Etienne Xavier Keller1,2,3, Vincent De Coninck1,2,4, Steeve Doizi1,2, Michel Daudon5, Olivier Traxer6,7. 1. Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. 2. GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. 3. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 4. Department of Urology, AZ Klina, Brasschaat, Belgium. 5. Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France. 6. Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. olivier.traxer@aphp.fr. 7. GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. olivier.traxer@aphp.fr.
Abstract
PURPOSE: To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. METHODS: Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. RESULTS: All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm. CONCLUSION: A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.
PURPOSE: To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. METHODS: Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. RESULTS: All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm. CONCLUSION: A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.
Entities:
Keywords:
Laser lithotripsy; Percutaneous nephrolithotomy; Stone composition; Stone dust; Ureteroscopy; Urolithiasis
Authors: Casey A Dauw; Laika Simeon; Abdulrahman F Alruwaily; Francesco Sanguedolce; John M Hollingsworth; William W Roberts; Gary J Faerber; J Stuart Wolf; Khurshid R Ghani Journal: J Endourol Date: 2015-08-21 Impact factor: 2.942
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