Mp29-07 a Comparison Between Vapor Tunnel and Virtual Basket for the Treatment of Proximal Ureteral Stones Using Holmium:yag Laser (Cyber Ho): Which Is the Best Tool to Reduce Retropulsion?

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) III (MP29)1 May 2024MP29-07 A COMPARISON BETWEEN VAPOR TUNNEL AND VIRTUAL BASKET FOR THE TREATMENT OF PROXIMAL URETERAL STONES USING HOLMIUM:YAG LASER (CYBER HO): WHICH IS THE BEST TOOL TO REDUCE RETROPULSION? Davide Perri, Umberto Besana, Andrea Pacchetti, Elena Morini, Federica Mazzoleni, Matteo Maltagliati, Javier Romero Otero, Maria Chiara Sighinolfi, Bernardo Rocco, and Giorgio Bozzini Davide PerriDavide Perri , Umberto BesanaUmberto Besana , Andrea PacchettiAndrea Pacchetti , Elena MoriniElena Morini , Federica MazzoleniFederica Mazzoleni , Matteo MaltagliatiMatteo Maltagliati , Javier Romero OteroJavier Romero Otero , Maria Chiara SighinolfiMaria Chiara Sighinolfi , Bernardo RoccoBernardo Rocco , and Giorgio BozziniGiorgio Bozzini View All Author Informationhttps://doi.org/10.1097/01.JU.0001008680.67760.37.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We performed a comparison between Vapor Tunnel (VT) and Virtual Basket (VB) to reduce retropulsion and improve dusting in the treatment of proximal ureteral stones using the same laser device (Cyber Ho). METHODS: Patients with a single proximal ureteral stone were considered and randomized into two groups: Group A was treated using the VT tool, while Group B using the VB tool. The 150 W Holmium:YAG Cyber Ho laser generator (Quanta System) was used in all cases. Energy and frequency settings were 0.8 J and 12 Hz (long impulse duration) in both groups. All procedures were performed by experienced endourologists. A ureteral stent was always positioned at the end of procedure and removed 15 days later. Patients with previous placement of ureteral stent or nephrostomy tube in an emergency setting were excluded. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. We also compared the stone-free rate (SFR) and the occurrence of postoperative ureteral strictures. RESULTS: 186 patients with a single proximal ureteral stone underwent holmium laser lithotripsy with the use of VT (92 patients, 49.5%, Group A) or VB (94 patients, 50.5%, Group B). Preoperative parameters were comparable between groups. Mean stone size was 0.92 mm (SD 0.38) in Group A vs. 0.91 mm (SD 0.31) in Group B (p=0.32). Mean total operative time was 24.5 min (SD 9.6) vs. 26.1 min (SD 10.0) (p=0.28), whereas mean dusting time was 11.3 min (SD 3.9) vs. 12.1 min (SD 2.5) (p=0.14) in Group A vs. Group B, respectively. 7 patients (7.6%) in Group A vs. 6 patients (6.4%) in Group B required a flexible ureteroscope because of stone push-up into the renal cavities (p=0.12). Scratches of the ureteral mucosa were observed in 15 cases (16.3%) in the VT group and in 18 cases (19.1%) in the VB group (p=0.09). In all cases the lesion was limited to the mucosa, with no wall perforations. At 1 month follow-up the SFR was comparable (97.8% vs 95.7%, p=0.41). We observed 1 case (1.1%) of postoperative ureteral stricture in the VT group vs. 2 cases (2.1%) in the VB group (p=0.19). CONCLUSIONS: The VT and VB technologies are both equally safe and effective tools in reducing retropulsion of ureteral stones, thus reducing operative time and facilitating complete stone dusting. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up into the renal cavities and prevented ureteral lesions, which may later occur in ureteral strictures. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e483 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Davide Perri More articles by this author Umberto Besana More articles by this author Andrea Pacchetti More articles by this author Elena Morini More articles by this author Federica Mazzoleni More articles by this author Matteo Maltagliati More articles by this author Javier Romero Otero More articles by this author Maria Chiara Sighinolfi More articles by this author Bernardo Rocco More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF downloadLoading ...