Histologic Impact of Dual-modality Intracorporeal Lithotripters to the Renal Pelvis - 26/06/13
Abstract |
Objective |
To test the hypothesis that dual-modality intracorporeal lithotripters used during percutaneous nephrolithotomy create a degree of tissue trauma in the dual-modality mode (ballistic and ultrasonic) similar to that in the single-modality mode (ultrasonic).
Materials and Methods |
The lithotripter devices tested were the Cyberwand and Swiss LithoClast Select. The activated probes, in both single- and dual-modality modes, were applied directly to the renal pelvis of 11 fresh nephrectomy specimens. The treated tissue sites were then processed for light microscopy and reviewed by a single genitourinary pathologist.
Results |
Microscopic examination of the renal pelvis after 2 seconds of direct contact showed minimal denudation of the urothelium, with no changes noted in the subepithelial or muscle layers for the 2 devices evaluated. Direct contact for 4 seconds showed urothelial denudation and subepithelial changes (n = 13 of 23). Muscle injury was observed in some dual-modality specimens (n = 6 of 12). Increasing the contact time to 8 seconds resulted in fragmentation of the muscle layers more frequently with both settings (n = 15 of 22), except for when the Cyberwand was used at the small stone setting (n = 0 of 7).
Conclusion |
In the ex vivo setting, minimal differences were noted in the degree of histologic trauma between the Cyberwand and Swiss LithoClast Select at 2 seconds. However, both dual-modality devices resulted in muscle damage at 4 and 8 seconds of contact time. Care should be taken during clinical procedures to avoid prolonged contact with the renal pelvis to minimize the potential for tissue trauma.
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Financial Disclosure: Bodo E. Knudsen is a consultant to Boston Scientific and a hands-on course instructor to Storz and Cook. The remaining authors declare that they have no relevant financial interests. |
Vol 82 - N° 1
P. 27-32 - juillet 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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