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To evaluate the efficiency and efficacy of HoLEP, and methods of tissue retrieval, in patients with prostate volume (PV) ≥ 200 cc (Group 1) and to compare these to patients with PV 80–199 cc (Group 2). A database of all cases performed under the care of two surgeons at a tertiary HoLEP centre was reviewed. 157 patients with PV ≥ 200 cc were compared to 157 of the most recent consecutive cases with PV 80–199 cc. Median (IQR) enucleation efficiency was greater in Group 1 [2.8 g/min (2.2–3.5)] than Group 2 [2.1 g/min (1.6–2.5), p

Background and ObjectiveDouble J (JJ) ureteric stenting represents one of the most significant causes of patient discomfort and dissat-isfaction following endourological procedures. At our institution, a large tertiary referral centre for complex stones, standard JJ stent removal was previously undertaken with a flexible cystoscope (FC) in the endoscopy department by a doctor. The pathway was prone to delays through capacity constraints and prioritization being given to cancer investigations. The Isiris® is a single-use stent removal system consisting of a ‘camera on chip’ disposable FC with an integrated grasper. We examine the feasibility of a nurse-led stent removal service using Isiris®, performed as an office-based procedure, and its effect on waiting times. Material and MethodsA specialist stone nurse undertook training in FC approved by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN). Once competency was reached, a nurse-led service was offered to patients in the outpatient setting. A prospective database from April 2018 to March 2020 was maintained to include patient data for stent removals in the nurse-led clinic using Isiris®. This was compared to a retrospective dataset of FC and stent removal between July 2016 and December 2016, per-formed by a doctor in the endoscopy department. The delays in stent removal compared to the ‘ideal’ stent removal date (planned date plus or minus 3 days tolerance allowed) were compared between the two pathways. ResultsThe specialist nurse undertook BAUS theory training and competency was reached using an approved BAUS/BAUN competency package. 414 stent removals were booked in the nurse group, of which 395 were undertaken. 291 of 395 (74%) patients in the nurse removal Isiris® group had their stent removed on time, whereas only 16 of 54 (30%) patients had their stents removed on time in the FC stent removal group. A delay of more than 21 days was seen in 22% of FC group vs only 2% in the nurse-led Isiris® group. Both planned removal and actual stent dwell time were longer in the FC group compared to Isiris® group (p < 0.0001). There were no major complications with the use of Isiris® for stent removal in the nurse-led clinic. ConclusionThis study has demonstrated that it is feasible to introduce a nurse-led stent removal service. The introduction of this service using the Isiris® system has led to a reduction in delays of stent removal, which is likely to trans-late into significant quality of life improvement for patients and economic benefits for the healthcare system.

Background: Multiple large bladder calculi are traditionally managed through open cystolithotomy or transurethrally in patients who have an open bladder neck. Open procedures are technically challenging in patients who may have had multiple previous open surgeries, and may be associated with significant morbidity in patients with a high comorbid burden. Therefore, a percutaneous approach to such stones has been used especially when there is a closed bladder neck, and has been shown to be effective. There are a number of available devices for breaking stones in these approaches, the newest of which is the LithoClast Trilogy™ (EMS, Nyon, Switzerland) device, a probe that provides ultrasonic and mechanical calculi fragmentation and suction in a single instrument. Case Presentation: We describe the first reported case of percutaneous cystolitholapaxy using the LithoClast Trilogy device in a 41-year-old woman with spina bifida, and multiple large bladder calculi with a history of ileocystoplasty and Mitrofanoff formation, and a bladder neck closure for neuropathic bladder. The calculi measured 31 and 25 mm, and had a volume of 19.6 and 7.9 cm(3) and average HU of 408 and 462, respectively. The calculi were composed of 37% calcium phosphate and 63% magnesium ammonium phosphate. Conclusion: We demonstrate that this approach can be used as a viable alternative to open surgery, which is of particular importance for complex patients who have undergone multiple previous open operations, and who may have a high comorbid burden.

With an increase in the number of ureteroscopy (URS) procedures, URS is now performed more widely and is becoming a standard procedure for all urologists. There is also a rise in the complexity of these procedures and URS is now offered for treatment of stones as well as for diagnosis and treatment of urothelial tumours. We wanted to provide a 'pictorial review' of the 'tips and tricks' of URS, as the finer and technical details are often easier to understand and remember with images rather than through textual explanations.

To evaluate the efficiency and efficacy of HoLEP, and methods of tissue retrieval, in patients with prostate volume (PV) ≥ 200 cc (Group 1) and to compare these to patients with PV 80-199 cc (Group 2).A database of all cases performed under the care of two surgeons at a tertiary HoLEP centre was reviewed.157 patients with PV ≥ 200 cc were compared to 157 of the most recent consecutive cases with PV 80-199 cc. Median (IQR) enucleation efficiency was greater in Group 1 [2.8 g/min (2.2-3.5)] than Group 2 [2.1 g/min (1.6-2.5), p 0.001]. Morcellation efficiency did not differ significantly. Cystotomy was required for tissue retrieval in Group 1 only (5.7%). Decrease in serum haemoglobin (Hb) was greater in Group 1 (19 g/l (30-8) vs 12 (18-3.5), p 0.001) with a transfusion rate of 4.5% vs 1.3%, respectively (p = 0.104). Length of stay was longer in Group 1 than Group 2 (1 day (1-2) vs 1 (1-1), p 0.001). There were no significant differences between groups in: time to and success of first trial without catheter, pre- and post-operative IPSS, Qmax and PVR, and 3 month catheter-free and urinary incontinence rates.HoLEP outcomes are largely PV-independent even when PV is ≥ 200 cc, although length of stay and reduction in Hb are greater in this group. Alternatives to pure morcellation, such as cystotomy and resection of nodules, are more likely to be necessary with PV ≥ 200 cc.

Objectifs L’etude in vitro de la lithotritie laser (LL) utilise des calculs humains (CH) ou synthetiques (CS). Devant l’augmentation de la pulverisation laser (Dusting), peu d’echantillons humains sont disponibles. Les CS sont donc privilegies, confectionnes par melange d’eau et de plâtre, avec la problematique de leur rehydratation lors des LL. L’objectif etait de comparer les volumes d’ablation (VA) entre CS homogenes (CSHo) ou heterogenes(CSHe), et par rapport au poids ablate (PA). Methodes Les CSHo et CSHe durs (COM) ou tendre (UA) etaient confectionnes par melange de BegostonePlus (Bego®) et brassage lent ou rapide avec exsufflation, respectivement. Des fibres laser (Boston Scientific®) connectees au TFL (IPG Photonics®) 50 W (272 μm ou 150 μm) ou au MH1 Ho :YAG 30 W (Rocamed®) (272 μm) ont ete utilisees selon trois parametres laser (« fine dusting » [FD : 0,15 J/100 Hz], « dusting » [D : 0,5 J/30 Hz] et « fragmentation » [Fr : 1 J/15 Hz]). Une emission laser de vingt secondes etait realisee respectant une spirale de rayon 4 mm en contact avec les CS cubiques de 10 mm, prealablement peses et immerges. Apres sechage, les calculs etaient peses et scannes (Quantum FX, Perkin Elmer). Les volumes d’ablation etaient mesures par segmentation (3DSlicer [NIH]) ( Fig. 1 ). La correlation PA-VA (cPA-VA) etait evaluee pour chaque groupe. Resultats Avec les CSHe, les VA en Dusting etaient quatre et trois fois superieurs avec le TFL par rapport au Ho :YAG contre COM (p Tableau 1 ). Avec les CSHo cette difference n’etait plus significative contre UA en Dusting (p = 0,08) et Fragmentation (p = 0,09). L’utilisation des CSHo etait associee a des differences non significatives entre TFL-150 μm et TFL-272 μm, et entre TFL-150 μm et Ho :YAG-272 μm. La cPA-VA etait superieure en cas de CSHo par rapport au CSHe (0,853 versus 0,428, p Tableau 2 ). Si la cPA-VA etait acceptable en cas de COM (CSHo ou CSHe), il n’est pas possible d’utiliser l’approximation du VA par le PA en cas d’UA. Conclusion L’efficacite in vitro d’une LL est plus precise en utilisant les VA plutot que les PA. L’approximation du VA par le PA est acceptable et moins couteuse en cas de CSHo et dur (COM) bien que les calculs urinaires ressemblent plus aux CSHe (COM ou UA).

Purpose: To evaluate in vitro the maximum pressure generated in an artificial kidney model when people of different levels of strengths used various irrigation systems. Materials and Methods: Fifteen people were enrolled and divided into three groups based on their strengths. Individual strength was evaluated according to the maximum pressure each participant was able to achieve using an Encore™ Inflator. The irrigation systems evaluated were as follows: T-Flow™ Dual Port, Hiline™, continuous flow single action pumping system (SAPS™) with the system close and open, Irri-flo II™, a simple 60-mL syringe, and Peditrol™. Each irrigation system was connected to URF-V2 ureteroscope, which was inserted into an artificial kidney model. Each participant was asked to produce the maximum pressure possible with every irrigation device. Pressure was measured with the working channel (WC) empty, with a laser fiber, and a basket inside. Results: The highest pressure was achieved with the 60 mL-syringe system an...

INTRODUCTION AND OBJECTIVE:Holmium laser enucleation of the prostate (HoLEP) is recommended as a treatment option for bladder outlet obstruction for large volume benign prostatic hyperplasia in AUA...

Isiris (TM) (Porges-Coloplast) is a single-use digital flexible cystoscope, with an integrated grasper approved for double-J stent removal with comparable characteristics with other digital cystoscopes in the market. Isiris has its own monitor that can be mounted anywhere; and also with an integrated camera and a grasper system, stent removal can be performed at any place without any time restriction and also without a delay between two procedures. Isiris provides the use of a brand-new device in each procedure without a risk of contamination. The digital image quality and easy maneuverability and the potential cost reduction with a single-use device are the advantages, which all urologists should appreciate.

Clinical data suggest an equipoise between single-use (disposable) and reusable flexible ureterorenoscope (fURS) in terms of scope characteristics, manipulation, view and clinical outcomes. The procedural cost of reusable fURS is dependent on the initial and repair cost, maintenance and scope sterilization and on the number of procedures performed/repair. We conducted a systematic review on the procedural cost ($) of fURS based on the individual authors reported data on the number of procedures performed before repair and to see if it is a feasible option compared to single use fURS. A systematic review carried out in a Cochrane style and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist using Medline, Scopus, CINAHL, EMBASE and Cochrane library for all English language articles. All papers on fURS cost analysis were searched from 2000-2018 (19 years), which mentioned the cost of fURS based on the number of procedures performed and the repairs needed (procedure/repair) as reported by the individual authors. Six studies reported on both the number of procedures performed with number of repairs needed and the cost calculated/procedure in the given time period. The number of uses/repair in various studies varied between 8-29 procedures and the cost per procedure varied between $120-1,212/procedure. A significant trend was observed between the decreasing cost of repair with the number of usages. With studies reporting on a minimum of 20 cases/ repair the mean cost was around $200/procedure. This is contrast to the disposable scopes such as Lithovue ($1,500-2,000/usage) and Pusen ($700/usage). The cost of reusable fURS is low in centres performing a high volume of procedures. Similarly, when a reasonable volume of procedures is performed before scope repair, the cost is lower than the disposable scopes. Although, the disposable and reusable scopes seem to be comparable in terms of their performance, this review proves that reusable fURS are still more cost effective than disposable scopes.

Background: Single-use flexible ureterorenoscopes (fURSs) have been recently introduced aiming to offer solutions to the sterilization, fragility and cost issues of the reusable fURSs. In order to be a viable alternative, the single-use scopes must prove similar capabilities when compared to their reusable counterparts. The goal of our in-vitro study was to compare the current reusable and single-use digital fURSs regarding their deflection, irrigation and vision characteristics. Methods: We compared in-vitro 4 single-use fURSs-LithoVue (TM) (Boston Scientific, Marlborough, Massachusetts, USA), Uscope (TM) (Zhuhai Pusen Medical Technology Co. Ltd., Zhuhai, Guangdong Province, China), NeoFlex (TM) (NeoScope Inc, San Jose, California, USA) and ShaoGang (TM) (YouCare Technology Co. Ltd., Wuhan, China) versus 4 reusable fURSs-FLEX-Xc (Karl Storz SE & Co KG, Tuttlingen, Germany), URF- V2 (Olympus, Shinjuku, Tokyo, Japan), COBRA vision and BOA vision (Richard Wolf GmbH, Knittlingen, Germany). Deflection and irrigation abilities were evaluated with different instruments inserted through the working channel: laser fibres (200/273/365 mu m), retrieval baskets (1.5/1.9/2.2 Fr), guide wires [polytetrafluoroethylene (PTFE) 0.038 inch, nitinol 0.035 inch] and a biopsy forceps. A scoring system was designed to compare the deflection impairment. Saline at different heights (40/80 cm) was used for irrigation. The flow was measured with the tip of the fURS initially straight and then fully deflected. The vision characteristics were evaluated (field of view, depth of field, image resolution, distortion and colour representation) using specific target models. Results: Overall, the single-use fURSs had superior in-vitro deflection abilities than the reusable fURSs, in most settings. The highest score was achieved by NeoFlexT and the lowest by ShaoGang (TM). PTFE guide wire had most impact on deflection for all fURSs. The 200 mu m laser fibre had the lowest impact on deflection for the single-use fURSs. The 1.5 Fr basket caused the least deflection impairment on reusable fURSs. At the end of the tests, deflection loss was noted in most of the single-use fURSs, while none of the reusable fURSs presented deflection impairment. ShaoGang (TM) had the highest irrigation flow. Increasing the size of the instruments occupying the working channel led to decrease of irrigation flow in all fURSs. The impact of maximal deflection on irrigation flow was very low for all fURSs. When instruments were occupying the working channel, the single-use fURSs had slightly better in-vitro irrigation flow than the reusable fURSs. The field of view was comparable for all fURSs, with LithoVue (TM) showing a slight advantage. Depth of field and colour reproducibility were almost similar for all fURSs. ShaoGang (TM) and UscopeT had the lowest resolution. FLEX Xc had the highest image distortion while LithoVueT had the lowest. Partial field of view impairment was not for Uscope (TM) and ShaoGang (TM). Conclusions: In-vitro, there are differences in technical characteristics of fURSs. It appears that single-use fURSs deflect better than their reusable counterparts. Irrespective of deflection, the irrigation flow of the singleuse fURSs was slightly superior to the flow of the reusable fURSs. Overall, reusable fURSs had better vision characteristics than single-use fURSs. Further in-vivo studies might be necessary to confirm these findings.

Cystine stone patients can be difficult to manage with frequent recurrences. We performed a systematic review with a view to assessing interventions, compliance and their long-term outcomes. Ten retrospective observational studies (253 patients) assessed the outcomes and long-term follow-up of cystine stone patients. The mean length of follow-up was 9.6 years (range 3.5–21.8 years). The overall mean number of surgical procedures/patient was 5.7 (range 2–9.8/patient) with the overall mean number of surgical procedures/patient/year at 0.59 (range 0.22–1.32/patient/year). While open surgery has decreased over the last decade and PCNL has been stable, there seems to be a rise of RIRS during this period. Patients with cystine stones need periodic interventions for stone recurrences despite medical management, with limited data showing the impact on renal function. While the management is individualised, wide variability exists with often poor and incomplete patient data.

INTRODUCTION AND OBJECTIVES:A novel Super-Pulse Thulium Fiber laser has recently been developed and used for urolithiasis. The initial results show a better efficacy than conventional Holmium laser...

INTRODUCTION AND OBJECTIVES:The Moses Technology developed to enhance the High power Holmium lasers (HPH) lithotripsy is challenged by the novel Super-pulse Thulium fibre laser. The goal of our stu...

International audience; Purpose: To evaluate how variable working distances between the laser fiber and the stone influence ablation volume. Methods: A laser fiber was fixed on a robotic arm perpendicular to an artificial stone. A single laser pulse was triggered at different working distances (0–2.0 mm in 0.2 mm increments) between the distal fiber tip and the stone. To achieve a measurable impact, pulse energy was set to 2 and 3 J, with either short or long pulse duration. Ablation volume was calculated with an optical microscope. Experiments were repeated five times for each setting. Results: Highest ablation volume was observed with a long pulse of 3 J at a working distance of 0.4 mm between the laser fiber and the stone surface (p value < 0.05). At 2 J, the highest ablation volume was noticed with a short pulse in contact mode. However, ablation volume of the latter was not significantly greater than with a long pulse of 2 J at a working distance of 0.4 mm (p value > 0.05). Compared to lithotripsy in contact mode, triggering a single long pulse at 0.4 mm increased ablation volume by 81% (p value = 0.016) at 2 J and by 89% (p value = 0.034) at 3 J. Conclusions: For Ho:YAG laser lithotripsy, ablation volume may be higher in non-contact mode using long pulses, rather than in direct contact to the stone. Findings of the current study support the need of further studies of lithotripsy in non-contact mode.

Introduction Research for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years. Material and methods A systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016. Results Over the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (

Purpose: To evaluate LithoVue, the new single-use digital flexible ureteroscope, in a human cadaveric model and compare it with a nondisposable fiber optic and digital flexible ureteroscopes. Materials and Methods: LithoVue, a conventional fiber optic, and digital flexible ureteroscopes were each tested in four renal units of recently deceased female cadavers by three surgeons. The following parameters were analyzed: accessibility to the kidney and navigation of the entire collecting system with and without ureteral access sheath (UAS), lower pole access measuring the deflection of the ureteroscope with the working channel empty, and with inside two different baskets and laser fibers. A subjective evaluation of maneuverability and visibility was assessed by each surgeon at the end of every procedure. Results: Kidney access into the Renal unit 1 was not possible without UAS for all ureteroscopes because of noncompliant ureter at the level of sacroiliac joint. The reusable digital ureteroscope was unable to reach one calix of the lower pole and one calix of the upper pole (Renal units 2 and 3) without UAS placement. Lower pole access with baskets and laser fibers was possible for each ureteroscope after UAS placement. No statistically significant differences were detected in angle deflection between ureteroscopes. The digital ureteroscope was preferred for visibility in all procedures: LithoVue for maneuverability in six procedures, fiber optic in five procedures, and the digital ureteroscope in one procedure. Conclusions: LithoVue seems to be comparable with conventional ureteroscopes in terms of visibility and manipulation into the collecting system in fresh human cadavers. Further studies in humans are needed to determine the clinical value of this new instrument.

The improvements in flexible ureteroscopes provide efficient access to the upper urinary tract and advancements in laser technology strengthens the endourologists' armamentarium. The endourologists must be aware of the advantages and the potential complications of these powerful technological equipments. Our aim is to demonstrate temperature evolution during laser use inside an artificial kidney model.We created a bench model using K-Box(®) immersed into a saline-filled heating tank, which was used to obtain the needed temperature inside the cavity to provide different real-time situations. An endotracheal thermometer was placed inside. We used Olympus URF-P6 ureteroscope and Rocamed Holmium:yttrium-aluminium-garnet laser with two different fibers; 200 and 272 μm, at five different settings. Irrigation at room (24.5°C) and body (36.5°C) temperatures was used. We measured temperatures at 15th, 30th, and 45th seconds and 1st, 2nd, and 5th minutes of laser use with and without irrigation. We stopped measurements when temperature reached the upper limit of the endotracheal thermometer.When irrigation was closed, with 272-μm laser fiber, we reached the temperature limit more rapidly with saline tank at 36.5°C than the tank at 24.5°C. When irrigation was closed, with both fibers and regardless of tank temperature and laser settings, the system surpassed the maximum temperature limit. With 272-μm laser fiber, the limit was reached as early as the 30th second. When the irrigation was open, we did not reach the maximum temperature limit regardless of tank temperature and laser setting. When two laser fibers were compared, the temperature increase was more pronounced with 272-μm fiber, but the difference was not statistically significant.Laser use during flexible ureteroscopy may cause increased intrarenal temperatures. Rapid increases should be kept in mind when irrigation is closed. The irrigation seems to limit the temperature increase when used with any laser setting.

INTRODUCTION: Flexible ureterorenoscopy (fURS) is one of the best solutions for treatment of renal calculi MATERIALS AND METHODS: Seven different fURS were used to compare the image quality (Lithovue, Olympus V, Olympus V2, Storz Flex XC-in White Light and in Clara+Chroma mode-Wolf Cobra Vision, Olympus P6, and Storx Flex X2). Two standardized grids to evaluate contrast and image definition and three stones of different composition were filmed in four standardized different scenarios. These videos were shown to 103 subjects (51 urologists and 52 nonurologists) who had to evaluate them with a rating scale from 1 (very bad) to 5 (very good).RESULTS: No difference in terms of scores was observed for sex of the participants. Digital (D) ureterorenoscopes were rated better than fiber optics (FOs) ureterorenoscopes. Overall, Flex XC White Light and XC Clara+Chroma image quality resulted steadily better than other fURS (p CONCLUSION: D ureterorenoscopes have a better image quality than FO ones. The only disposable ureterorenoscope tested was comparable to the majority of other D ureterorenoscopes. The best image quality was provided by Storz D ureterorenoscopes, being Clara Chroma the favorite Spies Mode, according to literature.

Introduction The advancements in telemedicine provide the possibility to send photos of hematuria cases to professionals for further evaluation. We aimed to evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria. Materials and methods Between December 2014 and April 2016, 212 patients were evaluated prospectively for hematuria by 2 groups of urologists; Group A: in direct contact with patients for evaluation; Group B: “blind” urologist who had no access to the patients’ data but received pictures via WhatsApp. Two photos of voided urine in a sterile container were taken and sent using WhatsApp. The opinions of Group A and B about the grade of hematuria were evaluated. Shapiro-Wilk test and Fleiss’ kappa statistics were used for statistical analyses. Results The median age of patients was 71 (min 22, max 96). The Group A urologists were in accordance in 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203) and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among “blind” urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and non-serious hematuria, the rate of misdiagnosing serious cases is approximately 6.5–7%. However, using WhatsApp, the urologists can differentiate normal urine and any form of hematuria with 100% accuracy. Conclusion It is possible to evaluate hematuria remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas.

Purpose Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. Materials and methods A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. Results The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. Conclusions Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Objectifs L’objectif de cette etude a ete de comparer les ureteroscopes souples (urss) numeriques reutilisables et a usage unique pour leur capacite a acceder au calice inferieur dans une configuration anatomique simple et complexe en utilisant le modele renal in vitro k-box en fonction de l’occupation du canal operateur (libre ou occupe). Methodes Quatre urss numeriques a usage unique (lithovue, pusen, neoflex, youcare) et quatre urss numeriques reutilisables (urf-v2, fle- xc, cobra vision, boa vision) ont ete compares pour leur capacite a acceder au calice inferieur dans une configuration anatomique simple et complexe en utilisant le modele renal in vitro k-box. Les experiences ont ete realisees avec un canal operateur libre ou occupe par differents instruments : fibre laser de 200 μm, 273 μm, 365 μm ; panier en nitinol de 1,5 fr, 1,9 fr, 2,2 fr ; fil guide ptfe de 0,038′′, fil guide en nitinol de 0,035′′ ; pince a biopsie piranha. Les taux de succes d’acces caliciel inferieurs ont ensuite ete analyses. Resultats Les resultats sont presentes dans les Fig. 1 , Fig. 2 . L’urss a usage unique lithovue et l’urss reutilisable flex-xc etaient ceux obtenant les meilleurs taux de succes pour l’acces caliciel inferieur simple et complexe quelle que soit la situation du canal operateur (libre ou occupe). Bien que la plupart des urss aient accede au calice inferieur simple, seul le flex-xc (urss reutilisable) et l’ensemble des urss a usage unique, hormis le youcare, ont accede au calice inferieur complexe quelle que soit la situation du canal operateur. Les resultats globaux etaient en faveur des urss a usage unique bien qu’il existait une large variabilite selon l’instrument utilise. Conclusion Ces resultats montrent une grande variabilite de deflexion des urss pour l’acces caliciel inferieur en fonction de la situation du canal operateur (libre ou occupe). L’urss a usage unique lithovue et l’urss reutilisable flex-xc etaient ceux obtenant les meilleurs resultats.

Objectifs Les objectifs ont ete de comparer les qualites optiques ainsi que les capacites de torque de plusieurs modeles d’URSS numeriques reutilisables et a usage unique. Methodes Concernant les qualites optiques, les parametres suivants ont ete compares in vitro : champ de vision (mire a frequence multiple), profondeur de champ (mire de profondeur de champ), resolution d’image (mires de resolution USAF 1951), distorsion (mire de distorsion a frequence fixe) et la representation des couleurs (modele Gretag Macbeth Color Checker). Concernant les capacites de torque, un dispositif permettant de maintenir la poignee de l’URSS a la verticale et d’imprimer un mouvement de rotation de l’URSS autour de son axe a 90° dans le sens horaire et antihoraire a ete cree. La gaine centrale de l’URSS passait ensuite a travers un canal dans lequel un ballon de dilatation ureterale haute pression de 4 cm/12-Fr etait positionne. Le ballon a ete place a 10 cm, 20 cm, 30 cm et 40 cm de l’extremite distale des URSS et a ete graduellement gonfle (increments de 0,5 atm). La rotation de la pointe de l’URSS obtenue lors de la rotation de la poignee de l’URSS a ete enregistree et comparee. Resultats Concernant les qualites optiques, tous les URSS avaient un champ de vision similaire, avec un leger avantage en faveur du LithoVue. La resolution et la profondeur de champ etaient similaires pour la plupart des URSS, excepte le YouCare qui avait des resultats inferieurs. La distorsion de l’image etait la plus elevee pour Flex-Xc et la plus faible pour LithoVue. La reproductibilite des couleurs n’a montre aucune difference significative entre les differents modeles d’URSS. Une alteration partielle du champ de vision a cependant ete notee pour certains URSS a usage unique (Pusen, YouCare) a differentes distances de la cible. Concernant le torque, l’URSS Olympus URF-V2 etait celui pour lequel le torque etait le plus important : arret de la rotation pour la pression la plus elevee quelle que soit la position du ballon sur la gaine de l’URSS. Le YouCare etait l’URSS ayant le plus faible torque : arret de la rotation pour la pression la plus basse avec le ballon place a 10 cm de l’extremite distale de l’URSS. A l’exception des URSS Olympus V2 et P6, tous les autres URSS ont progressivement perdu leurs capacites de torque lorsque la pression etait appliquee au plus proche de leur extremite distale ( Fig. 1 , Fig. 2 , Fig. 3 , Fig. 4 , Fig. 5 , Fig. 6 , Tableau 1 ). Conclusion Bien que les URSS a usage unique aient montre des qualites optiques in vitro presque similaires aux URSS reutilisables, les resultats globaux sont en faveur des URSS reutilisables. Les URSS avec les gaines les plus rigides etaient ceux obtenant les meilleures capacites de torque, ces resultats se maintenant pour une pression exercee proche de leur extremite distale.

Objectifs Lors d’une ureteroscopie souple, differents systemes d’irrigation peuvent etre utilises afin d’augmenter le flux d’irrigation pour ameliorer la visibilite lors de l’intervention. Cependant, cette augmentation du flux d’irrigation se fait au detriment d’une augmentation de la pression intra-pyelique, potentiellement morbide. L’objectif de cette etude a ete de comparer les pressions maximales atteintes par differents systemes d’irrigation d’ureteroscopie souple dans un modele in vitro et evaluer l’influence de l’assistant controlant cette derniere. Methodes Quinze personnes ont ete invitees a participer a cette etude, reparties en trois groupes en fonction de leur force physique. Cette repartition etait basee sur la force individuelle, evaluee par la pression maximale atteinte avec l’utilisation d’une seringue d’insufflation Encore. Les systemes d’irrigation evalues etaient : T-Flow, Dual Port, Hiline, Single Action Pumping System (SAPS) a flux continu, Irri-flo II, Peditrol et une simple seringue de 60 mL. Chaque systeme d’irrigation etait connecte a un ureteroscope souple Olympus URF-V2, ayant un canal operateur de 3,6-Fr, qui etait positionne dans un modele artificiel de rein. Chaque participant devait exercer la pression maximale possible avec chaque systeme d’irrigation. La pression etait mesuree avec un canal operateur d’ureteroscope vide, avec fibre laser et avec panier. Resultats La pression maximale etait obtenue avec la seringue de 60 mL tandis que la plus faible l’etait avec le systeme a flux continu SAPS, p Tableau 1 . La pression maximale etait d’autant plus importante que la force individuelle de base etait elevee, quel que soit le systeme d’irrigation et quelle que soit l’occupation du canal operateur par un instrument ou non. Aucune difference n’etait cependant observee entre ces groupes pour le systeme T-Flow. Tableau 2 . Conclusion Cette etude demontre que des niveaux importants de pression peuvent etre atteints avec les systemes d’irrigation lors d’une ureteroscopie souple, celle-ci etant d’autant plus importante que le canal operateur de l’endoscope est vide. L’influence de la force de l’assistant controlant le systeme d’irrigation lors de l’intervention est majeure puisque des pressions importantes sont atteintes quel que soit le systeme d’irrigation et quelle que soit l’occupation du canal operateur par un instrument ou non.

Objectifs La plupart des ureteroscopes souples (URS-S) de derniere generation, qu’ils soient a fibres optiques ou numeriques, ont des deflexions ventrales et dorsales d’environ 270. Malgre cette caracteristique commune, l’acces a un calice inferieur complexe avec angle pyelocaliciel aigu semble inegal entre les differents endoscopes. Comparer l’acces a un calice inferieur complexe et la deflexion de l’extremite distale entre plusieurs modeles d’ureteroscopes souples. Methodes Deux types d’URS-S ont ete utilises dans cette etude : – URS-S a fibres optiques : FLEX-X2 (K. Storz), URF-P5, URF-P6 (Olympus) ; – URS-S numeriques : URF-V, URF-V2 (Olympus) ; BOA vision, COBRA vision (R. Wolf) ; FLEX-Xc (K. Storz) ; LithoVue (Boston Scientific). Pour tester l’acces caliciel inferieur avec angle pyelocaliciel aigu entre les differents ureteroscopes, un simulateur in vitro a ete utilise pour realiser ces experiences : la K-Box (Porges-Coloplast). Pour comparer la deflexion maximale de l’extremite distale de chaque ureteroscope, ces derniers ont ete introduits dans une gaine d’acces ureterale puis l’angle de deflexion a ete mesure lorsque l’extremite distale etait sortie de 1, 2, 3 puis 4 cm en dehors de la gaine (Fig. 1). Resultats L’acces caliciel inferieur complexe a ete possible pour tous les URS-S a fibres optiques, hormis l’URF-P6, tandis que seul l’ureteroscope numerique Flex Xc y est parvenu ( Fig. 2 ). Concernant la deflexion de l’extremite distale des URS-S, les URS-S a fibres optiques avaient une meilleure deflexion maximale que les URS-S numeriques, sauf le Flex Xc qui avait des resultats similaires. La difference moyenne de deflexion maximale etait de 21 en faveur des URS-S a fibres optiques ( Tableau 1 ). L’ureteroscope obtenant le meilleur score etait le Flex X2 (meilleure deflexion maximale) tandis que celui qui avait le score le plus faible etait l’URF-V2 (moins bonne deflexion maximale). Conclusion Les resultats de l’acces caliciel inferieur complexe et de la deflexion maximale de l’extremite distale etaient moins bons pour les URS-S numeriques par rapport aux URS-S a fibres optiques. En d’acces difficile a un calice inferieur, il semble preferable d’utiliser un URS-S a fibres optiques.