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In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy

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Abstract

To test in-vitro and in-vivo the Flexor® Vue™ deflecting endoscopic system (FVDES) as a new technology able to improve the removal of residual intrarenal fragments.

This is an observational prospective “proof of concept” study performed in patients with renal calculi treated with flexible ureteroscopy and Ho:YAG laser lithotripsy (f-URS) in Humanitas Research Hospital (Rozzano, Italy). We assessed feasibility, efficacy and safety of FVDES as an in-vivo tool for removing residual fragments after f-URS. The stone-free rate (SFR) at 30 days post-operatively was evaluated using CT. An in-vitro model was developed to evaluate the FVDES when used for this purpose.

Eleven patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces and the renal pelvis in 3 and 8 patients, respectively. Mean stone size was 18 ± 3.2 mm. The procedure with FVDES was feasible and effective in all the patients. Mean operative time was 82 ± 13.7 min and median hospitalization was of 1.5 days. The SFR after 90 days was 81% (9/11). We reported no relevant complications (Clavien–Dindo > 2); one patient had fever and was treated with antibiotics. The experimental in-vitro model demonstrated the efficacy of FVDES, allowing the removal of about 90% of fragments.

Our study showed that FVDES is effective when used as a tool for retrieval of residual fragments at the end of f-URS. This technology could ensure a complete cleaning of the intrarenal collecting system and represent a safe alternative to basketing.

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Abbreviations

END:

Surgeon endoscopic evaluation

FVDES:

Flexor® Vue™ deflecting endoscopic system

KUB:

Kidney, ureter and bladder radiography

MCh:

Main channel

NCCT:

Non-contrast computer tomography

RIRS:

Retrograde intrarenal surgery

SCh:

Side channel

SFR:

Stone free rate

SFS:

Stone free status

f-URS:

Flexible ureteroscopy and Ho:YAG laser lithotripsy

US:

Ultrasonography

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Authors and Affiliations

  1. Department of Urology, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy

    Alberto Saita, Francesco Persico, Giovanni Lughezzani & Paolo Casale

  2. Division of Experimental Oncology/Unit of Urology URI, Ospedale San Raffaele IRCCS, Milan, Italy

    Luca Villa

  3. Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy

    Francesco Persico & Domenico Prezioso

  4. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy

    Giovanni Lughezzani

Authors
  1. Alberto Saita
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  2. Luca Villa
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  3. Francesco Persico
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  6. Paolo Casale
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Correspondence to Francesco Persico.

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Supplementary file1 Video 1: In-vitro study of Flexor® Vue™ application (MP4 44746 kb)

Supplementary file2 Video 2: In-vivo demonstration of Flexor® Vue™ application (MP4 120661 kb)

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Saita, A., Villa, L., Persico, F. et al. In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy. Urolithiasis 49, 239–245 (2021). https://doi.org/10.1007/s00240-020-01215-5

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