MP29-07: A comparison between Vapor Tunnel and Virtual Basket for the treatment of proximal ureteral stones using Holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Davide Perri*, Umberto Besana, Andrea Pacchetti, Elena Morini, Federica Mazzoleni, Matteo Maltagliati, Como, Italy, Javier Romero Otero, Madrid, Spain, Maria Chiara Sighinolfi, Bernardo Rocco, Milan, Italy, Giorgio Bozzini, Como, Italy
Introduction
We performed a comparison between Vapor Tunnel (VT) and Virtual Basket (VB) to reduce retropulsion and improve dusting in the treatment of proximal ureteral stones using the same laser device (Cyber Ho)
Methods
Patients with a single proximal ureteral stone were considered and randomized into two groups: Group A was treated using the VT tool, while Group B using the VB tool. The 150 W Holmium:YAG Cyber Ho laser generator (Quanta System) was used in all cases. Energy and frequency settings were 0.8 J and 12 Hz (long impulse duration) in both groups. All procedures were performed by experienced endourologists. A ureteral stent was always positioned at the end of procedure and removed 15 days later. Patients with previous placement of ureteral stent or nephrostomy tube in an emergency setting were excluded. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. We also compared the stone-free rate (SFR) and the occurrence of postoperative ureteral strictures
Results
186 patients with a single proximal ureteral stone underwent holmium laser lithotripsy with the use of VT (92 patients, 49.5%, Group A) or VB (94 patients, 50.5%, Group B). Preoperative parameters were comparable between groups. Mean stone size was 0.92 mm (SD 0.38) in Group A vs. 0.91 mm (SD 0.31) in Group B (p=0.32). Mean total operative time was 24.5 min (SD 9.6) vs. 26.1 min (SD 10.0) (p=0.28), whereas mean dusting time was 11.3 min (SD 3.9) vs. 12.1 min (SD 2.5) (p=0.14) in Group A vs. Group B, respectively. 7 patients (7.6%) in Group A vs. 6 patients (6.4%) in Group B required a flexible ureteroscope because of stone push-up into the renal cavities (p=0.12). Scratches of the ureteral mucosa were observed in 15 cases (16.3%) in the VT group and in 18 cases (19.1%) in the VB group (p=0.09). In all cases the lesion was limited to the mucosa, with no wall perforations. At 1 month follow-up the SFR was comparable (97.8% vs 95.7%, p=0.41). We observed 1 case (1.1%) of postoperative ureteral stricture in the VT group vs. 2 cases (2.1%) in the VB group (p=0.19)
Conclusions
The VT and VB technologies are both equally safe and effective tools in reducing retropulsion of ureteral stones, thus reducing operative time and facilitating complete stone dusting. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up into the renal cavities and prevented ureteral lesions, which may later occur in ureteral strictures
Source Of Funding
None
Author Block
Davide Perri*, Umberto Besana, Andrea Pacchetti, Elena Morini, Federica Mazzoleni, Matteo Maltagliati, Como, Italy, Javier Romero Otero, Madrid, Spain, Maria Chiara Sighinolfi, Bernardo Rocco, Milan, Italy, Giorgio Bozzini, Como, Italy
Introduction
We performed a comparison between Vapor Tunnel (VT) and Virtual Basket (VB) to reduce retropulsion and improve dusting in the treatment of proximal ureteral stones using the same laser device (Cyber Ho)
Methods
Patients with a single proximal ureteral stone were considered and randomized into two groups: Group A was treated using the VT tool, while Group B using the VB tool. The 150 W Holmium:YAG Cyber Ho laser generator (Quanta System) was used in all cases. Energy and frequency settings were 0.8 J and 12 Hz (long impulse duration) in both groups. All procedures were performed by experienced endourologists. A ureteral stent was always positioned at the end of procedure and removed 15 days later. Patients with previous placement of ureteral stent or nephrostomy tube in an emergency setting were excluded. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. We also compared the stone-free rate (SFR) and the occurrence of postoperative ureteral strictures
Results
186 patients with a single proximal ureteral stone underwent holmium laser lithotripsy with the use of VT (92 patients, 49.5%, Group A) or VB (94 patients, 50.5%, Group B). Preoperative parameters were comparable between groups. Mean stone size was 0.92 mm (SD 0.38) in Group A vs. 0.91 mm (SD 0.31) in Group B (p=0.32). Mean total operative time was 24.5 min (SD 9.6) vs. 26.1 min (SD 10.0) (p=0.28), whereas mean dusting time was 11.3 min (SD 3.9) vs. 12.1 min (SD 2.5) (p=0.14) in Group A vs. Group B, respectively. 7 patients (7.6%) in Group A vs. 6 patients (6.4%) in Group B required a flexible ureteroscope because of stone push-up into the renal cavities (p=0.12). Scratches of the ureteral mucosa were observed in 15 cases (16.3%) in the VT group and in 18 cases (19.1%) in the VB group (p=0.09). In all cases the lesion was limited to the mucosa, with no wall perforations. At 1 month follow-up the SFR was comparable (97.8% vs 95.7%, p=0.41). We observed 1 case (1.1%) of postoperative ureteral stricture in the VT group vs. 2 cases (2.1%) in the VB group (p=0.19)
Conclusions
The VT and VB technologies are both equally safe and effective tools in reducing retropulsion of ureteral stones, thus reducing operative time and facilitating complete stone dusting. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up into the renal cavities and prevented ureteral lesions, which may later occur in ureteral strictures
Source Of Funding
None