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Enhanced popcorning using polyanionic chelating solutions as irrigation.

Daniel G Wong1, Alexander Shiang2, Adam Ostergar2

  • 1Division of Urological Surgery, Department of Surgery, Washington University in St Louis School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA. d.g.wong@wustl.edu.

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Summary
This summary is machine-generated.

Concurrent irrigation with poly-anionic solutions like citrate or EDTA significantly enhances laser lithotripsy stone ablation. This method shows promise for improving endoscopic stone removal by reducing residual stone mass.

Keywords:
ChelatingCitrateEDTALithotripsy

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Area of Science:

  • Urology
  • Biochemistry
  • Medical Engineering

Background:

  • Poly-anionic compounds can chelate divalent cations and dissolve calcium oxalate stones.
  • Optimizing stone ablation rate during laser lithotripsy is crucial for effective stone removal.

Purpose of the Study:

  • To evaluate the impact of irrigating with poly-anionic chelating solutions during laser lithotripsy on stone ablation efficiency.
  • To compare the effectiveness of sodium citrate and ethylenediaminetetraacetate (EDTA) against sodium chloride and sodium hexa-metaphosphate in a popcorning model.

Main Methods:

  • A popcorning model using a ureteroscope and thulium fiber laser was employed.
  • Begostones were treated with laser irrigation using iso-osmolar solutions: 0.9% NaCl, sodium citrate, sodium hexa-metaphosphate, and EDTA.
  • Remaining stone fragments >1 mm were weighed to determine ablation efficiency.

Main Results:

  • Irrigation with 0.9% NaCl resulted in 27.8% remaining stone mass.
  • Sodium citrate and EDTA irrigation reduced remaining stone mass by 37% (17.5%) and 64.7% (9.8%), respectively, compared to NaCl.
  • EDTA demonstrated the most significant improvement in stone ablation efficacy.

Conclusions:

  • Concurrent irrigation with sodium citrate or EDTA synergistically enhances laser lithotripsy efficacy in an in vitro popcorning model.
  • These findings suggest potential for improved endoscopic stone removal outcomes.
  • Further investigation is needed on diverse stone types and safety during clinical application.