ABSTRACT
Introduction:
Thulium Fiber Laser (TFL) is the most modern technology to treat nephrolithiasis and ureterolithiasis in endourology. Although there are a lot of new studies coming up, we still don't have data on how this laser works in some rare diseases. Cystinuria is the most common genetic nephrolithiasis disorder (11 Prot-Bertoye C., Daudon M., Tostivint I., Dousseaux M.-P., Defazio J., Traxer O., Knebelmann B., Courbebaisse M. Cystinurie. Nephrol Ther. 2021;17:S100–S107.), known for its recurrent lithiasis (22 Rhodes HL, Yarram-Smith L, Rice SJ, Tabaksert A, Edwards N, Hartley A, et al. Clinical and genetic analysis of patients with cystinuria in the United Kingdom. Clin J Am Soc Nephrol. 2015;10:1235-45.).
Our main goal in this video is to show a successful case of cystine calculi treated with Thulium Fiber Laser (Laser Fiber Dust/Quanta System™). Cystinuria is the most common genetic nephrolithiasis disorder (11 Prot-Bertoye C., Daudon M., Tostivint I., Dousseaux M.-P., Defazio J., Traxer O., Knebelmann B., Courbebaisse M. Cystinurie. Nephrol Ther. 2021;17:S100–S107.), known for its recurrent lithiasis (22 Rhodes HL, Yarram-Smith L, Rice SJ, Tabaksert A, Edwards N, Hartley A, et al. Clinical and genetic analysis of patients with cystinuria in the United Kingdom. Clin J Am Soc Nephrol. 2015;10:1235-45.).
Materials and Methods:
A 25 years-old male, cystinuric, presented with a CT scan, showing a 10mm stone on the right side and two calculi 6 and 7 mm on the left side, all located in the lower calyx. Bilateral flexible ureteroscopy was done using a reusable digital flexible ureteroscope.
Starting on the left side, we repositioned the stone from the lower to the upper calyx, using a tipless front opening basket. Lithotripsy was performed using TFL. Settings were 100 Hz (frequency) and 100 mJ (energy) for dusting. Popcorn technique was also used, setting the laser at 100Hz and 200 mJ, obtaining good dusting. On the right side, lithotripsy was performed in the inferior calyx, also resulting in “snowstorm”.
Procedure time was 120 minutes.
Results:
The postoperative was uneventful. Follow up CT showed a 3 mm residual fragment in the right kidney.
Conclusion:
This video demonstrates the treatment of bilateral cystine calculi with Thulium Fiber Laser. Reasonable procedure time and excellent dusting results are encouraging, pointing towards great improvements in endourology.
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Available at: http://www.intbrazjurol.com.br/video-section/20230024_gismondi_et_al Int Braz J Urol. 2023; 49 (Video #9): 519-20
REFERENCES
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1Prot-Bertoye C., Daudon M., Tostivint I., Dousseaux M.-P., Defazio J., Traxer O., Knebelmann B., Courbebaisse M. Cystinurie. Nephrol Ther. 2021;17:S100–S107.
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2Rhodes HL, Yarram-Smith L, Rice SJ, Tabaksert A, Edwards N, Hartley A, et al. Clinical and genetic analysis of patients with cystinuria in the United Kingdom. Clin J Am Soc Nephrol. 2015;10:1235-45.
Publication Dates
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Publication in this collection
14 Aug 2023 -
Date of issue
Jul-Aug 2023
History
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Received
16 Jan 2023 -
Accepted
12 Feb 2023 -
Published
31 Mar 2023
