A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?

• Published in: World journal of urology Vol. 42; no. 1; p. 244
• Main Authors: Perri, Davide, Besana, U., Mazzoleni, F., Pacchetti, A., Morini, E., Verzotti, E., Maltagliati, M., Romero-Otero, J., Pastore, A. L., Gozen, A. S., Kallidonis, P., Pushkar, D., Govorov, A., Bozzini, G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 20-04-2024; Springer Nature B.V
• Subjects: Constriction, Pathologic - etiology; Holmium; Humans; Kidney stones; Lasers, Solid-State - therapeutic use; Lesions; Lithotripsy; Lithotripsy, Laser - adverse effects; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Postoperative Complications - etiology; Stricture; Treatment Outcome; Ureteral Calculi - surgery; Ureteroscopy - adverse effects; Urology; Vapors; Ureteral stone; Holmium:YAG laser; Retropulsion; Virtual basket; Vapor tunnel
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-024-04961-y

Purpose
To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones.
Methods
Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed.
Results
186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91 cm in Groups A vs. B (
p
 = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (
p
 = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (
p
 = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%,
p
 = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (
p
 = 0.19).
Conclusions
VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.