文献詳細
特集 今こそ考えよう! 尿路結石の再発予防
文献概要
▶ポイント
・結石の手術が再発の原因になるといわれるが,理由の1つに微小破砕片の残存が考えられる.
・ツリウムを用いたレーザーではホルミウムと比べて低パルスエネルギー・高パルス周波数・長パルス幅が可能となり,より細かいdustができる.
・灌流でdustを効率よく排出できれば再発を減らすことが期待できるが,熱損傷(サーマルインジャリー)には厳重な注意が必要である.
・結石の手術が再発の原因になるといわれるが,理由の1つに微小破砕片の残存が考えられる.
・ツリウムを用いたレーザーではホルミウムと比べて低パルスエネルギー・高パルス周波数・長パルス幅が可能となり,より細かいdustができる.
・灌流でdustを効率よく排出できれば再発を減らすことが期待できるが,熱損傷(サーマルインジャリー)には厳重な注意が必要である.
参考文献
1) Wang K, et al : Risk factors for kidney stone disease recurrence : a comprehensive metaanalysis. BMC Urol 22 : 62-74, 2022
2) Köhrmann KU, et al : The recurrence rate of stones following ESWL. World J Urol 11 : 26-30, 1993
3) Tashiro K, et al : Stone recurrence after stone free status with extracorporeal shock wave lithotripsy. Nihon Hinyokika Gakkai Zasshi 88 : 434-438, 1997
4) Mulley AG, et al : Extracorporeal shock-wave lithotripsy : slam-bang effects, silent side effects? Am J Roentgenol 150 : 316-318, 1988
5) Kamihira O, et al : Long-term stone recurrence rate after extracorporeal shock wave lithotripsy. J Urol 156 : 1267-1271, 1996
6) El-Assmy A, et al : Does lithotripsy increase stone recurrence? A comparative study between extracorporeal shockwave lithotripsy and non-fragmenting percutaneous nephrolithotomy. Arab J Urol 14 : 108-114, 2016
7) Portis AJ, et al : Repeat Surgery After Ureteroscopic Laser Lithotripsy With Attempted Complete Extraction of Fragments : Long-term Follow-up. Urology 85 : 1272-1278, 2015
8) Kronenberg P, et al : The laser of the future : reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 8 : S398-S417, 2019
9) Traxer O, et al : Managing Urolithiasis with Thulium Fiber Laser : Updated Real-Life Results ― A Systematic Review. J Clin Med 10 : 3390, 2021
10) Traxer O, et al : Thulium fiber laser : the new player for kidney stone treatment? A comparison with Holmium : YAG laser. World J Urol 38 : 1883-1894, 2020
11) Ulvik Ø, et al : Thulium Fibre Laser versus Holmium : YAG for Ureteroscopic Lithotripsy : Outcomes from a Prospective Randomised Clinical Trial. Eur Urol 82 : 73-79, 2022
12) Castellani D, et al : Comparison Between Holmium : YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults : A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. J Urol 210 : 323-330, 2023
13) Bergmann J. et al : First Clinical Experience of a Novel Pulsed Solid-State Thulium : YAG Laser during Percutaneous Nephrolithotomy. J Clin Med 12 : 2588, 2023
14) Lazarus J, et al : Novel syphon ureteric access sheath has the potential to improve renal pressures and irrigant flow. BJU Int 129 : 642-647, 2022
15) Chen Y, et al : Novel Flexible Vacuum-Assisted Ureteral Access Sheath Can Actively Control Intrarenal Pressure and Obtain a Complete Stone-Free Status. J Endourol 36 : 1143-1148, 2022
16) Sur RL, et al : Initial Safety and Feasibility of Steerable Ureteroscopic Renal Evacuation : A Novel Approach for the Treatment of Urolithiasis. J Endourol 36 : 1161-1167, 2022
17) Petzold R, et al : Temperature Assessment of a Novel Pulsed Thulium Solid-State Laser Compared with a Holmium : Yttrium-Aluminum-Garnet Laser. J Endourol 35 : 853-859, 2021
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