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Minerva Urology and Nephrology 2021 Mar 26

DOI: 10.23736/S2724-6051.21.04025-X


lingua: Inglese

“VirtualBasket” ureteroscopic holmium laser lithotripsy: intraoperative and early postoperative outcomes

Giorgio BOZZINI 1, 2, Matteo MALTAGLIATI 1, 3 , Lorenzo BERTI 1, 3, Umberto BESANA 1, Alberto CALORI 1, Antonio L. PASTORE 4, Ali GOZEN 2, 5, Alexander GOVOROV 2, 6, Evangelos LIATSIKOS 2, 7, Salvatore MICALI 3, Bernardo ROCCO 2, 3, Lütfi TUNC 2, 8, Carlo BUIZZA 1

1 Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy; 2 ESUT, European Section for UroTechnology; 3 Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy; 4 Department of Urology, ICOT Latina, Università la Sapienza, Roma, Italy; 5 Department of Urology, SLK Heilbronn Hospital, Heilbronn, Germany; 6 Department of Urology, Moscow University, Moscow, Russia; 7 Department of Urology, Patras University, Patras, Greece; 8 Department of Urology, Gazi University, Ankara, Turkey


BACKGROUND: The “VirtualBasket” technology is the result of pulse modulation during holmium laser emission: the laser emits part of the energy to create an initial bubble, and a second pulse is emitted when the vapor bubble is at its maximum expansion, so that it can pass through the previously created vapor channel. The aim of this study is to outline the outcomes of the “VirtualBasket” technology in ureteral and renal stones.
METHODS: 160 Patients were randomly assigned to holmium laser lithotripsy with or without the “VirtualBasket” technology in ureteric or renal cases (40 per 4 groups). All procedures were performed by four experienced urologists. The Quanta System Cyber Ho 100W laser generator with 365 μm fibers was used for all of the ureteral cases, whereas, 272 μm fibers were used for all of the cases in the renal pelvis. Demographic data, stone parameters, perioperative complications and success rates were compared. A statistical analysis was carried out to assess patients data and outcomes. All of the reported p-values were obtained with the two-sided exact method at the conventional 5% significance level. The degree of stone retropulsion was graded on a Likert scale from zero (no retropulsion) to 3 (maximum retropulsion).
RESULTS: All groups were comparable in terms of age, and pre-operative stone size (ureter stone size: 1.2 vs. 1.1 cm; renal pelvis stone size: 1.55 vs. 1.62 cm). Compared to the regular mode, the “VirtualBasket” technology was associated with significantly lower fragmentation time (mean time for ureteral stones: 20.4 vs. 16.1 minutes, p<0.05; mean time for renal stones: 28.7 vs. 19.8 minutes, p<0.05) and total procedural time (mean time for ureteral stones 49 vs. 35.7 minutes; mean time for renal stones 67.1 vs. 52.4 minutes). There were no significant differences in terms of energy delivered to the stones, intraoperative complications and success rate at 1 month. The “VirtualBasket” technology was associated with significantly lower retropulsion.
CONCLUSIONS: The “VirtualBasket” technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy, which improves stone fragmentation efficiency.

KEY WORDS: Holmium laser; Laser lithotripsy; Urolithiasis

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