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Der frequenzverdoppelte Doppelpuls-Neodym:YAG-Laser (FREDDY) bei Urolithiasis

Erste klinische Erfahrungen

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Zusammenfassung

Laserlithotripter spielen auch heute noch in der Therapie der Urolithiasis aufgrund unzulänglicher Fragmentationseffektivitäten und hoher Anschaffungs- sowie Wartungskosten eine untergeordnete Rolle. In der vorliegenden retrospektiven Studie wurde ein innovatives Lasersystem auf seine Praktikabilität und Effektivität in der klinischen Steinbehandlung hin untersucht.

Zwischen November 1998 und Oktober 1999 wurden 48 Patienten bei insgesamt 50 ureterorenalen Einheiten sowie einem Blasenstein mit dem frequenzverdoppelten Doppelpuls-Neodym:YAG-Laser (FREDDY) behandelt, davon 43 ureteroskopisch, 4 uretero–renoskopisch, 3 perkutan-nephroskopisch sowie einer zystoskopisch. Bei medianer Lasermanipulationszeit von 5 min (1–30 min) und einer Gesamtdauer des Eingriffs von 60 min (15–180 min) war die Steinfreiheitsrate am ersten postoperativen Tag für den oberen Harnleiter 62%, den mittleren 91% und den distalen 100% ohne Komplikationen.

Die Laserlithotripsie mit dem innovativen FREDDY-Laser ist effektiv, einfach und sehr sicher bei nur geringen Anschaffungs- und Wartungskosten. Die extrem dünne und flexible Quarzfaser erlaubt eine Erweiterung des endoskopischen Spektrums auf schlecht erreichbare hohe Harnleiter-, Nierenbecken- und Nierenkelchsteine. Daher ist eine prospektiv randomisierte Validierung im Vergleich mit mechanischen Lithotriptoren wünschenswert.

Abstract

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment.

Between November 1998 and October 1999, 48 patients were treated with the innovative frequency-doubled double-pulse Neodym:YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1–30 min) and a total procedure duration of 60 min (range: 15–180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen.

In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.

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Literatur

  1. Beaghler M, Poon M, Ruckle H, Stewart S, Weil D (1998) Complications employing the Holmium:YAG laser. J Endourol12: 533–535

  2. Bierkens AF, Hendrikx AJ, De La Rosette JJ et al. (1998) Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol 81: 31–35

  3. Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V (1982) First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 127: 417–420

    Google Scholar 

  4. Cheung MC, Yip SK, Lee FC, Tam PC (2000) Outpatient ureteroscopic lithotripsy: selective internal stenting and factors enhancing success. J Endourol14: 559–564

  5. Costello AJ, Westcott MJ, Peters JS (2000) Experience with the holmium laser as an endoscopic lithotrite. Aust N Z J Surg 70: 348–350

    Google Scholar 

  6. Delvecchio FC, Kuo RL, Preminger GM (2000) Clinical efficacy of combined lithoclast and lithovac stone removal during ureteroscopy: J Urol 164: 40–42

    Google Scholar 

  7. Denstedt JD, Clayman RV (1990) Electrohydraulic lithotripsy of renal and ureteral calculi. J Urol 143: 13–17

    Google Scholar 

  8. Denstedt JD, Eberwein PM, Singh RR (1992) The Swiss Lithoclast: a new device for intracorporeal lithotripsy. J Urol 148: 1088–1090

    Google Scholar 

  9. Devarajan R, Ashraf M, Beck RO, Lemberger RJ, Taylor MC (1998) Holmium: YAG lasertripsy for ureteric calculi: an experience of 300 procedures. Br J Urol 82: 342–347

    Google Scholar 

  10. Dretler SP, Watson G, Parrish JA, Murray S (1987) Pulsed dye laser fragmentation of ureteral calculi: initial clinical experience. J Urol 137: 386–389

    Google Scholar 

  11. Grasso M, Beaghler M, Loisides P (1995) The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology 45: 372–376

    Google Scholar 

  12. Grasso M (1996) Experience with the holmium laser as an endoscopic lithotrite. Urology 48: 199–206

    Google Scholar 

  13. Haupt G, Pannek J, Herde T, Schulze H, Senge T (1995) The Lithovac: new suction device for the Swiss Lithoclast. J Endourol 9: 375–377

    Google Scholar 

  14. Hofbauer J, Hobarth K, Marberger M (1995) Electrohydraulic vs. pneumatic disintegration in the treatment of ureteral stones: a randomized, prospective trial. J Urol 153: 623–625

    Google Scholar 

  15. Knispel HH, Klan R, Dieckmann KP (1993) Endoscopic lithotripsy with pneumatic shockwave (Swiss Lithoclast) using a mini-ureteroscope. Urologe A 32: 390–392

    Google Scholar 

  16. Knispel HH, Klan R, Heicappell R, Miller K (1998) Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients. J Endourol 12: 513–515

    Google Scholar 

  17. Kok TP, Ming TS, Consigliere D. (1998) Ureteroscopic lithoclast lithotripsy: A cost-effective option. J Endourol 12(4): 341–344

    Google Scholar 

  18. Menezes P, Dickinson A, Timoney AG (1999) Flexible ureterorenoscopy for the treatment of refractory upper urinary stones. Br J Urol 84: 257–260

    Google Scholar 

  19. Pearle MS, Sech SM, Cobb CG, Riley JR, Clark PJ, Preminger GM, Drach GW, Roehrborn C G (1998) Safety and efficacy of the Alexandrite laser for the treatment of renal and ureteral calculi. Urology 51: 33–38

    Google Scholar 

  20. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, Macaluso JN (1997) Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. J Urol 158: 1915–1921

    Google Scholar 

  21. Shroff S, Watson GM, Parikh A, Thomas R, Soonawalla PF, Pope A (1996) The holmium: YAG laser for ureteric stones. Br J Urol 78: 836–839

    Google Scholar 

  22. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD (2002) Holmium:Yag laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167: 31–34

    Google Scholar 

  23. Sun Y, Wang L, Liao G, Xu C, Gao X, Yang Q, Qian S (2001) Pneumatic lithotripsy vs. laser lithotripsy in the endoscopic treatment of ureteral calculi. J Endourol 15/6: 587–590

    Google Scholar 

  24. Teichmann JMH, Vassar GJ, Bishoff JT, Bellman GC (1998) Holmium:Yag lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol: 159: 17–23

  25. Turk TM, Jenkins AD (1999) A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol 161: 45–46

    Google Scholar 

  26. Watson GM, Wickham JE (1986) Initial experience with a pulsed dye laser for ureteric calculi. Lancet 1: 1357–1358

    Google Scholar 

  27. Zorcher T, Hochberger J, Schrott KM, Kuhn R, Schafhauser W (1999) In vitro study concerning the efficiency of the frequency-doubled double-pulse Neodymium:YAG laser (FREDDY) for lithotripsy of calculi in the urinary tract. Lasers Surg Med 25: 38–42

    Google Scholar 

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Authors and Affiliations

  1. Urologische Universitätsklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg,

    A. Ebert, J. Stangl & R. Kühn

  2. Klinik für Urologie und Kinderurologie im Klinikum Fichtelgebirge, Marktredwitz

    W. Schafhauser

  3. Klinik für Urologie und Kinderurologie im Klinikum Fichtelgebirge, Marktredwitz, Schillerhain 1, 95615, Marktredwitz

    W. Schafhauser

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  1. A. Ebert
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  2. J. Stangl
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  4. W. Schafhauser
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Correspondence to W. Schafhauser.

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Ebert, A., Stangl, J., Kühn, R. et al. Der frequenzverdoppelte Doppelpuls-Neodym:YAG-Laser (FREDDY) bei Urolithiasis. Urologe [A] 42, 825–833 (2003). https://doi.org/10.1007/s00120-002-0289-9

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