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A Comparison of Ureteroscopic Treatment of Nephrolithiasis With and Without Moses Technology

Overview

About this study

The purpose of this study is to evaluate the potential of Moses laser technology to reduce operative time compared to non-Moses settings for ureteroscopic treatment of nephrolithiasis.

 

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Participants must be 18 years or older.
  • Must be a suitable operative candidate for flexible ureteroscopy as first line treatment for their renal stone as per accepted guidelines and as deemed by their urologic surgeon.
  • Patients must additionally have a radiopaque solitary renal stone 8 to 20 mm in size or in the case of multiple stones, the conglomerate diameter (additive maximal diameter of all stones on axial imaging of computed tomography) of 8-20 mm is required.
  • Must be able to give consent.

Exclusion Criteria:

  • Participants with concomitant stones in the ureter.
  • Patients who have had prior ipsilateral upper urinary tract reconstructive procedures or history of ipsilateral ureteral stricture will also be excluded.
  • Patients who have undergone prior radiotherapy to the abdomen or pelvis and those who have a neurogenic bladder or spinal cord injury.
  • Pregnant subjects.
  • Patients with untreated UTI.
  • Attending surgeons participating in the study at Mayo Clinic must be urological surgeons.

Eligibility last updated 11/19/21. Questions regarding updates should be directed to the study team contact.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status

Scottsdale/Phoenix, Ariz.

Mayo Clinic principal investigator

Karen Stern, M.D.

Closed for enrollment

More information

Publications

  • Surgeon workload, or human "cost" of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Read More on PubMed
  • The Moses effect (ME) was described >30 years ago during normal laser functioning in a fluid medium. Recently, a laser device equipped with a pulse-modulating system called Moses™ technology (MT; Lumenis) was marketed for both stone lithotripsy and prostate endoscopic surgery. We aimed to perform a literature revision of ME from a historical perspective up until its present-day applications. A search of Medline, PubMed, and Scopus was performed to identify articles published in English within the past 30 years addressing both ME and MT in relation to their urologic applications. Relevant studies were then screened, and the data were extracted, analyzed, and summarized. The preferred reporting items for systematic reviews and meta-analysis criteria were applied. ME was first described in 1986 during endovascular laser tissue ablation. During the late 1980s and the early 1990s, the interest raised around ME led to its characterization and better definition. Despite this initial interest, ME gradually disappeared from the focus of researchers and clinicians. In 2017, MT was launched on the market, although postmarketing comparative efficacy and safety data are lacking. Although ME had been described and characterized during normal laser functioning >30 years ago, only very recently it began to regain some consideration after the marketing of MT, whose clinical outcomes are still awaited. Read More on PubMed
  • The Moses technology of the holmium laser has been shown to decrease retropulsion in the ureter and procedural time in kidney stones during laser lithotripsy. Theoretically, these improvements could lead to cost savings for the patient. Read More on PubMed
  • There is scant evidence in the literature to support dusting vs active basket extraction during ureteroscopy for kidney stones. We prospectively evaluated and followed patients to determine which modality produced a higher stone-free rate with the fewest complications. Read More on PubMed
  • The objective of this study was to compare fragmentation efficiency of the conventional regular mode of holmium laser to the Moses contact mode on a stone simulator. Read More on PubMed
  • Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics. Read More on PubMed
  • To evaluate in vitro and in vivo effects of Moses technology in Holmium laser and to compare it with the Regular mode in terms of lithotripsy efficiency and laser-tissue interactions. Read More on PubMed
  • This Guideline is intended to provide a clinical framework for the surgical management of patients with kidney and/or ureteral stones. The summary presented herein represents Part II of the two-part series dedicated to Surgical Management of Stones: American Urological Association/Endourological Society Guideline. Please refer to Part I for introductory information and a discussion of pre-operative imaging and special cases. Read More on PubMed
  • Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. Read More on PubMed

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