Controlled Fragmentation of Urinary Stones as a Method of Preventing Inflammatory Infections in the Treatment of Urolithiasis (Experience in Successful Clinical Use)

O S Streltsova; V V Vlasov; E V Grebenkin; A E Antonyan; V V Elagin; V F Lazukin; N I Ignatova; V A Kamensky

doi:10.17691/stm2021.13.3.07

Controlled Fragmentation of Urinary Stones as a Method of Preventing Inflammatory Infections in the Treatment of Urolithiasis (Experience in Successful Clinical Use)

Sovrem Tekhnologii Med. 2021;13(3):55-61. doi: 10.17691/stm2021.13.3.07. Epub 2021 Jun 28.

Authors

O S Streltsova¹, V V Vlasov², E V Grebenkin³, A E Antonyan³, V V Elagin⁴, V F Lazukin⁵, N I Ignatova⁶, V A Kamensky⁷

Affiliations

¹ Professor, Е.V. Shakhov Urology Department; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
² Associate Professor, Е.V. Shakhov Urology Department; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
³ PhD Student, Е.V. Shakhov Urology Department; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
⁴ Researcher, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
⁵ Associate Professor, Department of Medical Physics and Informatics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
⁶ Associate Professor, Department of Epidemiology, Microbiology and Evidence-Based Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
⁷ Leading Researcher, Federal Research Center Institute of Applied Physics of the Russian Academy of Sciences, 46 Ulyanova St., Nizhny Novgorod, 603950, Russia.

Abstract

The introduction of technologically advanced methods of lithotripsy into medical practice changes the nature of postoperative complications. Among them, the main complications are inflammatory infections. This largely determines the search for new, improved methods of stone fragmentation avoiding small stone fragments and dissemination of the pelvicalyceal system of the kidney with stone-associated infection. The authors have developed a method for controlled stone fragmentation using a continuous-wave diode laser with a hot-spot effect at the optical fiber end. The aim of the study was to evaluate the efficacy of controlled urinary stone fragmentation using a continuous-wave diode laser with a highly heated distal end of the optical fiber light guide as a method of preventing inflammatory infections in clinical practice.

Materials and methods: We analyzed 1666 case histories of urolithiasis patients who underwent percutaneous nephrolithotripsy/ nephrolithoextraction and contact ureterolithotripsy/ureteroextraction, we also performed a prospective analysis of complications based on the Clavien-Dindo classification in 90 patients who underwent fine fragmentation of stones with various lithotripters: ultrasonic, pneumatic, and holmium laser. The method of controlled stone fragmentation by a diode laser with a hot-spot effect was tested on postoperative samples of 26 renal calculi. For the first time in clinical practice, this method was tested in the bladder cavity (n=10).

Results: In the percutaneous nephrolithotripsy group, postoperative infectious and inflammatory complications occurred in 34.1% of cases, in the percutaneous nephrolithoextraction group - in 24.6%, in the contact ureterolithotripsy group - in 7.8%, in the ureterolithoextraction group - in 2.5%. The analysis made it possible to identify factors promoting the development of infectious and inflammatory complications. For the first time in clinical practice, there were successfully performed ten operations of stone fragmentation using a continuous-wave diode laser with a hot-spot effect. Controlled coarse fragmentation of stones providing the possibility to reduce the number of infectious and inflammatory complications was performed in the bladder as a model for testing the method.

Conclusion: The method of laser-induced controlled coarse fragmentation of stones with a hot-spot effect, developed and tested in clinical practice, is promising for the prevention of infectious and inflammatory complications in patients with potentially infected stones since their fine fragmentation and, consequently, spread of stone-associated toxins and microflora within the urinary system is avoided.

Keywords: infectious and inflammatory complications of lithotripsy; pyelonephritis; stone fragmentation in urolithiasis; urolithiasis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Kidney Calculi* / etiology
Lasers, Solid-State*
Lithotripsy* / methods
Lithotripsy, Laser* / adverse effects
Urinary Calculi* / therapy

Grants and funding

Study funding. The work on statistical processing and development of the experimental method for fragmentation was supported by the grant of Nizhny Novgorod region in the field of science and technology (2020), development of the clinical method for fragmentation of calculi was supported by the grant of the Russian Science Foundation No.21-15-00371.