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Review
. 2021 Jun;39(6):1673-1682.
doi: 10.1007/s00345-020-03481-9. Epub 2020 Oct 16.

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

Søren Kissow Lildal  1 , Kim Hovgaard Andreassen  2 , Joyce Baard  3 , Marianne Brehmer  4   5 , Matthew Bultitude  6 , Ylva Eriksson  4   5 , Khurshid R Ghani  7 , Helene Jung  8 , Guido Kamphuis  3 , Peter Kronenberg  9 , Ben Turney  10 , Olivier Traxer  11 , Øyvind Ulvik  12 , Palle Jörn Sloth Osther  13
Affiliations
Review

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

Søren Kissow Lildal et al. World J Urol. 2021 Jun.

Abstract

Purpose: To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety.

Methods: A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark.

Results and conclusions: Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.

Keywords: Endoscopes; Kidney stones; Laser lithotripsy; Safety; Technology; Ureteroscopy.

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Conflict of interest statement

Søren K. Lildal: no conflicts of interest. Kim Andreassen: consultant for AMBU. Joyce Baard: no conflicts of interest. Marianne Brehmer: no conflicts of interest. Matthew Bultitude: consultant for Boston Scientific. Ylva Eriksson: no conflicts of interest. Khurshid Ghani: consultant for Boston Scientific, Lumenis, and Olympus; Grant from Boston Scientific. Helene Jung: no conflicts of interest. Guido Kamphuis: consultant for Boston Scientific and Olympus. Peter Kronenberg: consultant for Olympus. Ben Turney: no conflicts of interest. Olivier Traxer: consultant for Boston Scientific, Olympus, Rocamed, and Coloplast. Øyvind Ulvik: consultant for Olympus. Palle J S Osther: consultant for Olympus, Boston Scientific, Bonvisi AB, and Coloplast.

Figures

Fig. 1
Fig. 1
Different positions of working channel depending on manufacturer and model of ureteroscope
See this image and copyright information in PMC

References

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    1. Kronenberg P, Traxer O. V1718 laser fibers, pulse energy and retropulsion—what we can see and what we can’t. J Urol. 2013;189(4s):e707.

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