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Vogt B et al, 2016: MiniJFil®: A New Safe and Effective Stent for Well-Tolerated Repeated Extracorporeal Shockwave Lithotripsy or Ureteroscopy for Medium-to-Large Kidney Stones?

Vogt B, Desfemmes FN, Desgrippes A, Ponsot Y.
Department of Urology, Blois Polyclinic, La Chaussee Saint-Victor, France.
Department of Urology, University of Sherbrooke, Sherbrooke, Canada.

Abstract

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is recommended for treating staghorn stones or stones measuring > 20 mm. Extracorporeal shockwave lithotripsy (ESWL) or flexible ureteroscopy (URS) may be used as a complement. However, PCNL can cause trauma to the kidney parenchyma, and patients may find a noninvasive procedure, such as ESWL, to be more attractive.
OBJECTIVES: The aim of this study was to evaluate the clinical efficiency of MiniJFil® stenting associated with ESWL or second-line URS for the treatment of medium-to-large kidney stones. The MiniJFil® is a stent reduced to a suture of 0.3F attached to a renal pigtail. The entire ureter is occupied only by the suture of the stent.
METHODS: We retrospectively analyzed the data of 28 patients. Twenty-four patients had kidney stones measuring > 15 mm (group 1) and four patients had staghorn stones (group 2). All of the patients were fitted with MiniJFil® 2 - 3 weeks before any treatment. ESWL was always our first-line therapy. Stone-free (SF) status was defined as no evidence of stones.
RESULTS: In group 1, the mean largest and cumulative stone diameters, respectively, were 18.7 ± 5.7 mm and 45.0 ± 12.0 mm. In group 2, the mean volume was 6,288.4 ± 2,733.0 mm3. The overall SF was 96.4% (100% for group 1 and 75% for group 2). The mean number of sessions of ESWL and URS, respectively, was 1.4 ± 0.7 and 0.8 ± 0.9 in group 1 and 4.0 ± 2.0 and 1.5 ± 1.3 in group 2. The mean times to achieve these rates were 3.2 ± 1.7 months and 5.6 ± 2.3 months for groups 1 and 2, respectively. One patient in group 2 was treated with only three sessions of ESWL. Renal colic was observed in only five patients (17.9%).
CONCLUSIONS: MiniJFil® stenting is safe and may be an alternative for the treatment of kidney stones during minimally invasive procedures. 

Nephrourol Mon. 2016 Aug 13;8(5):e40788.

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Comments 1

Hans-Göran Tiselius on Tuesday, 11 April 2017 10:35

Technical improvements of the kind described in this article are not commonly seen. The invention described by the authors is a short stent-loop to which a long suture is attached. The device was successfully used in 24 patients treated with SWL for >15 mm large stones. The stone-free rate of 100% is impressive, but perhaps more amazing was the successful stone clearance recorded in patients treated for staghorn stones with an average volume of 6288 mm3. Although repeated sessions were necessary it is surprising that clearance in 75% was obtained.

It needs to be taken into account that these authors had SWL as their first-line therapeutic choice with a clear ambition to be successful with the non-invasive approach. They accordingly combined SWL with high diuresis and “body gymnastics with head down feet up”. Nevertheless the achievements are noteworthy.

One aspect that is not appropriately described is how difficult it is to insert this short loop particularly with the tailored end. The technique is slightly better but not extensively described in the authors’ previous article with a longer, but still short stent [1]. If it will be possible to insert the MiniJFil with only local anaesthesia with or without analgesics is not clear. Hopefully the device will be user-friendly when commercially available from APSIDE® MEDICAL.

Nevertheless the results are so impressive that if they can be repeated it seems really attractive to test this device in association with SWL.

Reference
1. Vogt B, Desgrippes A, Desfemmes FN Changing the double-pigtail stent by a new suture stent to improve patient's quality of life: a prospective study. World J Urol. 2015 33(8):1061-8.

Technical improvements of the kind described in this article are not commonly seen. The invention described by the authors is a short stent-loop to which a long suture is attached. The device was successfully used in 24 patients treated with SWL for >15 mm large stones. The stone-free rate of 100% is impressive, but perhaps more amazing was the successful stone clearance recorded in patients treated for staghorn stones with an average volume of 6288 mm3. Although repeated sessions were necessary it is surprising that clearance in 75% was obtained. It needs to be taken into account that these authors had SWL as their first-line therapeutic choice with a clear ambition to be successful with the non-invasive approach. They accordingly combined SWL with high diuresis and “body gymnastics with head down feet up”. Nevertheless the achievements are noteworthy. One aspect that is not appropriately described is how difficult it is to insert this short loop particularly with the tailored end. The technique is slightly better but not extensively described in the authors’ previous article with a longer, but still short stent [1]. If it will be possible to insert the MiniJFil with only local anaesthesia with or without analgesics is not clear. Hopefully the device will be user-friendly when commercially available from APSIDE® MEDICAL. Nevertheless the results are so impressive that if they can be repeated it seems really attractive to test this device in association with SWL. Reference 1. Vogt B, Desgrippes A, Desfemmes FN Changing the double-pigtail stent by a new suture stent to improve patient's quality of life: a prospective study. World J Urol. 2015 33(8):1061-8.
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