PMID- 33067728 OWN - NLM STAT- MEDLINE DCOM- 20210916 LR - 20210916 IS - 1433-8726 (Electronic) IS - 0724-4983 (Print) IS - 0724-4983 (Linking) VI - 39 IP - 6 DP - 2021 Jun TI - Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy. PG - 1673-1682 LID - 10.1007/s00345-020-03481-9 [doi] AB - PURPOSE: To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety. METHODS: A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark. RESULTS AND CONCLUSIONS: Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies. FAU - Lildal, Soren Kissow AU - Lildal SK AD - Department of Urology, Aarhus University Hospital, Aarhus, Denmark. FAU - Andreassen, Kim Hovgaard AU - Andreassen KH AD - Department of Urology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. FAU - Baard, Joyce AU - Baard J AD - Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. FAU - Brehmer, Marianne AU - Brehmer M AD - Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden. AD - Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden. FAU - Bultitude, Matthew AU - Bultitude M AD - Urology Centre and Stone Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK. FAU - Eriksson, Ylva AU - Eriksson Y AD - Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden. AD - Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden. FAU - Ghani, Khurshid R AU - Ghani KR AD - Department of Urology, University of Michigan, Ann Arbor, MI, USA. FAU - Jung, Helene AU - Jung H AD - Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark. FAU - Kamphuis, Guido AU - Kamphuis G AD - Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. FAU - Kronenberg, Peter AU - Kronenberg P AD - Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal. FAU - Turney, Ben AU - Turney B AD - Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. FAU - Traxer, Olivier AU - Traxer O AD - Department of Urology, Tenon Hospital, Paris, France. FAU - Ulvik, Oyvind AU - Ulvik O AD - Department of Urology, Haukeland University Hospital, Bergen, Norway. FAU - Osther, Palle Jorn Sloth AU - Osther PJS AUID- ORCID: 0000-0001-7962-1640 AD - Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark. posther@health.sdu.dk. LA - eng PT - Consensus Development Conference PT - Journal Article PT - Review DEP - 20201016 PL - Germany TA - World J Urol JT - World journal of urology JID - 8307716 SB - IM MH - Combined Modality Therapy MH - Humans MH - Kidney Calculi/*therapy MH - Lithotripsy/*methods MH - Lithotripsy, Laser MH - *Ureteroscopy PMC - PMC8217045 OTO - NOTNLM OT - Endoscopes OT - Kidney stones OT - Laser lithotripsy OT - Safety OT - Technology OT - Ureteroscopy COIS- Soren K. Lildal: no conflicts of interest. Kim Andreassen: consultant for AMBU. Joyce Baard: no conflicts of interest. Marianne Brehmer: no conflicts of interest. Matthew Bultitude: consultant for Boston Scientific. Ylva Eriksson: no conflicts of interest. Khurshid Ghani: consultant for Boston Scientific, Lumenis, and Olympus; Grant from Boston Scientific. Helene Jung: no conflicts of interest. Guido Kamphuis: consultant for Boston Scientific and Olympus. Peter Kronenberg: consultant for Olympus. Ben Turney: no conflicts of interest. Olivier Traxer: consultant for Boston Scientific, Olympus, Rocamed, and Coloplast. Oyvind Ulvik: consultant for Olympus. Palle J S Osther: consultant for Olympus, Boston Scientific, Bonvisi AB, and Coloplast. EDAT- 2020/10/18 06:00 MHDA- 2021/09/18 06:00 PMCR- 2020/10/16 CRDT- 2020/10/17 05:30 PHST- 2020/08/22 00:00 [received] PHST- 2020/10/01 00:00 [accepted] PHST- 2020/10/18 06:00 [pubmed] PHST- 2021/09/18 06:00 [medline] PHST- 2020/10/17 05:30 [entrez] PHST- 2020/10/16 00:00 [pmc-release] AID - 10.1007/s00345-020-03481-9 [pii] AID - 3481 [pii] AID - 10.1007/s00345-020-03481-9 [doi] PST - ppublish SO - World J Urol. 2021 Jun;39(6):1673-1682. doi: 10.1007/s00345-020-03481-9. Epub 2020 Oct 16.