Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy s...Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.展开更多
Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral c...Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the“ureter”during the ureteroscopic holmium laser lithotripsy in vitro.Methods:An in vitro lithotripsy was performed using a modified catheter(5 Fr)as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet.Different laser power settings(10 W,20 W,and 30 W)with various firing times(3 s,5 s,and 10 s)and rates of irrigation(15 mL/min,20 mL/min,and 30 mL/min)were applied in the experiment.Temperature changes in the“ureter”were recorded with a thermometer during and after the lithotripsy.Results:During the lithotripsy,the local highest mean temperature was 60.3℃ and the lowest mean temperature was 26.7℃.When the power was set to 10 w,the temperature was maintained below 43℃ regardless of laser firing time or irrigation flow.Regardless of the power or firing time selected,the temperature was below 43℃ at the rate of 30 mL/min.There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing(3 s,5 s,or 10 s)compared to with not drainage(p<0.05)except for two conditions of 0.5 J×20 Hz,30 mL/min,firing 5 s,and 1.0 J×10 Hz,30 mL/min,firing 5 s.Conclusion:Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect,especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.展开更多
BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rar...BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.展开更多
Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of ...Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.展开更多
A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the fin...A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.展开更多
Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and ...Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were relieved in a short period of time and the original ureter diseases causing renal colic were cured. Conclusion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and effective manner.展开更多
Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (uppe...Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.展开更多
BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes.Currently,known removal methods are either ineffective or will cause additional d...BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes.Currently,known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation.Ureteroscopy and the holmium laser have been used in various surgical techniques in urology,and in theory,they are expected to be a good strategy for solving the problem of tissue incarceration.CASE SUMMARY Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported.All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope,and a new 16-F drain was then placed in the abdominal or pelvic cavity.The efficacy of this technique was evaluated by intraoperative conditions,success rate,and operating time;safety was evaluated by perioperative conditions and the probability of postoperative complications.All four operations went smoothly,and the drains were successfully removed in all patients.The average operating time was 24.5 min.Intraoperatively,the average irrigation volume was 892.0 mL,the average drainage volume was 638.5 mL,and no bleeding or damage to surrounding tissues was observed.Postoperatively,the average drainage volume was 32.8 mL and the new drains were removed within 36 h.All patients were able to get out of bed and move around within 12 h.Their visual analogue pain scores were all below 3.The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted.CONCLUSION Ureteroscopic holmium laser surgery is an effective,safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.展开更多
Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been ...Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been recently released in the market and the initial clinical results are encouraging.This article aims to review the main technology differences between the Ho:YAG laser and the TFL,discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.Methods:We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.Results:In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice.However,as TFL is a new technology,limited studies are currently available,and the optimal settings for lithotripsy are not yet established.Conclusion:TFL has the potential to be an alternative to the Ho:YAG laser,but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness,safety,and costs.展开更多
文摘Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.
基金The study was supported in part by Zhejiang Natural Science Foundation of China(No.LWY20H050001)Zhejiang Medical and Health Technology Program of China(No.2019KY101)Taizhou Enze Medical Center Group scientific fund(No.21EZD44).
文摘Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the“ureter”during the ureteroscopic holmium laser lithotripsy in vitro.Methods:An in vitro lithotripsy was performed using a modified catheter(5 Fr)as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet.Different laser power settings(10 W,20 W,and 30 W)with various firing times(3 s,5 s,and 10 s)and rates of irrigation(15 mL/min,20 mL/min,and 30 mL/min)were applied in the experiment.Temperature changes in the“ureter”were recorded with a thermometer during and after the lithotripsy.Results:During the lithotripsy,the local highest mean temperature was 60.3℃ and the lowest mean temperature was 26.7℃.When the power was set to 10 w,the temperature was maintained below 43℃ regardless of laser firing time or irrigation flow.Regardless of the power or firing time selected,the temperature was below 43℃ at the rate of 30 mL/min.There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing(3 s,5 s,or 10 s)compared to with not drainage(p<0.05)except for two conditions of 0.5 J×20 Hz,30 mL/min,firing 5 s,and 1.0 J×10 Hz,30 mL/min,firing 5 s.Conclusion:Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect,especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.
基金Supported by the Kunshan Research and Development Project,No.KSZ2203the Kunshan Research and Development Project,No.KZYY2205.
文摘BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.
文摘Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.
文摘A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.
文摘Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were relieved in a short period of time and the original ureter diseases causing renal colic were cured. Conclusion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and effective manner.
文摘Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.
基金Supported by The National Natural Science Foundation of China,No.31660293.
文摘BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes.Currently,known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation.Ureteroscopy and the holmium laser have been used in various surgical techniques in urology,and in theory,they are expected to be a good strategy for solving the problem of tissue incarceration.CASE SUMMARY Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported.All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope,and a new 16-F drain was then placed in the abdominal or pelvic cavity.The efficacy of this technique was evaluated by intraoperative conditions,success rate,and operating time;safety was evaluated by perioperative conditions and the probability of postoperative complications.All four operations went smoothly,and the drains were successfully removed in all patients.The average operating time was 24.5 min.Intraoperatively,the average irrigation volume was 892.0 mL,the average drainage volume was 638.5 mL,and no bleeding or damage to surrounding tissues was observed.Postoperatively,the average drainage volume was 32.8 mL and the new drains were removed within 36 h.All patients were able to get out of bed and move around within 12 h.Their visual analogue pain scores were all below 3.The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted.CONCLUSION Ureteroscopic holmium laser surgery is an effective,safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.
文摘Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been recently released in the market and the initial clinical results are encouraging.This article aims to review the main technology differences between the Ho:YAG laser and the TFL,discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.Methods:We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.Results:In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice.However,as TFL is a new technology,limited studies are currently available,and the optimal settings for lithotripsy are not yet established.Conclusion:TFL has the potential to be an alternative to the Ho:YAG laser,but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness,safety,and costs.
