De Shubha, Sarkissian Carl, Marchinni Giovanni, Monga Manoj
Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Int Braz J Urol. 2015 Jan-Feb;41(1):134-8. doi: 10.1590/S1677-5538.IBJU.2015.01.18.
To identify whether stabilization of larger bladder stones would improve the efficacy of combination (ultrasonic/pneumatic) lithotripsy in a phantom bladder stone model for percutaneous cystolithopaxy.
Using 1cm phantom Bego stones, a spherical model bladder was used to simulate percutaneous bladder access. A UroNet (US Endoscopy, USA) was placed alongside a Swiss Lithoclast probe through the working channel of a Storz 26Fr rigid nephroscope. Using a 30Fr working sheath, the stone was captured, and fragmented for 60 seconds. Resulting fragments and irrigation were filtered through a 1mm strainer, and recorded. Five trials were performed with and without the UN. Durability was then assessed by measuring net defects, and residual grasp strength of each instrument. Descriptive statistics (mean, standard deviations) were used to summarize the data, and Student's t-tests (alpha < 0.05) were used to compare trials.
The mean time to stone capture was 12s (8-45s). After fragmentation with UN stabilization, there were significant improvements in the amount of residual stone (22% dry weight reduction vs 8.1% without UN, p < 0.001), number of fragments (17.5 vs 5.0 frag/stone, p=0.0029), and fragment size (3.6mm vs. 7.05 mm, p=0.035). Mesh defects were noted in all nets, ranging from 2-14 mm, though all but one net retained their original grip strength (36.8N).
Bladder stone stabilization improved fragmentation when used in conjunction with ultrasonic/pneumatic lithotripsy. However, due to limitations in maneuverability and durability of the UN, other tools need to identified for this indication.
在用于经皮膀胱结石碎石术的模拟膀胱结石模型中，确定固定较大膀胱结石是否会提高联合（超声/气压）碎石术的疗效。
使用1厘米的模拟贝格结石，采用球形模型膀胱模拟经皮膀胱穿刺。通过史托斯26F硬性肾镜的工作通道，将UroNet（美国超声内镜公司）与瑞士碎石探针并排放置。使用30F工作鞘捕获结石，并进行60秒的碎石。将产生的碎片和冲洗液通过1毫米滤网过滤并记录。在有和没有UroNet的情况下各进行5次试验。然后通过测量净缺损和每种器械的残余抓持力来评估耐用性。使用描述性统计（均值、标准差）汇总数据，并使用学生t检验（α<0.05）比较试验。
结石捕获的平均时间为12秒（8 - 45秒）。在使用UroNet固定进行碎石后，残余结石量（干重减少22%，而未使用UroNet时为8.1%，p<0.001）、碎片数量（17.5块/结石 vs 5.0块/结石，p = 0.0029）和碎片大小（3.6毫米 vs 7.05毫米，p = 0.035）均有显著改善。所有滤网均出现网孔缺损，范围为2 - 14毫米，不过除一个滤网外，其他所有滤网均保持了其原始抓持力（36.8牛）。
膀胱结石固定与超声/气压碎石术联合使用时可改善碎石效果。然而，由于UroNet在操作性和耐用性方面存在局限性，需要确定适用于该适应症的其他工具。
