THE SUPERPULSE THULIUM FIBER LASER IN THE MANAGEMENT OF GIANT DISTAL URETER STONE

You have accessJournal of UrologyUrinary Stone Disease & Endourological Techniques (V04)1 Apr 2020V04-11 THE SUPERPULSE THULIUM FIBER LASER IN THE MANAGEMENT OF GIANT DISTAL URETER STONE Alexey Martov*, Dmitry Ergakov, Nikolay Baykov, Mirab Guseynov, Andrey Andronov, and Sergey Dutov, Moscow Alexey Martov*Alexey Martov* More articles by this author , Dmitry ErgakovDmitry Ergakov More articles by this author , Nikolay BaykovNikolay Baykov More articles by this author , Mirab GuseynovMirab Guseynov More articles by this author , Andrey AndronovAndrey Andronov More articles by this author , and Sergey Dutov, MoscowSergey Dutov, Moscow More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000863.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intracorporeal ureteroscopic management is currently standard approach when the stones are multiple, impacted, located in the distal ureter and they are larger than 1 cm in size. Holmium:YAG laser is used for the procedure. New Superpulse Thulium Fiber Laser (SPTFL) may offer an advantageous alternative. The aim of this video is to highlight how very large distal ureteral stone could be managed with the emerging SPTFL technology. METHODS: A 57 y.o. male suffering from left colic was admitted to our hospital. CT scan revealed two distal ureteral calculi 2.75 x 1.16cm and 7.54 mm with a density 1300 HU. They were X-Ray positive and appeared as one on the plain X-ray film. The rigid ureteroscopy approach has been chosen. After the introduction of the scope into the orifice we could pass a safety wire into the kidney. A 400 mcm laser fiber has been used. The initial laser settings were 1J, 10Hz for fragmentation and 0.15J, 200 Hz for dusting, eventually switching to 1J, 20Hz and 0.2J, 200Hz, respectively. No heating of the irrigation water at outflow has been detected. The rigid forceps have been used to remove large fragments. The hand pump-assisted gravity irrigation system has been used. As the continuity of the ureteral lumen was established, basket has been used as an anti-migration device. No perforation occurred. The operation was followed with JJ-stenting for 2 weeks. RESULTS: The stone management time was 29 min, while the total operation time was 37 min. The follow up examination after stent removal revealed no residuals and no renal pelvis dilation. This case can be placed in a more general context of our clinical experience with SPTFL. Up to now, we have treated 182 patients with total of 194 stones with all possible locations with size up to 29 mm. On average, 1-month SFR based on the CT scan is 98.5 %. No perforation or bleeding occurred in this group of patients. In 12 cases, short-term fever (C-DII) was observed. CONCLUSIONS: The new SPTFL laser is a valuable tool for intracorporeal stone management. It offers high efficacy/risks ratio and should be included in modern urologist’s armamentarium. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e390-e390 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexey Martov* More articles by this author Dmitry Ergakov More articles by this author Nikolay Baykov More articles by this author Mirab Guseynov More articles by this author Andrey Andronov More articles by this author Sergey Dutov, Moscow More articles by this author Expand All Advertisement PDF downloadLoading ...