Basulto-Martínez Mario, Denstedt John
Division of Urology, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Hospital, 268 Grosvenor St., London, ON, N6 A 4 V2, Canada.
Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Yucatan, Mexico.
Urolithiasis. 2025 May 2;53(1):85. doi: 10.1007/s00240-025-01753-w.
Surgical management of urinary stones has significantly evolved with the advent of extracorporeal shockwave lithotripsy, flexible ureterorenoscopy (fURS), and percutaneous nephrolithotomy. For lower pole stones larger than 1 cm, the choice between fURS and miniaturized percutaneous nephrolithotomy remains debated. fURS with ureteric access sheaths (UAS) is a widely utilized technique, but fragment clearance is challenging in unfavorable anatomical conditions and/or lower pole stones. This study compares a novel flexible suction UAS (FANS) with a standard UAS in an in vitro model of lower pole stones. An in vitro experiment was conducted using an anatomical model of the urinary tract with artificial stones simulating complex 1-cm lower pole stones. Fourteen procedures were performed using either a 12/14 Fr diameter standard UAS or FANS. Every experiment was performed by a single surgeon using a 8.4 Fr single-use digital flexible ureteroscope and holmium:YAG laser set at 0.5 J, 25 Hz, and short pulse with a 272 μm fiber. Operative times, stone clearance rates, lasering times, were recorded and the residual stone masses (> 2 mm) was quantified. Complete stone clearance was achieved in 5 out of 7 procedures using FANS while no complete stone clearance was achieved using the standard UAS. The median laser time [27:33 (26:06-28:24) vs 24:02 (21:25-25:04) mm:ss, p = 0.017] and total energy output energy [20663 (19,575-21,325) vs 18,270 (16,069-18,931) J, p = 0.017] were significantly lower in the FANS group (p = 0.017), and the operative time was comparable. This in vitro experiment suggests that fURS with novel FANS may improve stone clearance and improve laser efficiency when compared to the standard UAS, without increasing operative times. Further clinical trials are warranted to confirm these findings.
随着体外冲击波碎石术、可弯曲输尿管肾镜检查（fURS）和经皮肾镜取石术的出现，尿石症的外科治疗有了显著进展。对于直径大于1厘米的下极结石，fURS和小型化经皮肾镜取石术之间的选择仍存在争议。带输尿管通路鞘（UAS）的fURS是一种广泛应用的技术，但在解剖条件不利和/或下极结石的情况下，结石碎片清除具有挑战性。本研究在体外下极结石模型中比较了新型可弯曲吸引UAS（FANS）和标准UAS。使用带有模拟复杂1厘米下极结石的人工结石的尿路解剖模型进行体外实验。使用直径为12/14 Fr的标准UAS或FANS进行了14例手术。每项实验均由一名外科医生使用8.4 Fr一次性数字可弯曲输尿管镜和钬:钇铝石榴石激光进行，激光设置为0.5 J、25 Hz、短脉冲，光纤为272 μm。记录手术时间、结石清除率、激光照射时间，并对残余结石块（>2毫米）进行量化。使用FANS的7例手术中有5例实现了结石完全清除，而使用标准UAS未实现完全结石清除。FANS组的中位激光时间[27:33（26:06 - 28:24）对24:02（21:25 - 25:04）分:秒，p = 0.017]和总能量输出[20663（19575 - 21325）对18270（16069 - 18931）J，p = 0.017]显著更低（p = 0.017），且手术时间相当。这项体外实验表明，与标准UAS相比，采用新型FANS的fURS可能提高结石清除率并提高激光效率，且不增加手术时间。有必要进行进一步的临床试验来证实这些发现。
