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Ex vivo study: is it possible to overcome the blurriness caused by holmium laser fragmentation of kidney stones?

Abstract

Better endoscopic vision is mandatory for successful ureteroscopic stone operations to achieve shorter operating time. However, an important impairing factor for a good endoscopic view is the cloudiness of vision which was formed during laser fragmentation. Holmium laser fragmentation of calcium oxalate stones produces calcium carbonate solubility of which is dependent on pH, citrate, and phosphate. In this ex vivo research, the solubility of calcium carbonate has been investigated in solutions composed of various concentrations of citrate and phosphate buffered at different pH levels after laser fragmentation of calcium oxalate stones. Calcium oxalate stones were placed into the laboratory tubes filled with various concentrations of citrate–phosphate buffers with different pH values. Laser energy in dusting mode was applied to the stones and spectrophotometric measurement for optical density (OD) was calculated for each buffered solution for clarity comparison. In the first phase, solutions composed of four different molar concentrations of citrate–phosphate buffer (0.2, 0.3, 0.4 and 0.5 molars) at various pH levels were used. Then, the next phase of the study was designed to compare solutions demonstrating the lowest OD values with an isotonic saline solution. The results were most convenient at 0.5 molarity (pH = 6) followed by 0.4 molarity (pH = 7) in the first phase (OD values of 0.054 and 0.065, respectively). In the next phase, OD values of both buffered solutions were significantly lower than those of isotonic saline solution (p = 0). Two specific buffers have provided better optic visibility values after laser fragmentation supporting their use as an irrigation solution for the favor of less cloudiness.

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Availability of data and materials

All data and materials as well as software applications comply with field standards. The authors accept to share their data in case of acceptance of their study to be published in this journal.

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Acknowledgements

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Funding

This study received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

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Authors

Contributions

All authors contributed to write the manuscript, read and approved the final manuscript. MT: conception and design of the study; performance of the ex vivo experiment; collection, analysis and interpretation of the data; drafting the manuscript and revising it critically for important intellectual and technical content; given final approval of the version to be published. HÖ: conception and design of the study; collection, analysis and interpretation of the data; revising the manuscript critically for important intellectual and technical content; given final approval of the version to be published. MK: collection, analysis and interpretation of the data; given final approval of the manuscript to be published. NYS: analysis and interpretation of the data; given final approval of the manuscript to be published. MS: design of the study; collection, analysis and interpretation of the data; revising the manuscript critically for important intellectual and technical content; given final approval of the version to be published.

Corresponding author

Correspondence to Murat Tuğrul Eren.

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The authors declare they have no potential conflict of interest regarding the investigation, authorship, and/or publication of this article.

Ethical approval

This study was approved by the Acibadem Mehmet Ali Aydınlar University, Medical School, Board of Ethics Committee with the Approval No. 2107/9.

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The consent form is available to the Editor if requested, and will be treated confidentially.

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A written informed consent for the publication of any associated data and accompanying images of the human materials (kidney stones) was obtained from all patients.

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Eren, M.T., Özveri, H., Kolay, M. et al. Ex vivo study: is it possible to overcome the blurriness caused by holmium laser fragmentation of kidney stones?. Urolithiasis (2021). https://doi.org/10.1007/s00240-021-01285-z

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Keywords

  • Calcium oxalate stone
  • Retrograde intrarenal surgery
  • Holmium laser
  • Chemolysis