Project description:Background and aimsSingle-operator cholangioscopy-assisted electrohydraulic lithotripsy (SOC-EHL) is effective and safe in difficult choledocholithiasis. The optimal timing of SOC-EHL use, however, in refractory stones has not been elucidated. The following aims to determine the most cost-effective timing of SOC-EHL introduction in the management of choledocholithiasis.MethodsA cost-effectiveness model was developed assessing three strategies with a progressively delayed introduction of SOC-EHL. Probability estimates of patient pathways were obtained from a systematic review. The unit of effectiveness is complete ductal clearance without need for surgery. Cost is expressed in 2018 US dollars and stem from outpatient US databases.ResultsThe three strategies achieved comparable ductal clearance rates ranging from 97.3% to 99.7%. The least expensive strategy is to perform SOC-EHL during the first endoscopic retrograde cholangiography pancreatography (ERCP) (SOC-1: 18,506$). The strategy of postponing the use of SOC-EHL to the third ERCP (SOC-3) is more expensive (US$18,895) but is 2% more effective. (0.9967). SOC-EHL during the second ERCP in the model (SOC-2) is the least cost-effective. Sensitivity analyses show altered conclusions according to the cost of SOC-EHL, effectiveness of conventional ERCP, and altered willingness-to-pay (WTP) thresholds with early SOC-1 being the most optimal approach below a WTP cut-off of US$20,295.ConclusionsEarly utilization of SOC-EHL (SOC-1) in difficult choledocholithiasis may be the least costly strategy with an effectiveness approximating those achieved with a delayed approach where one or more conventional ERCP(s) are reattempted prior to SOC-EHL introduction.

| S-EPMC8600178 | biostudies-literature

Overtube-guided electrohydraulic lithotripsy through digital cholangioscopy for difficult biliary stones in a postoperative patient: challenging points with salvage techniques.

Project description: Not available

| S-EPMC7804995 | biostudies-literature

Endoscopic retrieval of a proximally migrated biliary stent using extracorporeal shockwave lithotripsy, electrohydraulic lithotripsy, and cholangioscopy with minisnare.

Project description:Video 1ERCP was notable for a proximally migrated biliary stent. Cholangiogram demonstrated multiple filling defects consistent with choledocholithiasis surrounding the proximally migrated biliary stent. Retrieval of the stent was successful using cholangioscopy-directed electrohydraulic lithotripsy, extracorporeal shockwave lithotripsy, mechanical lithotripsy, and minisnare over the course of 2 ERCPs. Complete duct clearance of stones was accomplished with balloon sweeps.

| S-EPMC8117789 | biostudies-literature

Balloon overtube-assisted cholangioscopy and laser lithotripsy of large bile duct stones.

Project description: Not available

| S-EPMC6098815 | biostudies-literature

Efficacy and Safety of Semirigid Ureteroscopy Combined with Holmium:yttrium-aluminum-garnet Laser Lithotripsy for the Treatment of Proximal Ureteral Calculi: A Single-arm Meta-analysis.

Project description:Background and objectiveUreteral stones are currently treated with holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy using rigid and flexible ureteroscopes. This study aims to evaluate the efficacy and safety of semirigid ureteroscopy combined with Ho:YAG laser lithotripsy for treating proximal ureteral stones in real-world studies.MethodsThe PubMed, Embase, and Web of Science databases were searched systematically to retrieve all relevant studies up to April 2024. A meta-analysis of the retrieved studies was performed using Stata 14.0 software and expressed as rate, mean difference, and 95% confidence interval (CI). The main outcomes of this meta-analysis were stone-free rate (SFR) and perioperative outcomes including operation time, hospital stay, postoperative ureteral stent placement, auxiliary procedures, and intra- or postoperative complications.Key findings and limitationsA total of 24 studies were included in this study, including 2058 patients with proximal ureteral stones. According to the results of the combined analysis, the SFR of semirigid ureteroscopy combined with Ho:YAG laser lithotripsy for the treatment of proximal ureteral stones was 78% (95% CI [75%, 82%]), operation time was 51.03 min (95% CI [43.5, 58.56]), hospital stay was 1.62 d (95% CI [1.54, 1.70]), auxiliary procedure rate was 20% (95% CI [15%, 25%]), and postoperative complication rate was 16% (95% CI [12%, 22%]).Conclusions and clinical implicationsThe results of this study show that semirigid ureteroscopic Ho:YAG laser lithotripsy is a commonly used treatment for proximal ureteral calculi, but its efficacy and safety need to be improved further, and its efficacy is not related to the diameter of the endoscope.Patient summaryThis study showed that Ho:YAG laser lithotripsy with semirigid ureteroscopes is commonly used for treating ureteral stones. However, its efficacy and safety need to be improved further, and future research should focus on these.

| S-EPMC11541942 | biostudies-literature

Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report.

Project description:BackgroundFlexible ureteroscopy (FURS) and holmium laser lithotripsy is considered one of the most minimally invasive and safe surgical methods for the treatment of renal calculi. Renal pseudoaneurysm is a rare complication after FURS holmium laser lithotripsy. We report a case of renal pseudoaneurysm after FURS and holmium laser lithotripsy and review the relevant literature to analyze the possible etiology and summarize the treatment.Case presentationA 29-year-old male with a 2-year history of diabetes was admitted to the hospital because of right back pain for 5 days. A doppler ultrasound demonstrated bilateral renal calculi with bilateral mild hydronephrosis. The patient underwent one-stage right FURS and holmium laser lithotripsy and bilateral ureteral stent implantation. The urine was clear on the second day after the operation, and he was discharged from the hospital. Due to severe gross hematuria, he had to be hospitalized 28 days after the operation. A CT scan showed multiple blood clots in the right renal pelvis and bladder. An emergency blood transfusion and removal of the bladder blood clots and bilateral double J tubes were performed. His urine was clear for one week, and he was discharged from the hospital. He was hospitalized again 47 days after the operation because of fever and hematuria. A CT scan demonstrated blood clots in the bladder and right renal pelvis. Angiography showed a pseudoaneurysm in a small branch of the right renal artery, and hematuria stopped after selective renal artery embolization with microcoils.ConclusionFURS and holmium laser lithotripsy is safe, but we should be aware of the possibility of renal artery pseudoaneurysms (RAP). Through careful operation during the surgery, avoiding kidney injury, reducing intrarenal pressure and controlling the time of operation may prevent the occurrence of this complication. Vascular embolization is the first choice for the treatment of pseudoaneurysms.

| S-EPMC9406514 | biostudies-literature

A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy.

Project description:ObjectiveMany studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter. The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the "ureter" during the ureteroscopic holmium laser lithotripsy in vitro.MethodsAn in vitro lithotripsy was performed using a modified catheter (5 Fr) as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet. Different laser power settings (10 W, 20 W, and 30 W) with various firing times (3 s, 5 s, and 10 s) and rates of irrigation (15 mL/min, 20 mL/min, and 30 mL/min) were applied in the experiment. Temperature changes in the "ureter" were recorded with a thermometer during and after the lithotripsy.ResultsDuring the lithotripsy, the local highest mean temperature was 60.3 °C and the lowest mean temperature was 26.7 °C. When the power was set to 10 w, the temperature was maintained below 43 °C regardless of laser firing time or irrigation flow. Regardless of the power or firing time selected, the temperature was below 43 °C at the rate of 30 mL/min. There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing (3 s, 5 s, or 10 s) compared to with not drainage (p<0.05) except for two conditions of 0.5 J×20 Hz, 30 mL/min, firing 5 s, and 1.0 J×10 Hz, 30 mL/min, firing 5 s.ConclusionOur modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect, especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

| S-EPMC9875157 | biostudies-literature

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