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Vacuum-assisted dedusting lithotripsy in the treatment of kidney and proximal ureteral stones less than 3 cm in size

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Abstract

Purpose

This study aimed to compare the outcomes of vacuum-assisted dedusting lithotripsy (VADL) using flexible vacuum-assisted ureteral access sheath (FV-UAS) versus traditional flexible ureteroscopic lithotripsy (fURL) in patients with kidney or proximal ureteral calculi less than 3 cm in size.

Methods

A total of 371 patients who successfully underwent fURL treatment were enrolled. These patients were divided into traditional fURL group and VADL group. Outcomes of both groups were compared using 1:1 propensity score-matched analysis. Stratified analyses based on stone size and location were also conducted.

Results

Finally, 103 well-matched patients in each group were identified. No septic shock or death occurred. The immediate stone-free rate (SFR) and follow-up SFR of VADL group were significantly higher (78.6% vs. 50.5%, p < 0.001; 94.2%% vs. 75.7%, p < 0.001). No difference was observed in postoperative fever rate (2.9% vs. 3.9%, p = 1.000) and duration of lithotripsy (37.7 ± 20.1 min vs. 40.3 ± 18.9 min, p = 0.235). For patients with stones ≤ 2 cm in size, the immediate SFR and follow-up SFR in VADL group were higher (86.7% vs. 60.6%, p < 0.001; 96.0% vs. 83.1%, p = 0.010). The same trend was observed in the 2–3 cm subgroup (57.1% vs. 28.1%, p = 0.023; 89.3% vs. 59.4%, p = 0.009). Although the in situ fragmentation strategy was employed more frequently in VADL group for lower pole stones, the SFR was still higher. Subgroup analyses did not reveal any significant differences in either infectious complications or duration of lithotripsy.

Conclusion

VADL technique can significantly improve the postoperative SFR for the patients with kidney or proximal ureteral stones less than 3 cm in size treated by flexible ureteroscope.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was funded by Tianjin Health Research Project (TJWJ2022ZD004), The Science and Technology Project of Tianjin (21JCYBJC01300), The Science and Technology Project of Tianjin (22YDTPJC00190), and Scientific Research Program of Tianjin Education Commission (2021KJ228).

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Author notes

  1. Junkai Huang and Yu Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People’s Republic of China

    Junkai Huang, Yu Yang, Haijie Xie, Zhihao Fu, Fu Zhu, Linguo Xie & Chunyu Liu

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  1. Junkai Huang
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  2. Yu Yang
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  3. Haijie Xie
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  4. Zhihao Fu
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  5. Fu Zhu
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  6. Linguo Xie
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  7. Chunyu Liu
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Contributions

JH and YY contributed equally to this work. JH, YY, and HX designed the research and wrote the manuscript. ZF, FZ, and LX collected and analyzed data. CL designed the project and edited the manuscript. All the authors approved the final version to be published.

Corresponding author

Correspondence to Chunyu Liu.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Since clinical data were retrospectively obtained from hospital records, the requirement for informed consent was waived.

Research involving human participants, their data, or biological material

The approval was obtained from the Ethics Committee of The Second Hospital of Tianjin Medical University, and our procedures were carried out according to the Declaration of Helsinki.

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Huang, J., Yang, Y., Xie, H. et al. Vacuum-assisted dedusting lithotripsy in the treatment of kidney and proximal ureteral stones less than 3 cm in size. World J Urol 41, 3097–3103 (2023). https://doi.org/10.1007/s00345-023-04595-6

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  • DOI: https://doi.org/10.1007/s00345-023-04595-6

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