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Factors affecting the intraoperative calculi excretion during flexible ureteroscopy lithotripsy: an in vitro analysis

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Abstract

Objective

To explore the parameters influencing intraoperative calculi excretion (ICE) during flexible ureteroscopy lithotripsy (fURL) using in vitro simulation experiments.

Methods

3D-printed human kidney models were used to simulate the elimination of gravel during fURL. The factors influencing the ICE during fURL were analyzed by comparing the effects of different degrees of hydronephrosis (mild, moderate, and severe), surgical positions (supine and lateral position), ratios of endoscope-sheath diameter (RESD) (0.625, 0.725, and 0.825), gravel sizes (0.50–1.00 mm, 0.25–0.50 mm, and 0.10–0.25 mm), and ureteral access sheaths (UASs) (traditional UAS and negative-pressure UAS) on ICE.

Results

The impacts of various UAS, RESD, degree of hydronephrosis, surgical positions, and gravel sizes on ICE were all significant (p < 0.05). We found no evidence of multicollinearity for all the independent variables, and the linear regression equation fitted as \(\mathrm{ICE }\,({\mathrm{g}}/{\mathrm{min}}) = 0.102 + 0.083*\mathrm{UAS\,grade }- 0.050*\mathrm{RESD\,grade }- 0.048*\mathrm{hydronephrosis\,grade }+ 0.065*\mathrm{position\,grade }- 0.027*\mathrm{gravel\,size\,grade}\) (R2 = 0.569).

Conclusion

Employing negative-pressure UAS, smaller RESD, milder hydronephrosis, lateral position, and smaller gravel size contribute to improved ICE during fURL. Among them, the adoption of negative-pressure UAS had the most substantial effects.

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Data availability

Data and materials are not publicly available, but are available by the corresponding author upon reasonable request.

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Acknowledgements

This research was supported by Ningbo Top Medical and Health Research Program (No. 2022020203) and Medical Scientific Research Projects of Zhejiang Province (No. 2019326541). The authors also thank Ningbo Hongyong Culture Communication Co., Ltd for the help of figure drawing (Fig. 1C).

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Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People’s Republic of China

    Baiyang Song, Yue Cheng, Ting Huang, Jingyu Shi & Li Fang

  2. Health Science Center, Ningbo University, Ningbo, Zhejiang, 315211, People’s Republic of China

    Baiyang Song & Hao Rong

  3. Ningbo Clinical Research Center for Urological Disease, Ningbo, Zhejiang, 315010, People’s Republic of China

    Yue Cheng, Ting Huang, Jingyu Shi & Li Fang

  4. Medical Record Statistics Room, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, People’s Republic of China

    Yunfei Lu

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  1. Baiyang Song
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Contributions

BS: manuscript writing and data collection. YC: project development. YL: data analysis. HR: data analysis. TH: project development. JS: project development. LF: project development and manuscript revision.

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Correspondence to Yue Cheng or Li Fang.

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Song, B., Cheng, Y., Lu, Y. et al. Factors affecting the intraoperative calculi excretion during flexible ureteroscopy lithotripsy: an in vitro analysis. World J Urol 42, 130 (2024). https://doi.org/10.1007/s00345-024-04794-9

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