Category: Clinical Stones: PCNL

MP12-3 - First Ultra-mini-percutaneous Nephrolithotripsy (UM-PCNL) with the New Thulium SuperPulse Fiber Laser (TSPFL)

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : UM-PCNL is a safe and efficient procedure for the endourological management of renal stones less than 2 cm and the holmium laser is typically used for the stone disintegration. New Thulium SuperPulse Fiber Laser (TSPFL) with wavelength 1940 nm has been developed, cleared and introduced into the clinical practice in 2016 (IRE-Polyus, RF). The aim of the study is to evaluate stone free-rate and safety of UM-PCNL with TSPFL.


Methods : since November 2017 till March 2018, UM-PCNL (19 – prone, 15-supine) have been done in 34 patients (13f, 21m, age range – 32-77 y.o.) with 39 renal stones (size range 1.2-2.4 cm) with application of  the TSPFL (Urolase®, IRE-Polyus, RF). We used the 200 μm laser fiber and the 7.5 F nephroscope (Karl Storz, MIP S, OS 11/12 F) with 2 channels. Routine preoperative exam included multispiral CT scan with the evaluation of stone density and location. Stone density varied from 670 to 1430 HU, stones were located in the renal pelvis (13), lower calyx (10), middle calyx (4), upper calyx (calyceal diverticula – 2). 5 patients had multiple calculi (3 – pelvis and lower calyx, 2 – pelvis and middle calyx). The high supracostal access was used in 11 cases. The laser mode for fragmentation was 1-1.5 J and 15-30 Hz and for dusting 0.1-0.3 J and 50-100 Hz, the stone fragments were evacuated with the irrigation fluid according to Venturi effect.  Control exam with kidney MCT was provided 30 days after surgery.


Results : Stone free-rate (no residual fragments) was 94% (32 cases) 30 days after surgery, clinically insignificant residuals (less than 3 mm) were found in 2 cases (6%). Operation time was 29±9 min. Stone fragmentation time was 8±6 min. No bleeding or tissue perforation was observed during operation. Nephrostomy tube has been placed in 23 patients, rest cases were finished with JJ-stent, which was removed after 2 weeks. Nephrostomy tubes were removed on 2-nd day after the intervention. Postoperative stay was 3.4±1.2 days.


Conclusions : UM-PCNL conducted with the new TSPFL is effective and safe for the endourological management of renal stone disease.

Alexey G. Martov

Head of Urology department
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Moscow, Russia
Moscow, Moskva, Russia

Martov Alexey G., MD, PhD, Honored Doctor of Russia
Professor and Chairman, Department of Urology, Federal Medico-biology Agency
Professor of Urology, Russian Medical Academy of Postgraduate Education
Head of Urology Department, Moscow City Hospital № 57
Ph/fax: +7 499 7800853
e-mail: martovalex@mail.ru
www.amartov.ru

1978-1982. First Moscow Medical Institute
1982-1988. Residenship, Institute of Urology, Moscow
1988. Doctorate Thesis «Percutaneous Treatment of Kidney Stones»
1988-2006. Institute of Urology, from Head of Endourology Department to Vice-President
1993. PhD degree, «Endourological Treatment of Upper Urinary Tract Diseases»
2006 – p. t. Head of Urology Department, Moscow City Hospital №57, Professor of Urology, Russian Medical Academy of Postgraduate Education
2012 – p.t. Professor and Chairman Department of Urology, Federal Medico-biology Agency, Russia


Activities
• Founding Member and President of the Russian Endourology and New Urotechnology Society
• Vice-president of the Russian Urology Association
• Co-Editor of Russian Journal “Urology”
• Member of EAU, SIU, AUA, Endourological Society
• CROES, ESUT activity
• Director of Training Center for Endourology, Moscow, Russia
• Honorary member of Russian, Georgian and Azerbaijan Urology Association
Specialisations / Interests
• Endourology
• BPH
• Stone desease
• Urooncology

over 400 scientific publications (PubMed-cited Journals), 15 books, 35 books chapters
3 educational CD for Urologists (Endourology, BPH, Prostate cancer)
Numerous international invitations for live surgery meetings / presentations / workshops / congresses and teaching events in Russia and countries of former Soviet Union, Germany, France, Austria, Switzerland, Turkey, Sweden etc.
Moscow, 2018

Dmitry V. Ergakov

Associate Professor
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Pletnews Municipal Hospital, Moscow, Russia
Moscow, Moskva, Russia

Andrey Andronov

Moscow, Moskva, Russia

Mirab Guseynov

Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Moscow, Russia
Moscow, Moskva, Russia

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France