Stone fragmentation with subsequent evacuation using a novel single-use flexible cystoscope/nephroscope with integrated direct in-scope suction: An ex vivo experimental study.

Abstract

Introduction: This study aims to evaluate the feasibility of stone fragmentation and aspiration of dust and small stone particles via a direct-in-scope suction (DISS) system using a novel single-use flexible cystoscope (PC200, Pusen Medical Technology, Guangdon, China) in a straight position and with extreme bending.

Material and methods: An ex vivo experimental study was performed on freshly harvested porcine lower urinary systems (bladder and urethra) with natural urinary stones (calcium oxalate dihydrate 70%, urate 30%). In the first set of trials (3 trials) the stones were placed in the bladder and lithotripsy was performed with a scope in a straight position. For the second set of trials, porcine gallbladder was additionally used, circumferentially sutured to the anterior wall of the porcine bladder, and the stone was positioned in the gallbladder (imaginary diverticulum). In the latter trials, lithotripsy was achieved with the scope at an almost 180° bend.

Results: Laser lithotripsy was successfully completed in all trials. Stone fragmentation and aspiration were faster in the first set of trials with the cystoscope in a straight position. In the second set, to access the anterior-wall "diverticulum", continuous suction and irrigation were employed. After lithotripsy, the stone fragments were effectively flushed from the simulated diverticulum into the main bladder cavity.

Conclusions: Bladder stone lithotripsy using a flexible cystoscope with DISS is feasible. The DISS system offers several advantages, including improved visibility through simultaneous fluid and dust aspiration, as well as enhanced maneuverability of the scope due to suction-assisted positioning.