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Transurethral contact ureterolithotripsy in gas (СО2) medium

Transurethral contact ureterolithotripsy in gas (СО2) medium

In press - Corrected proof

Article Type: SURGICAL TECHNIQUE

Article Subject: Nephrolithiasis

DOI:10.5301/uj.5000233

Authors

Dmitry O. Korolev, Peter V. Glybochko, Leonid M. Rapoport, Dmitry G. Tsarichenko

Abstract

Background

Transurethral intracorporeal lithotripsy is the modality of choice for the endoscopic disintegration of large, long-standing, radiolucent or high-density stones. Despite several advantages and proven benefits of contact ureterolithotripsy/ureterolithoextraction (CULT), the application of irrigation carries significant risks of untoward perioperative events including retrograde stone migration and postoperative pyelonephritis.

Methods

We describe a new technique – endoscopic intracorporeal lithotripsy in the gas (СО2) medium. It is a prospective randomized, single blinded pilot study that included total of (n = 60) patients with urolithiasis who were allocated to either experimental or control group. Out of the total pool of patients, 30 underwent treatment with the new approach (experimental group) and other 30 (control group) had contact ureterolithotripsy in a standard of care 0.9% NaCL medium. We included patients >18 years old, with known symptomatic renal calculi disease who were eligible and scheduled for CULT and free from significant coexisting pathologies of urinary tract.

Results

No retrograde migration of the stone fragments into the kidney was reported in the experimental group [complications rate 0%, confidence interval (CI): 0-11.6%]. In the control group, complications were observed in eight cases (complications rate 26.7%, CI: 14.7-42.3%); retrograde migration was in five patients (16.6%), and acute pyelonephritis/exacerbation of chronic pyelonephritis was seen in three (10%) patients. There was not any acute pyelonephritis in the experimental group. Reliability of frequency differences – p = 0.0023 (χ2).

Conclusions

The novel method of contact ureterolithotripsy is a safe and promising alternative to the conventional contact ureterolithotripsy in a fluid medium in a carefully selected patient population.

Article History

Disclosures

Financial support: The authors received no financial support for the research.
Conflicts of interest: The authors declare that there are no conflicts of interest.

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Authors

Affiliations

  • I.M. Sechenov First Moscow State Medical University, Moscow - Russia

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