A prospective, randomized controlled trial of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy

doi:10.3877/cma.j.issn.1674-3253.2021.03.011

Abstract

Abstract:

Objective

To explore the effects of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy.

Methods

Patients undergoing flexible ureteroscopy with holmium laser lithotripsy were randomly divided into four groups: patients in group Ⅰ were perfused with saline at room temperature (25℃) and treated with a lithotripsy power of 15 W, group Ⅱ: (5℃, 15 W), group Ⅲ: (25℃, 30 W), group Ⅳ: (5℃, 30 W). The temperature of the reflux saline in the ureteral access sheath of the flexible ureteroscope was measured, and the operation time was recorded.

Results

Under the same power, when the temperature of the perfusate was lowered, the temperature of the reflux fluid decreased. With the same perfusate temperature, high-power laser lithotripsy (30 W) exhibited greater stone fragmentation efficacy. Compared group Ⅳ with group Ⅰ, increasing the laser power while decreasing the perfusate temperature increased the rate of lithotripsy, shortened operation time, and reduced the thermal damage caused by the holmium laser.

Conclusion

In the context of laser lithotripsy, hypothermic perfusion can effectively reduce thermal effects and thermal damage to the urinary system.

Key words: Flexible ureteroscope, Holmium laser, Thermal damage

Wei Zhang, Yong Lu, Yanbo Wang, Chuqi Lin. A prospective, randomized controlled trial of hypothermic perfusion during flexible ureteroscopic holmium laser lithotripsy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 229-232.

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References 15

[1]	Diomidis GK, Zisis KK, Stefanos KP, et al. How effective is retrograde semirigid and flexible ureteroscopic lithotripsy for the treatment of large ureteral stones equal of or greater than 15 mm? results from a single center[J]. Urol Int, 2019, 103(1): 74-80.
[2]	Christian T, Aleš P, Kemal S, et al. EAU guidelines on diagnosis and conservative management of urolithiasis[J]. Eur Urol, 2016, 69(3): 468-474.
[3]	Yuchen X, Zhengming B, Dongyue M, et al. Laparoscopic ureterolithotomy, flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for treatment of upper urinary calculi in patients with autosomal dominant polycystic kidney disease[J]. Clin Exp Nephrol, 2020, 24(9): 842-848.
[4]	李海博，周伟民，秦振乾, 等. 输尿管软镜钬激光碎石术治疗不同大小肾结石临床疗效的比较分析[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(1): 44-47.
[5]	钟键，卞卫星，仇佳星, 等. 输尿管软镜与微通道经皮肾镜治疗2～3 cm肾盂结石的疗效分析[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(3): 202-205.
[6]	Marks AJ,Teichman JM．Lasers in clinical urology: state of the art and new horizons[J]. World J Urol, 2007, 25(3): 227-233.
[7]	Bultitude M,Smith D. Thomas K. Contemporary management of stone disease: the new eau urolithiasis guidelines for 2015[J]. Eur Urol, 2016, 69(3): 483-484.
[8]	张旭辉，刘凡秦，琪琪, 等. 泌尿系结石钬激光碎石热效应的体外研究[J]. 中华实验外科杂志, 2019, 36(12): 2160-2162.
[9]	Aldoukhi AH, Ghani KR, Hall TL, et al. Thermal response to high-power holmium laser lithotripsy[J]. J Endourol, 2017, 31(12): 1308-1312.
[10]	Molina WR, Silva IN, Donalisio DSR, et al. Influence of saline on temperature profile of laser lithotripsy activation[J]. J Endourol, 2015, 29(2): 235-239.
[11]	Adam DM, Brian M, Jonathan DH, et al. Simulation of laser lithotripsy-induced heating in the urinary tract[J]. J Endourol, 2019, 33(2): 113-119.
[12]	蒋双键，桂程鹏，莫承强, 等. 钬激光热效应的体外模型研究[J]. 中山大学学报(医学版), 2018, 39(5): 797-801.
[13]	Ng EYK, Tan HM,Ooi EH. Boundary element method with bioheat equation for skin burn injury[J]. Burns, 2009, 35(7): 987-997.
[14]	Winship B, Wollin D, Carlos E, et al. The rise and fall of high temperatures during ureteroscopic holmium laser lithotripsy[J]. J Endourol, 2019, 33(10): 794-799.
[15]	Hein S, Petzold R, Schoenthaler M, et al. Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model[J]. World J Urol, 2018, 36(9):1469-1475.

组别	例数	功率（W）	灌注液温度（℃）	年龄（岁）	术前肌酐（μmoI/L）	结石大小（cm）
组一	30	15（1.0 J×15 Hz）	25	53.4±12.6	118.5±44.8	1.52±0.17
组二	30	15（1.0 J×15 Hz）	5	54.9±11.8	130.0±46.6	1.60±0.15
组三	30	30（1.0 J×30 Hz）	25	54.7±11.8	125.8±47.0	1.51±0.23
组四	30	30（1.0 J×30 Hz）	5	60.9±10.5	124.4±49.8	1.50±0.18
P值				>0.05	>0.05	>0.05

组别	例数	功率（W）	灌注液温度（℃）	年龄（岁）	术前肌酐（μmoI/L）	结石大小（cm）
组一	30	15（1.0 J×15 Hz）	25	53.4±12.6	118.5±44.8	1.52±0.17
组二	30	15（1.0 J×15 Hz）	5	54.9±11.8	130.0±46.6	1.60±0.15
组三	30	30（1.0 J×30 Hz）	25	54.7±11.8	125.8±47.0	1.51±0.23
组四	30	30（1.0 J×30 Hz）	5	60.9±10.5	124.4±49.8	1.50±0.18
P值				>0.05	>0.05	>0.05

组别	例数	激光功率(W)	灌注液温度(℃)	回流液温度(℃)	手术时间(min)	残石率(%)	肌酐下降值(μmoI/L)
组一	30	15	25	33.08±1.56	41.40±5.85	0.07	32.14±18.13
组二	30	15	5	16.97±2.16	39.80±4.40	0.07	37.13±14.42
组三	30	30	25	38.42±2.17	22.33±3.53	0.03	39.65±19.71
组四	30	30	5	26.76±1.90	27.83±3.86	0.07	32.88±18.66
P值				<0.05	<0.05	>0.05	>0.05

组别	例数	激光功率(W)	灌注液温度(℃)	回流液温度(℃)	手术时间(min)	残石率(%)	肌酐下降值(μmoI/L)
组一	30	15	25	33.08±1.56	41.40±5.85	0.07	32.14±18.13
组二	30	15	5	16.97±2.16	39.80±4.40	0.07	37.13±14.42
组三	30	30	25	38.42±2.17	22.33±3.53	0.03	39.65±19.71
组四	30	30	5	26.76±1.90	27.83±3.86	0.07	32.88±18.66
P值				<0.05	<0.05	>0.05	>0.05

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