Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy
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TOPIC PAPER
Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy Søren Kissow Lildal1 · Kim Hovgaard Andreassen2 · Joyce Baard3 · Marianne Brehmer4,5 · Matthew Bultitude6 · Ylva Eriksson4,5 · Khurshid R. Ghani7 · Helene Jung8 · Guido Kamphuis3 · Peter Kronenberg9 · Ben Turney10 · Olivier Traxer11 · Øyvind Ulvik12 · Palle Jörn Sloth Osther8 Received: 22 August 2020 / Accepted: 1 October 2020 © The Author(s) 2020
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 Laser lithotripsy · Ureteroscopy · Kidney stones · Endoscopes · Safety · Technology
* Palle Jörn Sloth Osther [email protected] 1
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Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Department of Urology, Herlev‑Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Department of Surgery and Urology, Danderyd University Hospital, Stockholm,
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