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This study aims to evaluate the feasibility, safety, and effectiveness of an optimized treatment approach for complex renal calculi, utilizing visual needle nephroscopy in conjunction with standard PCNL and holmium YAG laser. We collected data from 62 patients diagnosed with complex kidney stones who underwent this combined procedure using the visual needle nephroscope (Needle-perc®, Youcare Tech, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20 F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. All 62 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 62 patients before operation was 10.5 ± 0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5 ± 12.7) minutes, and the average hospital stay was (7.3 ± 2.1) days. After operation, 2 patients developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 4 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (58/62). The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope by holmium YAG laser has good feasibility, safety and effectiveness. [ABSTRACT FROM AUTHOR]

A 79-year-old man visited our hospital with a mass at the external urethral meatus after 4 months of clean intermittent self-catheterization (CIC). Cryotherapy was started as a treatment for condylomata acuminata, and the mass at the external urethral meatus disappeared. Cystoscopy of the urethra revealed multiple masses extending the entire length of the urethra, and a biopsy was performed to diagnose pan-urethral condylomata acuminata. CIC was discontinued, cystostomy was performed, and urethral tumor ablation using a holmium YAG laser was performed. Because residual lesions were observed in the urethra, intraurethral instillation therapy with 5-fluorouracil (5-FU) was administered once a week for seven weeks. No significant adverse events were observed, the mass disappeared, and no recurrence has been observed to date. Condylomata acuminata occurs most frequently in males on the foreskin of the penis, coronal sulcus, glans, external urethral meatus, and anus, but it is relatively rare in the urethra. This case suggested that cystoscopic observation is necessary in cases of condylomata acuminata of the external urethral meatus. Although the risk factors for urethral condylomata acuminata are unknown, the pathogenesis of this case is presumed to be intraurethral dissemination due to CIC. Various treatment methods for urethral condylomata acuminata have been reported, including laser ablation and surgical resection, each of which has its own problems, such as complications and high recurrence rates. The results of this study suggest that adjuvant treatment with intraurethral instillation of 5-FU may be useful for patients with urethral condylomata acuminata that is difficult to cure by surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of prolonged laser activation on irrigation fluid temperature by varying the power settings flow rate (10–30 ml/min). Materials and methods: An experimental study using a 20 ml syringe, 12/14 ureteral access sheath, a dual-lumen catheter and a thermocouple was performed. The laser was fired with 12 W (0.3 J × 40 Hz), 40 W (1 J × 40 Hz), 60 W (1.5 J × 40 Hz) using Quanta Ho 150 W (Quanta System, Samarate, Italy). All trials were performed with fluid outflow rate of 10, 20 and 30 ml/min with the fixed fluid volume at 10 ml. Results: Continuous laser activation for 10 min with the outflow rate of 10 ml/min using only 12 W resulted to continuous temperature rise to as high as 83 °C. Similar rise of temperatures were observed for 40 W and 60 W with 10 ml/min outflow rate with intermittent laser activation. With 20 and 30 ml/min outflow rates the maximum temperatures for all power settings were below the threshold (< 43 °C). However, the time to reach the same total emitted energy was 60% and 40% shorter 60 W and 40 W, respectively. Conclusion: Our study found that continuous laser activation with as less as 12 W using 10 ml/min outflow rate increased the irrigation fluid temperature above the threshold only after 1 min. In the current experimental setup, with the fluid outflow rate of 20 and 30 ml/min safe laser activation with 60 W and 40 W (temperature < 43 °C) can be achieved reaching the same total emitted energy as with 12 W in significantly shorter time period. [ABSTRACT FROM AUTHOR]

Background: Parotid sialolithiasis is a common condition in middle-aged individuals, with most cases occurring in the submandibular and sublingual glands, followed by the parotid glands and minor salivary glands. The treatment of salivary gland stones, particularly those of the parotid glands, remains challenging. Endoscopic surgery using a yttrium aluminum garnet (YAG)-holmium laser for parotid sialolithiasis is a minimally invasive approach that provides effective treatment for patients. This study aimed to evaluate the outcomes of the endoscopic laser treatment of parotid sialolithiasis a YAG-holmium laser., Materials and Methods: A prospective case series study was conducted on 21 patients diagnosed with salivary gland stones in the parotid gland based on clinical features and imaging findings (including ultrasound and computed tomography scans), from March 2022 to March 2024. These patients underwent sialendoscopy surgery using a YAG-holmium laser and were evaluated for surgical results at 2, 4, and 12 weeks., Results: Cases with completely reduced symptoms accounted for 90.5%, whereas cases with partially reduced symptoms accounted for 9.5%. The ultrasound image of the salivary gland after surgery was significantly improved compared to that before surgery. After three months of surgery, most patients (90.5%) were satisfied. The postoperative complication rate was 14.3%, which included scarring at the opening of the salivary gland and in the salivary duct., Conclusion: Sialendoscopic surgery using a YAG-holmium laser for parotid sialolithiasis is a minimally invasive surgical intervention that leaves no scarring, reduces the risk of complications as seen in open surgery, and shortens the postoperative care time for patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Hue Central Hospital, Hue, Vietnam issued approval 653/QD-BVH. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nguyen et al.)

Introduction and Objectives: The Moses effect (ME) was described >30 years ago during normal laser functioning in a fluid medium. Recently, a laser device equipped with a pulse-modulating system called Moses™ technology (MT; Lumenis®) was marketed for both stone lithotripsy and prostate endoscopic surgery. We aimed to perform a literature revision of ME from a historical perspective up until its present-day applications. Evidence Acquisition: A search of Medline, PubMed, and Scopus was performed to identify articles published in English within the past 30 years addressing both ME and MT in relation to their urologic applications. Relevant studies were then screened, and the data were extracted, analyzed, and summarized. The preferred reporting items for systematic reviews and meta-analysis criteria were applied. Results: ME was first described in 1986 during endovascular laser tissue ablation. During the late 1980s and the early 1990s, the interest raised around ME led to its characterization and better definition. Despite this initial interest, ME gradually disappeared from the focus of researchers and clinicians. In 2017, MT was launched on the market, although postmarketing comparative efficacy and safety data are lacking. Conclusions: Although ME had been described and characterized during normal laser functioning >30 years ago, only very recently it began to regain some consideration after the marketing of MT, whose clinical outcomes are still awaited. [ABSTRACT FROM AUTHOR]

Patients with skeletal deformities represent a challenge during surgical management of renoureteral lithiasis. We present a case of supine percutaneous treatment in a 24-year-old female with spastic tetraparesis and complex skeletal deformity. A diagnosis of left ureterohydronephrosis caused by a 7mm distal ureteral calculus and 18mm left renal pelvis lithiasis was established. A lower pole ultrasound-fluoroscopy-guided percutaneous nephrostomy tube was inserted into the dilated pyelocaliceal system for the immediate relief of the obstructive nephropathy. Afterwards, a definitive approached with a mid pole puncture was performed. The pyelic stone was removed using a rigid nephroscop and a Swiss lithoclast for stone fragmentation. Then, anterograde flexible ureteroscopy combined with holmium: YAG laser was used in order to approach the ureteral stone for intracorporeal lithotripsy. The fragmented stones were passed down to the bladder by irrigation and a 6 nephroureteral catheter was left in place at the end of the procedure. [ABSTRACT FROM AUTHOR]

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Ab externo thermal sclerostomy was performed with the holmium YAG (thulium, holmium, chromium-doped YAG crystal) laser in 21 eyes of 20 patients with refractory glaucoma. We used either the 5-fluorouracil (5-FU) or mitomycin C (MMC) antimetabolites in all cases. The rate of intraocular pressure (IOP) control defined as IOP < 21 mmHg regardless of whether antiglaucoma medication was applied postoperatively) was estimated by the life-table methods of Kaplan-Meier. The postoperative IOP control rate was 47.1% in the MMC-treated group at 57 months, and 14.3% in the 5-FU-treated group at 52 months. There were statistically significant differences in success rates between the MMC- and 5-FU-treated groups. We observed no clinically significant complications except excess filtration associated with a shallow anterior chamber in one case. This procedure is thought to have several advantages over more conventional filtration surgery; the operation time is shorter, and there is no need for intraocular manipulation, which means conjunctival trauma is minimal. However, the IOP control rate was substantially lower than that achieved via conventional trabeculectomy. Our results suggest that the selection of patients and the use of MMC is an important factor in maintaining successful filtration. [ABSTRACT FROM AUTHOR]