GRC Urolithiasis no. 20 Tenon Hospital, Sorbonne University, Paris, France.
Department of Urology AP-HP, Tenon Hospital, Sorbonne University, Paris, France.
J Endourol. 2022 Nov;36(11):1468-1474. doi: 10.1089/end.2022.0244. Epub 2022 Sep 27.
: We aimed to evaluate if the biochemical composition of urinary stones can be determined by analyzing the stone dust only, and whether a photo taken during the surgery could be useful for completing the morpho-constitutional analysis. : Twenty patients went through a retrograde intrarenal surgery for renal stone treatment with thulium fiber laser (Fiber Dust; Quanta, 2020) using 150 μm silica core laser fibers. After laser lithotripsy, residual fragments (RF) were removed with a basket (ZeroTip; Boston Scientific) and spontaneously floating stones particles were considered stone dust and were aspirated through the working channel. Pairs of RF and stone dust were labeled and sent to analysis by scanning electron microscopy and Fourier transform infrared spectroscopy. Photos of the stone (surface and section) were taken from videos recorded during the surgery. : A total of 20 patients were included in this study. Mean age was 49.8 years with metabolic and genetic disorders. Mean stone volume was 750 mm for ureteral stones and 2334 mm for renal stones. Mean stone density was 1187 HU. Positive urine culture was found in 25% patients. In 2/20 (10%), the biochemistry differed only in the relative proportions of each constituent, while in 5/20 (25%), only one component was missing. Laser crystalline conversion was found in 3/20 (15%). Whewellite and weddellite layers were found in photos, thus adding missing information from dust stone analysis. : By analyzing aspirated dust through the ureteroscope's working channel with physical techniques, we can understand the lithogenic process of the urinary stone, without needing to analyze the stone fragment. Morphologic analysis, given by a proper stone picture, adds missing information in specific cases.
我们旨在评估仅通过分析结石粉尘是否可以确定尿石的生化组成，以及手术过程中拍摄的照片是否有助于完成形态学-组成分析。
20 名患者接受钬纤维激光（Fiber Dust；Quanta，2020 年）逆行肾内手术治疗肾结石，使用 150μm 二氧化硅芯激光纤维。激光碎石后，用篮子（ZeroTip；Boston Scientific）取出残余碎片（RF），并通过工作通道自动抽吸漂浮的结石颗粒作为结石粉尘。将 RF 和结石粉尘的成对样本贴上标签，然后通过扫描电子显微镜和傅里叶变换红外光谱进行分析。从手术过程中录制的视频中拍摄结石的照片（表面和剖面）。
这项研究共纳入 20 名患者。平均年龄为 49.8 岁，伴有代谢和遗传疾病。输尿管结石的平均结石体积为 750mm，肾结石的平均结石体积为 2334mm。平均结石密度为 1187HU。25%的患者尿液培养阳性。在 20 例中，有 2 例（10%）仅在每种成分的相对比例上有所不同，而在 5 例（25%）中仅有一种成分缺失。发现 3 例（15%）激光结晶转化。在照片中发现了鸟粪石和文石层，从而补充了结石粉尘分析中缺失的信息。
通过使用物理技术经输尿管镜工作通道分析抽吸的粉尘，我们可以了解尿石的成石过程，而无需分析结石碎片。在特定情况下，适当的结石图片进行形态学分析可以补充缺失的信息。
