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2018
Journal Article
Titel
Viability and biocompatibility of an adhesive system for intrarenal embedding and endoscopic removal of small residual fragments in minimally‑invasive stone treatment in an in vivo pig model
Abstract
Purpose To evaluate the viability and biocompatibility of a novel, patented bioadhesive system for intrarenal embedding and retrieval of residual fragments after endoscopic lithotripsy. Complete stone clearance via active removal of residual fragments (RF) after intracorporeal laser lithotripsy may be time-consuming and fail in many cases. Therefore, the novel adhesive has been developed and evaluated for the first time in an in vivo pig model in the present work. Methods Four female domestic pigs underwent flexible ureteroscopy (RIRS) or percutaneous nephrolithotomy (PNL) undergeneral anesthesia (8 kidneys, 4 × RIRS, 4 × PNL) evaluating the bioadhesive system. Interventions: RIRS without adhesive system (sham procedure, kidney I); 3 × RIRS using the bioadhesive system (kidneys II-IV); and 4 × PNL using thebioadhesive system (V-VIII). We endoscopically inserted standardized human stone probes followed by comminution usingHo:YAG lithotripsy. The bioadhesive (kidney II-VIII) was then applied and the adhesive-stone fragment complex extracted. After nephrectomy, all kidneys were evaluated by two independent, blinded pathologists. Endpoints were the procedure's safety and adhesive system's biocompatibility. Results We observed no substantial toxic effects. We were able to embed and remove 80-90% of fragments. However, because of the pig's hampering pyelocaliceal anatomy, a quantified, proportional assessment of the embedded fragments was compromised. Conclusions For the first time, we demonstrated the proven feasibility and safety of this novel bioadhesive system for embedding and endoscopically removing small RF in conjunction with a lack of organ toxicity in vivo.
Author(s)
Hein, Simon
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg (Institution to Which this Work is Attributed), Hugstetterstr. 55, 79106 Freiburg, Germany
Schoeb, Dominik Stefan
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg (Institution to Which this Work is Attributed), Hugstetterstr. 55, 79106 Freiburg, Germany
Haberstroh, Jörg
Experimental Surgery, Faculty of Medicine, CEMT‑FR, Medical Center, University of Freiburg, Breisacher Str. 66, 79106 Freiburg, Germany
Seidl, Maximilian
Faculty of Medicine, Institute for Surgical Pathology, Medical Center, University of Freiburg, Breisacher Str. 115a, 79106 Freiburg, Germany
Bronsert, Peter
Faculty of Medicine, Institute for Surgical Pathology, Medical Center, University of Freiburg, Breisacher Str. 115a, 79106 Freiburg, Germany
Wetterauer, Ulrich
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg (Institution to Which this Work is Attributed), Hugstetterstr. 55, 79106 Freiburg, Germany
Schoenthaler, Martin
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg (Institution to Which this Work is Attributed), Hugstetterstr. 55, 79106 Freiburg, Germany