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Qiu M. et al., 2024: Physical Techniques to Remove Residual Stone Fragments in the Urinary System.

Qiu M, Zhang T, Zhang Y, Liang T, Chen J, Gao H.
Graduate School, Guangxi University of Chinese Medicine, Nanning, China,
Graduate School, Guangxi University of Chinese Medicine, Nanning, China.
Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.

Abstract

Background: Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy.

Summary: External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy.

Key messages: We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.

Urol Int. 2024;108(1):9-19. doi: 10.1159/000535298. Epub 2023 Nov 26. PMID: 38008076
FREE PMC ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, 28 June 2024 11:00

Based on my own experience, the dominating problem after SWL is the presence of residual fragments. Such stone residues might cause symptoms, grow into larger stones and require frequent controls as well as recurrence preventive treatment.
Moreover, fragments remaining in the kidney are “cosmetically” disturbing and considered as treatment failure, particularly by the patients. Other features of SWL such as the need of repeated treatment sessions in certain patients is a minor problem given the possibility to treat patients without general or regional anesthesia. SWL-resistant stones are commonly described as a problem that in the general opinion are considered impossible to treat with SWL. But most stones also those referred to as “resistant” (such as those composed of COM, brushite and cystine) usually can be disintegrated with appropriate technique.
Accordingly, the most important problem that remains are residual fragments, usually in the lower calyces.
This article describes recent progress in fragment elimination, some methods are invasive, others non-invasive.
Percussion, diuresis and inversion (PDI, in my own hands termed DIVE) is a promising alternative that can increase stone-free rates. The current methodology, however, needs some standardization.
Special devices have been invented such as the Lithecbole, a Chinese equipment. With this device improved fragment elimination from the kidney has been reported. Since this device is constructed to be user-friendly, it seems attractive for further use and clinical studies. If Lithecbole is used outside China is unknown to me.
The other methods mentioned in the article such as magnetic extraction and use of biocompatible stone adhesives are invasive and thus do not fulfill the criteria required for least invasive treatment.
Ultrasonic propulsion can be used to move stone residuals, but limited experience of this method is available.
It is the reviewer’s opinion that great efforts should be devoted to methods for non-invasive fragment elimination with the aim of maintain the non-invasive or least invasive character of SWL.

Hans-Göran Tiselius

Based on my own experience, the dominating problem after SWL is the presence of residual fragments. Such stone residues might cause symptoms, grow into larger stones and require frequent controls as well as recurrence preventive treatment. Moreover, fragments remaining in the kidney are “cosmetically” disturbing and considered as treatment failure, particularly by the patients. Other features of SWL such as the need of repeated treatment sessions in certain patients is a minor problem given the possibility to treat patients without general or regional anesthesia. SWL-resistant stones are commonly described as a problem that in the general opinion are considered impossible to treat with SWL. But most stones also those referred to as “resistant” (such as those composed of COM, brushite and cystine) usually can be disintegrated with appropriate technique. Accordingly, the most important problem that remains are residual fragments, usually in the lower calyces. This article describes recent progress in fragment elimination, some methods are invasive, others non-invasive. Percussion, diuresis and inversion (PDI, in my own hands termed DIVE) is a promising alternative that can increase stone-free rates. The current methodology, however, needs some standardization. Special devices have been invented such as the Lithecbole, a Chinese equipment. With this device improved fragment elimination from the kidney has been reported. Since this device is constructed to be user-friendly, it seems attractive for further use and clinical studies. If Lithecbole is used outside China is unknown to me. The other methods mentioned in the article such as magnetic extraction and use of biocompatible stone adhesives are invasive and thus do not fulfill the criteria required for least invasive treatment. Ultrasonic propulsion can be used to move stone residuals, but limited experience of this method is available. It is the reviewer’s opinion that great efforts should be devoted to methods for non-invasive fragment elimination with the aim of maintain the non-invasive or least invasive character of SWL. Hans-Göran Tiselius
Friday, 12 July 2024