Montanari Emanuele, Longo Fabrizio, Macchione Nicola, Traxer Olivier
A.O. San Paolo, Urological Department, Medical School University of Milan, Via Antonio di Rudini 8, 20146, Milan, Italy,
Urolithiasis. 2015 Apr;43(2):177-82. doi: 10.1007/s00240-014-0740-6. Epub 2014 Nov 13.
A new anti-retropulsion device for the endoscopic treatment of ureteral stones was evaluated for safety and potential efficacy. The Xenx™ (Rocamed, Monaco-Montecarlo) is an anti-retropulsion device that operates as a normal hydrophilic guidewire when "closed" and as a nitinol ureteral mesh when "open". We performed semirigid ureterorenoscopy and Ho:YAG Laser lithotripsy in 15 patients, with a single ureteral stone. For each procedure, the papilla was negotiated with the Xenx™, the radiopaque markers were positioned over the stone via direct visualization and the device was opened under fluoroscopic control. The ureteroscope was then retracted and reinserted beside the Xenx™. At the end of the procedure, the Xenx™ was closed, and a ureteral catheter was coaxially placed and left for 24-48 h post-operation. We evaluated device positioning success with respect to pushability, ease of deployment, full expansion and fitting with the ureteral walls, kink resistance and stone retention capabilities during lithotripsy and device retrieval. Operative time, post-operative complications (Clavien-Dindo scale), ultrasound kidney stone-free rate and the hydronephrosis grade, were also recorded. At 4 weeks post-operation, the stone-free rate was assessed via non-contrast computed tomography with 1-mm slices. All procedures were successfully accomplished without complications according to the Clavien-Dindo scale. In all the cases, Xenx™ was inserted successfully past the stone and opened over it. In 4/15 cases (27%) some difficulties in pushability and kink resistance were recorded. In no case stone fragment basketing was performed. The median operative time was 24 min. At hospital discharge, 14/15 patients (93%) were kidney stone-free. At 4 weeks, the NCCT stone-free rate was 100%. This study demonstrated that the Xenx™ is safe and effective in terms of the stone-free rate, complications and operating time. Moreover, use of the Xenx™ allows the use of a basket or guide wire to be avoided.
对一种用于输尿管结石内镜治疗的新型抗反流装置的安全性和潜在疗效进行了评估。Xenx™（Rocamed，摩纳哥-蒙特卡洛）是一种抗反流装置，在“关闭”时作为普通亲水导丝工作，在“打开”时作为镍钛诺输尿管网工作。我们对15例单发性输尿管结石患者进行了半硬性输尿管肾镜检查和钬激光碎石术。对于每例手术，通过Xenx™进入乳头，通过直接观察将不透射线标记物置于结石上方，并在荧光镜控制下打开装置。然后将输尿管镜撤回并在Xenx™旁边重新插入。手术结束时，关闭Xenx™，同轴放置输尿管导管并在术后留置24 - 48小时。我们评估了装置在推送性、展开容易程度、完全扩张以及与输尿管壁贴合情况、抗扭结能力以及碎石和装置取出过程中的结石固定能力方面的定位成功率。还记录了手术时间、术后并发症（Clavien-Dindo分级）、超声检查的无结石率以及肾积水程度。术后4周，通过1毫米层厚的非增强计算机断层扫描评估无结石率。根据Clavien-Dindo分级，所有手术均成功完成且无并发症。在所有病例中，Xenx™均成功插入结石上方并打开。在4/15例（27%）病例中记录到在推送性和抗扭结方面存在一些困难。无一例进行结石碎片篮取操作。中位手术时间为24分钟。出院时，14/15例患者（93%）无肾结石。4周时，非增强计算机断层扫描的无结石率为100%。本研究表明，就无结石率、并发症和手术时间而言，Xenx™是安全有效的。此外，使用Xenx™可避免使用篮筐或导丝。
