Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patie...Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patients with FURL admitted to the hospital from March 2023 to March 2025 were selected and randomly divided into two groups.The observation group was treated with FURL combined with Shiwei Powder,while the control group was treated with FURL monotherapy.Based on the stone composition of the two groups,the stone removal efficiency,complication rates,recurrence rates,TCM syndrome scores,and inflammatory factor levels were compared.Results:The stone removal efficiency of the observation group was higher than that of the control group.The stone composition was mainly calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.The incidence of postoperative complications was lower in the observation group than in the control group(P<0.05).After 3–6 months of follow-up,the recurrence rate in the observation group was lower than that in the control group(P<0.05).After treatment,the TCM syndrome scores and inflammatory factor levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on the results of urinary stone composition analysis,patients treated with Shiwei Powder after FURL have higher stone removal efficiency.The most significant effect is observed in urinary stones composed of calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.This treatment can improve stone removal,prevent complications,reduce recurrences,effectively improve disease symptoms,and reduce inflammation.展开更多
BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of cases.This condition is most often reported in females.The diagnosis can be challenging an...BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of cases.This condition is most often reported in females.The diagnosis can be challenging and is often missed due to atypical presentations,which occasionally mimic gastric outlet obstruction symptoms such as nausea,vomiting,loss of appetite and hematemesis.The symptoms vary with stone size.Larger stones are managed with a surgical approach,but this carries increased morbidity and mortality.Over the past decade,the endoscopic approach has emerged as an alternative mode of treatment,but it is generally unsuccessful in the management of larger-sized stones.A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm.Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction,who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy.CASE SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain,vomiting,decreased appetite and weight loss.An abdominal computed tomography showed a 4.5 cm×4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction.Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb.Endoscopic nets and baskets were used in an attempt to remove the stone,but this approach was unsuccessful.Given her advanced age,poor physical condition and underlying comorbidities,she was deemed to be high-risk for surgery.Thus,a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone.Post-procedure,the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet.She was subsequently discharged home at 48 h,with an uneventful recovery.CONCLUSION In our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates.展开更多
BACKGROUND Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum.Due to its rarity,the diagnosis of Bouveret’s syndrome is often delayed ...BACKGROUND Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum.Due to its rarity,the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.CASE SUMMARY A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting.A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus.Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation.A Dornier Medilas H Solvo lithotripsy 350μm laser fiber(10 Hz,2 Joules)was used to disintegrate the stone into smaller pieces.The patient recovered completely.CONCLUSION A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5%of patients who have cholelithiasis.Stones larger than 2 cm can become impacted in the digestive tract,which occurs mostly in the terminal ileum.In approximately 1%-3%of cases,the stones cause obstruction in the duodenum.This phenomenon is called Bouveret’s syndrome.As this condition is mostly observed in elderly individuals with multiple comorbidities,treatment by an open surgical approach is unsuitable.Endoscopic removal is the preferred technique.The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury.Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.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
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
Objective: to observe and analyze the effect of holmium laser lithotripsy in patients with ureteral stones. Methods: included in our hospital from September 2020 to January 2022 admitted 40 patients, random digital ta...Objective: to observe and analyze the effect of holmium laser lithotripsy in patients with ureteral stones. Methods: included in our hospital from September 2020 to January 2022 admitted 40 patients, random digital table group (group name: research group, control group, group of cases: 20 cases), control group in vitro shock wave lithotripsy treatment, research group for holmium laser lithotripsy treatment, evaluate the comparison of treatment between groups. Results: the total response rate of the patients in the study group was higher than the control group, CD3 +, CD 3 + and CD4 +, inflammatory factors such as hypersensitive C-reactive protein and procalcitonin at 30 days after the operation, and the perioperative complication rate was lower than the control group (P <0.05). Conclusion: the effect and safety of holmium laser lithotripsy treatment are helpful to improve the early postoperative immune status and inflammatory conditions.展开更多
Objective: to evaluate the therapeutic value of holmium laser lithotripsy with flexible ureteroscope in the treatment of patients with isolated renal kidney calculi. Methods: 84 patients with isolated renal kidney cal...Objective: to evaluate the therapeutic value of holmium laser lithotripsy with flexible ureteroscope in the treatment of patients with isolated renal kidney calculi. Methods: 84 patients with isolated renal kidney calculi in this study were randomly selected from 2018/1 to 2020/1 and divided into two groups. One group was the control group treated with percutaneous nephrolithotomy (n=42) and the other group was the experimental group treated with ureteroscopic holmium laser lithotripsy (n=42). The operation conditions and prognosis indexes of the two groups were evaluated. Results: through the clinical treatment using the "laser lithotripsy" technique of flexible ureteroscope holmium, aiming at the patients in the experimental group, the operation process will lead to intraoperative blood loss, and effectively control the operation time, hospital stay time and relevant index value of catheter indwelling time set by laser lithotripsy during the operation. The observation group is obviously better than the control group using percutaneous nephroscope treatment (P < 0.05), but the first-stage stone removal rate of the experimental group is not different from that of the control group (P > 0.05). Conclusion: for kidney calculi patients with "isolated kidney" before operation, laser lithotripsy with special clinical treatment of "flexible ureteroscope and holmium" is adopted during the treatment, and the treatment effect is significant in stone removal. The operation time is short, the postoperative recovery is fast, and the hospitalization time is short, which reduces the economic burden for patients and is helpful for popularization.展开更多
Objective: to observe the patients with ureteral calculi, and to observe and compare the application of holmium laser lithotripsy and extracorporeal shock wave lithotripsy respectively. Methods: the research time was ...Objective: to observe the patients with ureteral calculi, and to observe and compare the application of holmium laser lithotripsy and extracorporeal shock wave lithotripsy respectively. Methods: the research time was controlled from November 2020 to November 2021. The research work was carried out on 74 patients with ureteral calculi. Among them, the control group was treated with extracorporeal shock wave lithotripsy and the observation group was treated with holmium laser lithotripsy. Results: (1) combined with the treatment effect, through comparison, the observation group 35/37, accounting for 94.59%, the control group 28/37, accounting for 75.68%, the observation group effect is more obvious, and compared with the control group, there is a significant difference, p < 0.05. (2) Based on clinical indicators, the corresponding comparison was made. the operation time of the observation group was (40.29±7.95), the control group was (56.97±8.99), the hospitalization time of the observation group was (4.24±0.51), and the control group was (5.98±1.51). The comparison results showed that the operation time of the observation group was lower than that of the control group (p < 0.05). (3) In terms of stone removal rate, 36/37 (97.30%) in the observation group and 26/37 (70.27%) in the control group were higher in the observation group (p < 0.05). (4) Combined with complications, complete the observation. in the observation group, 1/37, accounting for 2.70%, in the control group, 9/37, accounting for 24.32%, significantly lower in the observation group (p < 0.05). Conclusion: the overall treatment effect of extracorporeal shock wave lithotripsy is relatively insufficient based on the analysis of patients with ureteral calculi. Holmium laser lithotripsy can be adopted to ensure the improvement of clinical symptoms and the completeness of treatment. It is beneficial to improve the treatment effect of patients, ensure the completeness of stone removal and reduce the risk of complications.展开更多
Objective: To analyze the main treatment status and shortcomings of flexible ureteroscopic holmium laser lithotripsy, and to investigate the specific effect of adding stone capsule in patients with renal calculi. Meth...Objective: To analyze the main treatment status and shortcomings of flexible ureteroscopic holmium laser lithotripsy, and to investigate the specific effect of adding stone capsule in patients with renal calculi. Methods: After consideration set implementation of kidney stones in patients with tubal soft lens holmium laser lithotripsy, involved in the scheme of the 100 cases information early in 2021, after screening, COINS as grouping treatment appliance, foundation treatment, stone tong capsules are the scenario mainly discusses measures to plan after the collection of related data in early 2022, The relevant life parameters, treatment profile, pain and utility survey were used as the basis for the conclusion. Results: The capsule group could live a normal life under the treatment effect and mechanism, and the optimization of the overall prognosis was more obvious in the objective evaluation. The prognosis life was developed according to the rehabilitation direction in the plan, and the utility value was fully verified (P < 0.05). In the capsule group, most of the stones could be discharged within the planned period of time, the time from operation to the discharge of gravel was shorter, and there was no accumulation of gravel after operation, and the utility value was fully verified (P < 0.05). With the general level of pain assessment for patients with different stages, the analysis of the level of pain to be in capsule group formed by stones in continuous medication pain symptoms were effectively controlled, gradually retreat from severe to mild, and that can be observed in patients with execution of nursing, nursing attitude are significantly increased, and the utility value fully test (P < 0.05);The results of utility analysis, analgesia analysis and applicability analysis in the capsule group fully showed that this measure was beneficial to the discharge and prognosis of stones, and its utility value was fully verified (P < 0.05). Conclusion: Jiyitong capsule is both targeted and scientific, and has significant effect on the excretion of renal stones in patients, which can effectively shorten the treatment cycle of patients and improve the overall quality of life展开更多
Objective: to analyze and study the nursing methods and nursing effects of patients with upper urinary tract stones after treatment with ureteroscopic holmium laser lithotripsy. Methods: the study began in January 202...Objective: to analyze and study the nursing methods and nursing effects of patients with upper urinary tract stones after treatment with ureteroscopic holmium laser lithotripsy. Methods: the study began in January 2020 and ended in November 2021. Forty-eight patients who came to the hospital for treatment during the study period were selected as the research objects. All of them were hospitalized for upper urinary tract stones. They were divided into two different groups by random drawing of lots. They were named as the contrast group and the observation group, with 24 patients in each group. Holmium laser lithotripsy with flexible ureteroscope was used as the treatment between the two groups. The former received surgical treatment while carrying out routine care, while the latter carried out comprehensive care. The nursing effect between the groups was compared and analyzed. Results: compared with the two groups, the operation index of the observation group was better (p < 0.05). The clinical indexes of the observation group improved more (P < 0.05). The observation group had a relatively lower incidence of complications and higher nursing satisfaction (P < 0.05). In terms of quality of life, the observation group improved better (P < 0.05). Conclusion: in the process of implementing ureteroscopic holmium laser lithotripsy for patients with upper urinary tract calculi, combined with comprehensive nursing intervention can produce a relatively ideal intervention effect, which is suitable for universal use.展开更多
Objective The use of lasers has been an important part of urology in the treatment of stone and prostate disease.The thermal effects of lasers in lithotripsy have been a subject of debate over the years.The objective ...Objective The use of lasers has been an important part of urology in the treatment of stone and prostate disease.The thermal effects of lasers in lithotripsy have been a subject of debate over the years.The objective of this review was to assess the current state of knowledge available on the thermal effects of lasers in lithotripsy,as well as explore any new areas where studies are needed.Methods In August 2022,a keyword search on Google Scholar,PubMed,and Scopus for all papers containing the phrases“thermal effects”AND“laser”AND“lithotripsy”AND“urology”was done followed by citation jumping to other studies pertaining to the topic and 35 relevant papers were included in our study.The data from relevant papers were segregated into five groups according to the factor studied and type of study,and tables were created for a comparison of data.Results Temperature above the threshold of 43℃ was reached only when the power was>40 W and when there was adequate irrigation(at least 15–30 mL/min).Shorter lasing time divided by lithotripsy time or operator duty cycles less than 70%also resulted in a smaller temperature rise.Conclusion At least eight factors modify the thermal effects of lasers,and most importantly,the use of chilled irrigation at higher perfusion rates,lower power settings of<40 W,and with a shorter operator duty cycle will help to prevent thermal injuries from occurring.Stones impacted in the ureter or pelvi-ureteric junction further increase the probability of thermal injuries during laser firing.展开更多
Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This lit...Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.展开更多
BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct...BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi(PDC)in chronic pancreatitis.POP uses two techniques:Electrohydraulic lithotripsy(EHL)and laser lithotripsy(LL).Data on the safety and efficacy are limited for this procedure.We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP.The secondary aim was to assess pooled rates of technical success,clinical success for the two individual techniques,and adverse event rates.AIM To perform a systematic review and meta-analysis of POP,EHL and LL for management of PDC in chronic pancreatitis.METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed,EMBASE,Cochrane,Google Scholar and Web of Science databases(from 1999 to October 2019)to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP,EHL and LL.The primary outcome assessed involved the pooled technical success and clinical success rate of POP.The secondary outcome included the pooled technical success and clinical success rate for EHL and LL.We also assessed the pooled rate of adverse events for POP,EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP:Hemorrhage,post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),perforation,abdominal pain,fever and infections.Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain.Randomeffects model was used for analysis.Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics.Publication bias was ascertained,qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.RESULTS A total of 16 studies including 383 patients met the inclusion criteria.The technical success rate of POP was 76.4%(95%CI:65.9-84.5;I2=64%)and clinical success rate was 76.8%(95%CI:65.2-85.4;I2=66%).The technical success rate of EHL was 70.3%(95%CI:57.8-80.3;I2=36%)and clinical success rate of EHL was 66.5%(95%CI:55.2-76.2;I2=19%).The technical success rate of LL was 89.3%(95%CI:70.5-96.7;I2=70%)and clinical success rate of LL was 88.2%(95%CI:66.4-96.6;I2=77%).The incidence of pooled adverse events for POP was 14.9%(95%CI:9.2-23.2;I2=49%),for EHL was 11.2%(95%CI:5.9-20.3;I2=15%)and for LL was 13.1%(95%CI:6.3-25.4;I2=31%).Subgroup analysis of adverse events showed rates of PEP at 7%(95%CI:3.5-13.6;I2=38%),fever at 3.7%(95%CI:2-6.9;I2=0),abdominal pain at 4.7%(95%CI:2.7-7.8;I2=0),perforation at 4.3%(95%CI:2.1-8.4;I2=0),hemorrhage at 3.4%(95%CI:1.7-6.6;I2=0)and no mortality.There was evidence of publication bias based on funnel plot analysis and Egger’s test.CONCLUSION Our study highlights the high technical and clinical success rates for POP,EHL and LL.POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.展开更多
objective: to analyze the therapeutic effects of soft ureteroscopic holmium laser lithotriptomy (RIRS) and microchannel percutaneous nephrolithotriptomy (mPCNL) in the treatment of upper ureteral calculi with diameter...objective: to analyze the therapeutic effects of soft ureteroscopic holmium laser lithotriptomy (RIRS) and microchannel percutaneous nephrolithotriptomy (mPCNL) in the treatment of upper ureteral calculi with diameter ≤2cm. Methods: a total of 53 patients with upper ureteral calculi ≤2cm admitted in our hospital from May 2020 to May 2021 were selected as the study subjects. Patients in the control group were treated with soft ureteroscopic holmium laser lithotripsy, while patients in the observation group were treated with microchannel percutaneous nephrolithotomy. Results: compared with the control group, the calculus clearance rate of patients in the observation group was relatively higher after treatment, and the incidence of pulmonary infection, bleeding, sepsis and other complications was relatively lower. Conclusion: for 2 cm or less Duan Jieshi patients treated in the process of the ureter, compared with soft ureter mirror holmium laser lithotripsy, using microchannel percutaneous nephroscope lithotripsy removed, not only can effectively improve the patient's one-time calculi clearance rate, at the same time also can effectively reduce the probability of patients with complications, relevant treatment in clinical use value is higher.展开更多
Objective: to study the efficacy of ureteroscopic holmium laser lithotripsy (FURSL) and minimally invasive percutaneous nephrolithotripsy (MPCNL) in the treatment of 2 to 3 cm kidney stones. Methods: 160 urology patie...Objective: to study the efficacy of ureteroscopic holmium laser lithotripsy (FURSL) and minimally invasive percutaneous nephrolithotripsy (MPCNL) in the treatment of 2 to 3 cm kidney stones. Methods: 160 urology patients from January 2017 to January 2020 were 80 patients with ureteral stones of 2 to 3 cm, 80 patients (n80) and VAS80) before and after surgery, including renal function, change in infection index, pain visual simulation score (VAS). Conclusions: the 2dBUN, PCT and MPCNL groups after the P U R S L group (P <0.05) were lower than the MPCNL group (P <0.05). The postoperative 2dBUN and PCT groups (P <0.05) were all lower than those in the MPCNL group (P <0.05). The postoperative 2dBUN, PCT, and PCT groups (P <0.05) were all lower than those in the MPCNL group (P <0.05). In the PCT group, the postoperative 2dBUN, PCT, and PCT group (P <0.05) were all lower than those in the MPCNL group (P <0.05). No postoperative 2dBUN, PCT and PCT groups (P <0.05) (P <0.05);After surgery of the FURSL group, the 2dBUN, PCT and PCT group (P <0.05) were all lower than those of the MPCNL group (P <0.05). None of the results were statistically significant. The ureteroscopic holmium laser lithotripsy group applied natural cavity technology without surgical incision, which causes small harm to the patient, the patient recovers quickly after the operation, will not cause serious kidney damage, and the patient need not bear severe pain after surgery, and the chance of complications is relatively low. Compared with minimally invasive percutaneous nephrolithotripsy, the time will be longer for 2 to 3 cm, and the first surgical stone clearance is lower than that of minimally invasive percutaneous nephrolithotripsy. The time of treatment should also be determined by the state of the patients condition.展开更多
文摘Objective:To analyze the effect of Shiwei Powder combined with stone composition analysis on stone removal efficiency and complication rates after ureteroscopic holmium laser lithotripsy(FURL).Methods:Ninety six patients with FURL admitted to the hospital from March 2023 to March 2025 were selected and randomly divided into two groups.The observation group was treated with FURL combined with Shiwei Powder,while the control group was treated with FURL monotherapy.Based on the stone composition of the two groups,the stone removal efficiency,complication rates,recurrence rates,TCM syndrome scores,and inflammatory factor levels were compared.Results:The stone removal efficiency of the observation group was higher than that of the control group.The stone composition was mainly calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.The incidence of postoperative complications was lower in the observation group than in the control group(P<0.05).After 3–6 months of follow-up,the recurrence rate in the observation group was lower than that in the control group(P<0.05).After treatment,the TCM syndrome scores and inflammatory factor levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on the results of urinary stone composition analysis,patients treated with Shiwei Powder after FURL have higher stone removal efficiency.The most significant effect is observed in urinary stones composed of calcium oxalate monohydrate and composite stones containing calcium oxalate monohydrate.This treatment can improve stone removal,prevent complications,reduce recurrences,effectively improve disease symptoms,and reduce inflammation.
文摘BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of cases.This condition is most often reported in females.The diagnosis can be challenging and is often missed due to atypical presentations,which occasionally mimic gastric outlet obstruction symptoms such as nausea,vomiting,loss of appetite and hematemesis.The symptoms vary with stone size.Larger stones are managed with a surgical approach,but this carries increased morbidity and mortality.Over the past decade,the endoscopic approach has emerged as an alternative mode of treatment,but it is generally unsuccessful in the management of larger-sized stones.A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm.Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction,who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy.CASE SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain,vomiting,decreased appetite and weight loss.An abdominal computed tomography showed a 4.5 cm×4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction.Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb.Endoscopic nets and baskets were used in an attempt to remove the stone,but this approach was unsuccessful.Given her advanced age,poor physical condition and underlying comorbidities,she was deemed to be high-risk for surgery.Thus,a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone.Post-procedure,the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet.She was subsequently discharged home at 48 h,with an uneventful recovery.CONCLUSION In our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates.
文摘BACKGROUND Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum.Due to its rarity,the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.CASE SUMMARY A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting.A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus.Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation.A Dornier Medilas H Solvo lithotripsy 350μm laser fiber(10 Hz,2 Joules)was used to disintegrate the stone into smaller pieces.The patient recovered completely.CONCLUSION A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5%of patients who have cholelithiasis.Stones larger than 2 cm can become impacted in the digestive tract,which occurs mostly in the terminal ileum.In approximately 1%-3%of cases,the stones cause obstruction in the duodenum.This phenomenon is called Bouveret’s syndrome.As this condition is mostly observed in elderly individuals with multiple comorbidities,treatment by an open surgical approach is unsuitable.Endoscopic removal is the preferred technique.The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury.Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.
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.
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.
文摘Objective: to observe and analyze the effect of holmium laser lithotripsy in patients with ureteral stones. Methods: included in our hospital from September 2020 to January 2022 admitted 40 patients, random digital table group (group name: research group, control group, group of cases: 20 cases), control group in vitro shock wave lithotripsy treatment, research group for holmium laser lithotripsy treatment, evaluate the comparison of treatment between groups. Results: the total response rate of the patients in the study group was higher than the control group, CD3 +, CD 3 + and CD4 +, inflammatory factors such as hypersensitive C-reactive protein and procalcitonin at 30 days after the operation, and the perioperative complication rate was lower than the control group (P <0.05). Conclusion: the effect and safety of holmium laser lithotripsy treatment are helpful to improve the early postoperative immune status and inflammatory conditions.
文摘Objective: to evaluate the therapeutic value of holmium laser lithotripsy with flexible ureteroscope in the treatment of patients with isolated renal kidney calculi. Methods: 84 patients with isolated renal kidney calculi in this study were randomly selected from 2018/1 to 2020/1 and divided into two groups. One group was the control group treated with percutaneous nephrolithotomy (n=42) and the other group was the experimental group treated with ureteroscopic holmium laser lithotripsy (n=42). The operation conditions and prognosis indexes of the two groups were evaluated. Results: through the clinical treatment using the "laser lithotripsy" technique of flexible ureteroscope holmium, aiming at the patients in the experimental group, the operation process will lead to intraoperative blood loss, and effectively control the operation time, hospital stay time and relevant index value of catheter indwelling time set by laser lithotripsy during the operation. The observation group is obviously better than the control group using percutaneous nephroscope treatment (P < 0.05), but the first-stage stone removal rate of the experimental group is not different from that of the control group (P > 0.05). Conclusion: for kidney calculi patients with "isolated kidney" before operation, laser lithotripsy with special clinical treatment of "flexible ureteroscope and holmium" is adopted during the treatment, and the treatment effect is significant in stone removal. The operation time is short, the postoperative recovery is fast, and the hospitalization time is short, which reduces the economic burden for patients and is helpful for popularization.
文摘Objective: to observe the patients with ureteral calculi, and to observe and compare the application of holmium laser lithotripsy and extracorporeal shock wave lithotripsy respectively. Methods: the research time was controlled from November 2020 to November 2021. The research work was carried out on 74 patients with ureteral calculi. Among them, the control group was treated with extracorporeal shock wave lithotripsy and the observation group was treated with holmium laser lithotripsy. Results: (1) combined with the treatment effect, through comparison, the observation group 35/37, accounting for 94.59%, the control group 28/37, accounting for 75.68%, the observation group effect is more obvious, and compared with the control group, there is a significant difference, p < 0.05. (2) Based on clinical indicators, the corresponding comparison was made. the operation time of the observation group was (40.29±7.95), the control group was (56.97±8.99), the hospitalization time of the observation group was (4.24±0.51), and the control group was (5.98±1.51). The comparison results showed that the operation time of the observation group was lower than that of the control group (p < 0.05). (3) In terms of stone removal rate, 36/37 (97.30%) in the observation group and 26/37 (70.27%) in the control group were higher in the observation group (p < 0.05). (4) Combined with complications, complete the observation. in the observation group, 1/37, accounting for 2.70%, in the control group, 9/37, accounting for 24.32%, significantly lower in the observation group (p < 0.05). Conclusion: the overall treatment effect of extracorporeal shock wave lithotripsy is relatively insufficient based on the analysis of patients with ureteral calculi. Holmium laser lithotripsy can be adopted to ensure the improvement of clinical symptoms and the completeness of treatment. It is beneficial to improve the treatment effect of patients, ensure the completeness of stone removal and reduce the risk of complications.
文摘Objective: To analyze the main treatment status and shortcomings of flexible ureteroscopic holmium laser lithotripsy, and to investigate the specific effect of adding stone capsule in patients with renal calculi. Methods: After consideration set implementation of kidney stones in patients with tubal soft lens holmium laser lithotripsy, involved in the scheme of the 100 cases information early in 2021, after screening, COINS as grouping treatment appliance, foundation treatment, stone tong capsules are the scenario mainly discusses measures to plan after the collection of related data in early 2022, The relevant life parameters, treatment profile, pain and utility survey were used as the basis for the conclusion. Results: The capsule group could live a normal life under the treatment effect and mechanism, and the optimization of the overall prognosis was more obvious in the objective evaluation. The prognosis life was developed according to the rehabilitation direction in the plan, and the utility value was fully verified (P < 0.05). In the capsule group, most of the stones could be discharged within the planned period of time, the time from operation to the discharge of gravel was shorter, and there was no accumulation of gravel after operation, and the utility value was fully verified (P < 0.05). With the general level of pain assessment for patients with different stages, the analysis of the level of pain to be in capsule group formed by stones in continuous medication pain symptoms were effectively controlled, gradually retreat from severe to mild, and that can be observed in patients with execution of nursing, nursing attitude are significantly increased, and the utility value fully test (P < 0.05);The results of utility analysis, analgesia analysis and applicability analysis in the capsule group fully showed that this measure was beneficial to the discharge and prognosis of stones, and its utility value was fully verified (P < 0.05). Conclusion: Jiyitong capsule is both targeted and scientific, and has significant effect on the excretion of renal stones in patients, which can effectively shorten the treatment cycle of patients and improve the overall quality of life
文摘Objective: to analyze and study the nursing methods and nursing effects of patients with upper urinary tract stones after treatment with ureteroscopic holmium laser lithotripsy. Methods: the study began in January 2020 and ended in November 2021. Forty-eight patients who came to the hospital for treatment during the study period were selected as the research objects. All of them were hospitalized for upper urinary tract stones. They were divided into two different groups by random drawing of lots. They were named as the contrast group and the observation group, with 24 patients in each group. Holmium laser lithotripsy with flexible ureteroscope was used as the treatment between the two groups. The former received surgical treatment while carrying out routine care, while the latter carried out comprehensive care. The nursing effect between the groups was compared and analyzed. Results: compared with the two groups, the operation index of the observation group was better (p < 0.05). The clinical indexes of the observation group improved more (P < 0.05). The observation group had a relatively lower incidence of complications and higher nursing satisfaction (P < 0.05). In terms of quality of life, the observation group improved better (P < 0.05). Conclusion: in the process of implementing ureteroscopic holmium laser lithotripsy for patients with upper urinary tract calculi, combined with comprehensive nursing intervention can produce a relatively ideal intervention effect, which is suitable for universal use.
文摘Objective The use of lasers has been an important part of urology in the treatment of stone and prostate disease.The thermal effects of lasers in lithotripsy have been a subject of debate over the years.The objective of this review was to assess the current state of knowledge available on the thermal effects of lasers in lithotripsy,as well as explore any new areas where studies are needed.Methods In August 2022,a keyword search on Google Scholar,PubMed,and Scopus for all papers containing the phrases“thermal effects”AND“laser”AND“lithotripsy”AND“urology”was done followed by citation jumping to other studies pertaining to the topic and 35 relevant papers were included in our study.The data from relevant papers were segregated into five groups according to the factor studied and type of study,and tables were created for a comparison of data.Results Temperature above the threshold of 43℃ was reached only when the power was>40 W and when there was adequate irrigation(at least 15–30 mL/min).Shorter lasing time divided by lithotripsy time or operator duty cycles less than 70%also resulted in a smaller temperature rise.Conclusion At least eight factors modify the thermal effects of lasers,and most importantly,the use of chilled irrigation at higher perfusion rates,lower power settings of<40 W,and with a shorter operator duty cycle will help to prevent thermal injuries from occurring.Stones impacted in the ureter or pelvi-ureteric junction further increase the probability of thermal injuries during laser firing.
基金supported by the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Grant No.ZYGD18011 and No.ZYJC18015 to Wang K).
文摘Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.
文摘BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi(PDC)in chronic pancreatitis.POP uses two techniques:Electrohydraulic lithotripsy(EHL)and laser lithotripsy(LL).Data on the safety and efficacy are limited for this procedure.We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP.The secondary aim was to assess pooled rates of technical success,clinical success for the two individual techniques,and adverse event rates.AIM To perform a systematic review and meta-analysis of POP,EHL and LL for management of PDC in chronic pancreatitis.METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed,EMBASE,Cochrane,Google Scholar and Web of Science databases(from 1999 to October 2019)to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP,EHL and LL.The primary outcome assessed involved the pooled technical success and clinical success rate of POP.The secondary outcome included the pooled technical success and clinical success rate for EHL and LL.We also assessed the pooled rate of adverse events for POP,EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP:Hemorrhage,post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),perforation,abdominal pain,fever and infections.Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain.Randomeffects model was used for analysis.Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics.Publication bias was ascertained,qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.RESULTS A total of 16 studies including 383 patients met the inclusion criteria.The technical success rate of POP was 76.4%(95%CI:65.9-84.5;I2=64%)and clinical success rate was 76.8%(95%CI:65.2-85.4;I2=66%).The technical success rate of EHL was 70.3%(95%CI:57.8-80.3;I2=36%)and clinical success rate of EHL was 66.5%(95%CI:55.2-76.2;I2=19%).The technical success rate of LL was 89.3%(95%CI:70.5-96.7;I2=70%)and clinical success rate of LL was 88.2%(95%CI:66.4-96.6;I2=77%).The incidence of pooled adverse events for POP was 14.9%(95%CI:9.2-23.2;I2=49%),for EHL was 11.2%(95%CI:5.9-20.3;I2=15%)and for LL was 13.1%(95%CI:6.3-25.4;I2=31%).Subgroup analysis of adverse events showed rates of PEP at 7%(95%CI:3.5-13.6;I2=38%),fever at 3.7%(95%CI:2-6.9;I2=0),abdominal pain at 4.7%(95%CI:2.7-7.8;I2=0),perforation at 4.3%(95%CI:2.1-8.4;I2=0),hemorrhage at 3.4%(95%CI:1.7-6.6;I2=0)and no mortality.There was evidence of publication bias based on funnel plot analysis and Egger’s test.CONCLUSION Our study highlights the high technical and clinical success rates for POP,EHL and LL.POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.
文摘objective: to analyze the therapeutic effects of soft ureteroscopic holmium laser lithotriptomy (RIRS) and microchannel percutaneous nephrolithotriptomy (mPCNL) in the treatment of upper ureteral calculi with diameter ≤2cm. Methods: a total of 53 patients with upper ureteral calculi ≤2cm admitted in our hospital from May 2020 to May 2021 were selected as the study subjects. Patients in the control group were treated with soft ureteroscopic holmium laser lithotripsy, while patients in the observation group were treated with microchannel percutaneous nephrolithotomy. Results: compared with the control group, the calculus clearance rate of patients in the observation group was relatively higher after treatment, and the incidence of pulmonary infection, bleeding, sepsis and other complications was relatively lower. Conclusion: for 2 cm or less Duan Jieshi patients treated in the process of the ureter, compared with soft ureter mirror holmium laser lithotripsy, using microchannel percutaneous nephroscope lithotripsy removed, not only can effectively improve the patient's one-time calculi clearance rate, at the same time also can effectively reduce the probability of patients with complications, relevant treatment in clinical use value is higher.
文摘Objective: to study the efficacy of ureteroscopic holmium laser lithotripsy (FURSL) and minimally invasive percutaneous nephrolithotripsy (MPCNL) in the treatment of 2 to 3 cm kidney stones. Methods: 160 urology patients from January 2017 to January 2020 were 80 patients with ureteral stones of 2 to 3 cm, 80 patients (n80) and VAS80) before and after surgery, including renal function, change in infection index, pain visual simulation score (VAS). Conclusions: the 2dBUN, PCT and MPCNL groups after the P U R S L group (P <0.05) were lower than the MPCNL group (P <0.05). The postoperative 2dBUN and PCT groups (P <0.05) were all lower than those in the MPCNL group (P <0.05). The postoperative 2dBUN, PCT, and PCT groups (P <0.05) were all lower than those in the MPCNL group (P <0.05). In the PCT group, the postoperative 2dBUN, PCT, and PCT group (P <0.05) were all lower than those in the MPCNL group (P <0.05). No postoperative 2dBUN, PCT and PCT groups (P <0.05) (P <0.05);After surgery of the FURSL group, the 2dBUN, PCT and PCT group (P <0.05) were all lower than those of the MPCNL group (P <0.05). None of the results were statistically significant. The ureteroscopic holmium laser lithotripsy group applied natural cavity technology without surgical incision, which causes small harm to the patient, the patient recovers quickly after the operation, will not cause serious kidney damage, and the patient need not bear severe pain after surgery, and the chance of complications is relatively low. Compared with minimally invasive percutaneous nephrolithotripsy, the time will be longer for 2 to 3 cm, and the first surgical stone clearance is lower than that of minimally invasive percutaneous nephrolithotripsy. The time of treatment should also be determined by the state of the patients condition.
