Abstract
A new anti-retropulsion device for the endoscopic treatment of ureteral stones was evaluated for safety and potential efficacy. The Xenx™ (Rocamed, Monaco-Montecarlo) is an anti-retropulsion device that operates as a normal hydrophilic guidewire when “closed” and as a nitinol ureteral mesh when “open”. We performed semirigid ureterorenoscopy and Ho:YAG Laser lithotripsy in 15 patients, with a single ureteral stone. For each procedure, the papilla was negotiated with the Xenx™, the radiopaque markers were positioned over the stone via direct visualization and the device was opened under fluoroscopic control. The ureteroscope was then retracted and reinserted beside the Xenx™. At the end of the procedure, the Xenx™ was closed, and a ureteral catheter was coaxially placed and left for 24–48 h post-operation. We evaluated device positioning success with respect to pushability, ease of deployment, full expansion and fitting with the ureteral walls, kink resistance and stone retention capabilities during lithotripsy and device retrieval. Operative time, post-operative complications (Clavien-Dindo scale), ultrasound kidney stone-free rate and the hydronephrosis grade, were also recorded. At 4 weeks post-operation, the stone-free rate was assessed via non-contrast computed tomography with 1-mm slices. All procedures were successfully accomplished without complications according to the Clavien-Dindo scale. In all the cases, Xenx™ was inserted successfully past the stone and opened over it. In 4/15 cases (27 %) some difficulties in pushability and kink resistance were recorded. In no case stone fragment basketing was performed. The median operative time was 24 min. At hospital discharge, 14/15 patients (93 %) were kidney stone-free. At 4 weeks, the NCCT stone-free rate was 100 %. This study demonstrated that the Xenx™ is safe and effective in terms of the stone-free rate, complications and operating time. Moreover, use of the Xenx™ allows the use of a basket or guide wire to be avoided.
Similar content being viewed by others
References
Wosnitzer M, Xavier K, Gupta M (2009) Novel use of a ureteroscopic stone entrapment device to prevent antegrade stone migration during percutaneous nephrolithotomy. J Endourol 23:203–208
Pedro RN, Hendlin K, Weiland D et al (2007) In vitro evaluation of ureteral perforation forces. Urology 70:592–594
Dretler SP (2001) The stone cone: a new generation of basketry. J Urol 165:1593–1596
Finley DS, Petersen J, Abdelshehid C et al (2005) Effect of holmium:YAG laser pulse width on lithotripsy retropulsion in vitro. J Endourol 19:1041–1044
Lee H, Ryan RT, Teichman JM et al (2003) Stone retropulsion during holmium:YAG lithotripsy. J Urol 169:881–885
Marguet CG, Sung JC, Springhart WP et al (2005) In vitro comparison of stone retropulsion and fragmentation of the frequency doubled, double pulse nd:YAG laser and the holmium:YAG laser. J Urol 173:1797–1800
Sarkissian C, Paz A, Zigman O, Webster K, Tamir I, Monga M (2012) Safety and efficacy of a novel ureteral occlusion device. Urology 80:327
Macchione N, Sanguedolce F, Stephan H, Longo F, Karchrilas S, Masood J, Bucholz N, Montanari E (2013) A novel stone management device during endolithotripsy for ureteral stones: first multi-institutional experience. J Endourol 27:A470
Macchione N, Sanguedolce F, Stephan H, Longo F, Karchrilas S, Masood J, Bucholz N, Montanari E (2014) Xenx (Xenolith), a new anti-repulsion device in the treatment of ureteral stones: a multicenter European study. Eur Urol Suppl 13:eV6
Macchione N, Longo F, Zanetti G, Trinchieri A, Montanari E (2013) Xenx, a new device to prevent stone and fragments migration during the endoscopic laser lithotripsy: experience in a single center. Eur Urol Suppl 12:47
Turney BW, Reynard JM, Noble JG et al (2011) Trends in urological stone disease. BJU Int 109:1082–1087
Elashry OM, Elgamasy AK, Sabaa MA et al (2008) Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience. BJU Int 102:1010–1017
Sea J, Jonat LM, Chew BH et al (2012) Optimal power settings for holmium:YAG lithotripsy. J Urol 187:914–919
Chew B, Poh B, Jonat L et al (2011) Anti-retropulsion devices increase stone fragmentation efficiency with holmium:YAG laser lithotripsy. Urology 78:S376
Lee HJ, Box GN, Abraham JB et al (2008) In vitro evaluation of nitinol urological retrieval coil and ureteral occlusion device: retropulsion and holmium laser fragmentation efficiency. J Urol 180:969–973
Elashry OM, Tawfik AM (2012) Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol 9:691–698
Olbert PJ, Keil C, Weber J et al (2010) Efficacy and safety of the Accordion stone-trapping device: in vitro results from an artificial ureterolithotripsy model. Urol Res 38:41–46
Abdelsayed M, Onal E, Wax SH (1977) Avulsion of the ureter caused by stone basket manipulation. J Urol 118:868–870
Durano AC, Hanosh JJ (1988) A new alternative treatment for entrapped stone basket in the distal ureter. J Urol 139:116–117
Ursiny M, Eisner BH (2013) Cost-effectiveness of anti-retropulsion devices for ureteroscopic lithotripsy. J Urol 189:1762–1766
Ahmed M, Pedro RN, Kieley S et al (2009) Systematic evaluation of ureteral occlusion devices: insertion, deployment, stone migration, and extraction. Urology 73:976–980
Conflict of interest
No competing financial interests exist.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Montanari, E., Longo, F., Macchione, N. et al. Xenx (Xenolith): preliminary considerations of a new “all-in-one” ureteral guidewire and anti-repulsion device. Urolithiasis 43, 177–182 (2015). https://doi.org/10.1007/s00240-014-0740-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-014-0740-6