Mp05-14 enhanced popcorning using polyanionic solutions as irrigation

You have accessJournal of UrologyCME1 Apr 2023MP05-14 ENHANCED POPCORNING USING POLYANIONIC SOLUTIONS AS IRRIGATION Daniel Wong, Alex Shiang, Connor McCormick, Adam Ostergar, Henry Lai, and Kenneth Sands Daniel WongDaniel Wong More articles by this author , Alex ShiangAlex Shiang More articles by this author , Connor McCormickConnor McCormick More articles by this author , Adam OstergarAdam Ostergar More articles by this author , Henry LaiHenry Lai More articles by this author , and Kenneth SandsKenneth Sands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The goal of popcorning or pop-dusting is to reduce stone fragments to submillimeter size, allowing spontaneous passage through the urinary tract. Polyanionic compounds can dissolve human calcium oxalate kidney stones. We explore the novel application of polyanionic solutions to enhance popcorning efficiency. METHODS: BegoStones with matching size and mass were treated in a 12 mm test tube calyceal model with a 60 W TFL (SOLTIVE, Olympus). 200 mm fiber was introduced into our model calyx through a flexible ureteroscope and positioned 1-2 mm from the stones. Stones were treated at 1.0 J × 40 Hz for 4 minutes with irrigation at 30 ml/min. We compared sodium chloride (NaCl), sodium citrate (Citrate), sodium hexametaphosphate (HMP), and sodium EDTA (EDTA) solutions. The osmolality of all solutions was matched to 0.9% NaCl. The pH for solutions of NaCl, EDTA, HMP, and Citrate was 6.0, 8.3, 6.7, and 8.6 respectively. After treatment, stones were passed through a 1 mm sieve and remaining fragments weighed. The primary outcome was residual stone mass >1 mm. RESULTS: The average remaining stone mass >1 mm after 17 observations with NaCl irrigation was 27.8% (±10.0%). After 15 observations with HMP, Citrate, and EDTA irrigation, the average remaining stone mass >1 mm was 28.9% (±13.4%), 17.5% (±10.5%), and 9.8% (±5.7%) respectively (Figure 1). HMP had no significant effect on residual stone burden compared with NaCl. There was a 37% reduction in residual stone mass when using Citrate compared with NaCl (p=0.008). Using EDTA reduced residual stone mass by 65% compared with NaCl (p<0.001). CONCLUSIONS: Citrate and EDTA show promising results for enhancing the efficacy of popcorning in this in vitro model. Further testing will be required to determine effectiveness on different stone types and safety on urothelium in short duration. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e48 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Alex Shiang More articles by this author Connor McCormick More articles by this author Adam Ostergar More articles by this author Henry Lai More articles by this author Kenneth Sands More articles by this author Expand All Advertisement PDF downloadLoading ...