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Category: Lesser Toes; Trauma Introduction/Purpose: It has been reported that fractures of interphalangeal coalition often result in delayed union or nonunion. Although there are scattered reports of surgical treatment of painful nonunion after fractures of the interphalangeal coalition, there is currently lack of data on the efficacy of extracorporeal shock wave therapy (ESWT) for nonunion of fractures of the interphalangeal coalition. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy for patients with painful nonunion of fractures of the interphalangeal coalition. Methods: A total of 7 patients (7 feet) diagnosed with painful nonunion due to persistent pain and no tendency toward bony fusion at least 3 months after fracture of the interphalangeal coalition from 2022 to 2023 were included in this study. Focused ESWT was performed in all patients. There were 2 males and 5 females with a mean age of 51.3 years (range, 23-62). The fourth toe was present in two cases, and the fifth toe in five cases. The mean time from the date of injury to the start of ESWT was 3.8 months (range, 3-5 months). 4000 shots at 0.25 mJ/mm2 (4 Hz) was administered at 2-week intervals. Visual analog scale (VAS) before and after ESWT were recorded. Results: The attainment of complete bony union was documented in all seven patients (Figure 1). The application of focused ESWT was carried out a mean of 2.8 times (range, 2-4 times), and the mean duration from the initiation of treatment to the confirmation of bony union was 1.8 months (range, 1-2 months). In all cases, the symptoms of swelling and pain were successfully alleviated. The VAS scores exhibited a significant improvement, with the mean VAS score decreasing from 3.9 (range, 2-6) before ESWT to 0 after the achievement of union. Conclusion: Fractures occurring at interphalangeal coalitions have been reported to require a considerable amount of time for bony union, and surgical intervention has been reported in cases of painful nonunion. However, in the present study, all 7 cases of painful nonunion achieved complete bony fusion following focused ESWT. Moreover, bony union was observed within just 2 months of the start of ESWT. These findings suggest that focused ESWT is a valuable treatment option for achieving bony fusion in cases of painful nonunion of fractures at the interphalangeal coalitions.

Background and Objective The flexible and navigable suction ureteral access sheath (FANS) with continuous flow lithotripsy may improve stone-free rates (SFR) in ureterorenolithotripsy procedures, reducing operative time and the need for fragment extraction. This study aimed to compare the safety and efficacy of FANS versus conventional sheaths in patients undergoing retrograde intrarenal surgery (RIRS) for renal stones. Methods From January to September 2024, patients undergoing RIRS with high-power pulsed lasers (60 W Ho:YAG or 100 W pTm:YAG) were randomized to receive either a conventional sheath (Group 1) or FANS (Group 2). Data on baseline characteristics, operative details, and complications were collected. SFR, defined as the absence of fragments > 3 mm, was assessed with non-contrast CT scans one-month post-surgery. Statistical significance was set at p < 0.05. Results A total of 132 patients were enrolled (70 with conventional sheath, 62 with FANS). The FANS group had shorter operative times (55.25 vs. 61.36 min, p = 0.028), while laser time was similar between groups. Postoperative complications were lower in the FANS group. At one month, the FANS group had a higher SFR (95% vs. 67%, p < 0.005) and fewer re-interventions (p = 0.02). Conclusions FANS significantly improves SFR without increasing postoperative complications postoperative complications or negatively affecting recovery, offering a promising alternative to conventional sheaths in ureterorenolithotripsy procedures. Patient Summary FANS improves kidney stone surgery outcomes, providing better stone removal, fewer complications, and faster recovery compared to the standard tool.

To establish if a retropulsion prevention device for ureteral stones equalizes surgical success and push-back rates of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones. Patients with upper ureteral stones (n = 267) were treated endoscopically at the Department of Urology between April 2014 and December 2015. Patients were randomly assigned to pneumatic and Ho:YAG laser lithotripters as group-1 and group-2, respectively. Lithotripsy was performed with Stone ConeTM in both groups. The surgical success rate on the first postoperative day was 81.5 % (n = 106) and 90.6 % (n = 116) for group-1 and group-2, respectively, and the difference between the groups was statistically significant (p < 0.05). The relation between stone size and surgical success was statistically significant for both groups (p < 0.01). Surgical success for the stones closer than 2 cm to the UPJ was 23.1 % for the pneumatic group versus 64 % for the laser group (p < 0.01). Lithotripsy time was significantly longer in group-2 (16.48 ± 4.74 min) than group-1 (12.24 ± 3.95 min) (p < 0.01). Ho:YAG laser lithotripsy is more successful than pneumatic lithotripsy for upper ureteral stones and a retropulsion prevention device does not equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones on the first postoperative day and one month after surgery. Although the success rate of the first month after surgery is higher in group-2, the difference is not statistically significant.

Objective To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. Materials and methods From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3–4 weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. Results The success rate was higher in the ureteroscopy group than in the SWL group ( p  = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group ( p  = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group ( p  = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30 h in the ureteroscopy group. SWL was performed without the need for hospital admission. Conclusion Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

Background Kidney stone disease is a common problem. The holmium: yttrium–aluminum–garnet (HO:YAG) laser is currently the gold standard laser for ureterorenoscopic (URS) lithotripsy. Recently, the superpulse thulium fiber laser (SP TFL) has shown potential as a substitute for the HO:YAG laser. We aim to compare and evaluate the clinical efficacy and safety of the HO:YAG laser and SP TFL in the treatment of upper urinary calculi in this trial. Methods In this randomized, positive control, blinded management, single-center clinical study, patients with upper urinary calculi will be randomized (1:1) to the experimental group (SP TFL group) or the control group (HO:YAG laser group). Patients in both groups will undergo URS lithotripsy under general anesthesia, and according to the results of randomization, the patients will be treated with an SP TFL (trial group) or a holmium laser (control group). The primary outcome is the stone-free rate at 30 ± 7 days after surgery. The secondary outcomes include the duration of surgery, the duration of laser use, the length of postoperative hospital stay, postoperative clinical indicators, total hospitalization costs, the second-stage stone clearance rate, perioperative complications, the average hemoglobin change, and the mean white blood cell count change. Discussion This study aims to evaluate and compare the clinical efficacy and safety of the SP TFL and HO:YAG for URS lithotripsy in the treatment of upper urinary calculi. Trial registration {2a and 2b} chictr.org.cn ChiCTR2300076893. Registered on October 24, 2023, with ChiCTR ( https://www.chictr.org.cn/bin/project/edit?pid=206827 ). Protocol version {3} August 15, 2023 (V.20230815).

To investigate the feasibility of conventional (basketing + dusting) and Moses (pop-dusting) holmium lasers during flexible ureteroscopy (FURS) in the treatment of 2–3 cm renal calculi and to compare the efficiency and safety of the two methods, a total of 230 patients with 2–3 cm kidney stones who underwent FURS were randomly divided into the conventional group and the Moses group. The mode of lithotripsy in the conventional group was fragmentation and dusting. The mode of lithotripsy in the Moses group was dusting and pop-dusting. Clinical and perioperative variables and complications were compared between the two cohorts. Multivariate analyses of factors contributing to the stone-free rate (SFR) and operation time were performed. No statistically significant differences were found in the demographics, renal stone-related data, SFR, or complications between the cohorts. The laser energy was higher in the Moses cohort than in the conventional cohort (119.3 ± 15.2 vs. 92.8 ± 15.1 kJ; P < 0.001), and the operation time was shorter in the Moses cohort than in the conventional cohort (99.5 ± 18.9 vs. 105.3 ± 13.7 min; P = 0.009). When there was isolated stone, the operation time was shorter in the Moses cohort than in the conventional cohort (99.6 ± 17.5 vs. 111.4 ± 10.7 min; P < 0.001), while there was no significant difference between the two cohorts when there were multiple stones (99.5 ± 20 vs. 101.2 ± 14 min; P = 0.415). Multivariate analyses found that an increase in stone volume can decrease the SFR and prolong the operation time, and use of a Moses laser can shorten the operation time. Both holmium laser modes during FURS can effectively treat 2–3 cm renal calculi. The Moses mode is recommended as the first choice for the treatment of isolated 2–3 cm renal stones. When treating multiple stones, the efficiency of these two laser modalities is the same.Trial registrationChiCTR2200056091

To compare the safety and effectiveness of the combination of intelligent intrarenal pressure control platforms and flexible end ureteral access sheath combined with flexible ureteroscopic lithotripsy (FURL) for the treatment of renal stones less than 2 cm with day case mode. From November 2023 to July 2024, a prospective, randomized, double-blind, parallel-controlled study was conducted to recruit 60 patients with upper urinary tract calculi measuring ≤ 2 cm in longest diameter. A total of 60 eligible patients were consecutively enrolled. Based on a pre-generated random number table and allocation scheme using SPSS 27.0, patients were assigned to either the intelligent pressure control group (IFURL, n  = 30) or the head bending group (BFURL, n  = 30). Blinding measures were implemented for patients, data collectors, statisticians, and analysts, with the allocation results disclosed to the surgeons prior to the start of the procedure in the operating room. The operation duration for IFURL and BFURL was 52.50 (48.00, 60.00) vs. 46.00 (36.00, 56.25), respectively ( p  = 0.047). Stone free rate (SFR) on the first postoperative day was 73.33% vs. 93.33% for IFURL and BFURL, respectively ( p  = 0.038). While, SFR was no significant difference between the two groups after two months(90.00% vs. 96.67%, p  = 0.301). One patient in IFURL was readmitted after discharge due to fever 2 days post-discharge, and improved after 2 days of anti-infection treatment. One patient in BFURL was readmitted due to lumbar and abdominal pain from urine extravasation, which improved after 3 days of anti-infection treatment. SFR of one-month post-surgery for renal calculi ≤ 2 cm treated with intelligent pressure control and flexible UAS combined with FURL in day surgery mode was similar, with low infection-related complications and rehospitalization rates, showing no statistical difference. However, the overall hospitalization costs for the BFURL was lower than IFURL.

Objective To compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10–20 mm lower pole stone (LPS). Methods This study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10–20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively. Results A total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up ( p  = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p  = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p  < 0.001). Conclusion A satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.

Background We aimed to evaluate and compare the rise in the temperature for the safety of the kidney parenchyma on firing the Holmium: Yttrium Aluminium Garnet laser and the Thulium Fiber Laser during laser lithotripsy in humans. Method We included 30 pre-stented patients with renal calculi undergoing Retrograde intra-renal surgery. They were randomized into two groups – 15 patients underwent holmium laser lithotripsy and 15 patients underwent TFL laser lithotripsy. We used Philips paediatric esophageal probe to measure rise in temperature on firing holmium or TFL laser with irrigation at 10 ml/min and pressure at 100 mmHg. Different laser settings were used. Result The mean size of the calculi was 0.8 mm. The rise in temperature with holmium and TFL lasers depended on the firing time and irrigation flow, keeping power constant. On continuous firing for 10s, 20s, and 30s, the average rise in temperature went up to 28.67 °C, 29.70 °C, and 37.17 °C with holmium and with TFL it was 28.77 °C, 29.83 °C, and 37.62 °C, respectively. The difference in rise in temperature between two groups was statistically insignificant with p-values > 0.05. The maximum temperature reached with TFL was 39.4 °C with a 30s lasing time, and that with Ho: YAG was 38.9 °C. Conclusions The rise in temperature was almost equivalent with holmium and TFL. Hence, both Ho: YAG and TFL can be safely used in laser lithotripsy. Adequate irrigation is a must during the surgery. The continuous lasing time should be strictly restricted to less than 20s.

This study evaluated the adherence of bacteria, calcium, and magnesium to three different ureteral stents after endoscopic surgery for urinary calculi. We randomly assigned 61 patients requiring the insertion of ureteral stents after urinary calculi treatment into three groups: Percuflex with a coating composition of Hydroplus ( n  = 21); Tria with a coating composition of Percushied ( n  = 22); and InLay Optima, which had a proprietary pHreeCoat coating ( n  = 18). All stents were removed and evaluated 1 month after treatment. The primary outcome was biomineral attachment to the ureteral stent. Calcium and magnesium contents were measured using atomic absorption spectrometry after the stent had been vortexed in a solution of saline and hydrochloric acid at pH 2. Bacteria were measured through flow cytometry of the washing solution collected by decantation after stent fragments had been immersed and vortexed in a saline solution. Median amounts of calcium and magnesium adhered to Percuflex were significantly higher than those adhered to Tria and InLay Optima. The median number of bacteria adhered was also highest in Percuflex compared to that in the other two groups, although without a statistically significant difference. These findings suggest that selecting stents with superior coating materials enhances patient outcomes and reduces stent-related complications.