcomes of ureteroscopic stone treatment in two high-volume stone centers comparing two typical laser settings for fragmenting and dusting. METHODS Patients with solitary ureteral or renal stones were included in the prospective data assessment. All patients were treated under generalanesthesia and fluoroscopic control. Perioperative antibiotic prophylaxis was applied or UTIs were treated preoperatively. Ureteroscopy was performed using rigid or flexible scopes (7-8.5 F, Karl Storz Endoscopes, Germany). Stone disintegration was performed using a holmium laser (Dornier Medilas H Solvo, Germany) and 275um ball-tip laser fibers. The lithotripsy settings (dusting (D)= 18-20 Hz, 0.4-0.6J, or fragmenting (F)= 8-12 Hz, 1.2-1.8 J) were chosen according to the surgeon's preference. A total of 177 patients were treated. Statistical analysis was performed by two-sided t-test. RESULTS Stones sizes in both groups were comparable (D: 93 vs. F: 76 mm, p=0.2). Pre-stenting was common (D: 83% vs. F: 87%; n.s.). 116 stones were located in the kidney, 61 stones in the ureter. Ureteral access sheaths were used in83% of renal stones. Fragmenting was chosen for 49/116 renal and 43/61 ureteral stones. Overall OR time was comparable (D: 47 vs. F: 50 min.; n. s.) but laser time was significantly longer for dusting (456 sec. vs. 63 sec.; p<0.01). Dusting had a negative impact on intraoperative vision in 46% compared to 27% (F), p<0.05). On day 1, all but one patients with ureteral stones were stone free with both settings. With fragmenting, SFR was 91.8% for renal stones, while after dusting stone residuals were seen on KUB in 34%.Intra- and postoperative complications were comparable CONCLUSIONS Both concepts for laser lithotripsy demonstrated efficacy. However, by definition, dusting cannot achieve an immediate stone free status thus close follow-up is mandatory. We therefore recommend dusting settings for patients with large stone mass or when direct extraction seems difficult due to anatomic factors. Fragmenting and direct stone extraction should be attempted whenever possible. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e750-e751 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Thomas Knoll More articles by this author Mira Sieg More articles by this author Jan Jessen More articles by this author Gunnar Wendt-Nordahl More articles by this author Thorsten Bach More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...