Use of a polymeric gel to prevent retropulsion during intracorporeal lithotripsy | Actas Urológicas Españolas (English Edition)

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B) El gel BackStop® se dispensó por encima de la piedra (2cm) C) La fragmentación de la piedra se realizó con láser de holmio. D) Eliminación de los fragmentos con cesta. E) El gel se disolvió con solución salina tibia. F) Se realizó URS completa." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "W.R. Molina, A. Pompeo, D. Sehrt, G. Pohlmann, F.J. Kim" "autores" => array:5 [ 0 => array:2 [ "nombre" => "W.R." "apellidos" => "Molina" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Pompeo" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Sehrt" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Pohlmann" ] 4 => array:2 [ "nombre" => "F.J." 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Rodríguez, A. Breda, S. Esquena, H. Villavicencio" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Rodríguez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Breda" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Esquena" ] 3 => array:2 [ "nombre" => "H." 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Molina, A. Pompeo, D. Sehrt, G. Pohlmann, F.J. Kim" "autores" => array:5 [ 0 => array:4 [ "nombre" => "W.R." "apellidos" => "Molina" "email" => array:1 [ 0 => "wilson.molina@dhha.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Pompeo" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Sehrt" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Pohlmann" ] 4 => array:2 [ "nombre" => "F.J." "apellidos" => "Kim" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO, USA" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de un gel polimérico para evitar retropulsión durante la litotricia intracorpórea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 597 "Ancho" => 800 "Tamanyo" => 106131 ] ] "descripcion" => array:1 [ "en" => "BackStop catheter injector." ] ] ] "textoCompleto" => "IntroductionBoth the American Urological Association and the European Association of Urology recommend ureteroscopy (URS) as one of the first-line treatment modalities for ureteral calculi. Advances in technique and instrument technology have encouraged urologists to choose URS rather than extracorporeal shockwave lithotripsy (SWL) for ureteral stones. Despite these advances, urologists continue to seek effective means of addressing the problem of retrograde stone migration (retropulsion) during URS and intracorporeal laser lithotripsy.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Retropulsion occurs in 5–40% of all URS cases.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The location, source of energy, and stone size influence these rates. Retropulsion has been reported in 3–15% of distal ureteral stones<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and 28–48% of proximal stones.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Pneumatic and electrohydraulic lithotriptors cause more retropulsion than holmium laser lithotripsy; and smaller stones are more likely to undergo retropulsion.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Retropulsion may increase the need for additional procedures such as flexible URS, shock wave lithotripsy, or even percutaneous nefrolithotomy.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Additional fragmentation can lead to increased hospital visits and surgical cost. If left untreated, these fragments can cause persistent infection and renal colic.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Several devices have been developed to address retropulsion such as the stone cone (Boston Scientific, Boston, MA), Cook N-Trap (Cook Urological, Spencer, IN), and the PercSys Accordion (Percutaneous System, Palo Alto, CA). While these devices achieve some level of effectiveness, they all have mechanical elements with the potential to cause direct injury to the ureter. Moreover, they may interfere with the energy delivered by the laser source.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> BackStop is a new generation tool to prevent retropulsion and it is a polymeric thermo reversible gel that is dispensed proximally to the stone using a catheter.From the best of our knowledge, we present the first single-center experience using BackStop to prevent retropulsion during URS.Materials and methodsProduct descriptionBackStop is a water soluble viscous liquid at room temperature that forms a plug when introduced into the ureter to prevent stone migration. It is injected using a 3 Fr radiopaque tipped catheter and it is dissolved using cold saline following stone extraction.Procedure descriptionBeginning November 2011, a prospective data analysis of our initial experience was performed using BackStop collected from 7 procedures. Three patients had bilateral ureteral stones while 1 patient had unilateral ureterolithiasis. Preoperative imaging included non-contrast computed tomography.URS and stone fragmentation were performed with the patient in the lithotomy position under general anesthesia. An 8.5 Fr digital flexible or 7.5 Fr semirigid ureteroscope (Olympus Corp, Tokyo, Japan) was used depending on stone location. Irrigation with saline was performed using a single action pump (Boston Scientific, Boston, MA). Cystoscopy was routinely performed and a wire was passed to the renal pelvis under fluoroscopy. The stone was accessed and BackStop was dispensed approximately 2cm proximal to the stone under fluoroscopy. Lithotripsy was performed using a Holmium laser with a power of 10W. Larger fragments were removed using a basket while smaller fragments were flushed out by the saline backflow developed secondary to the BackStop plug. Following complete stone removal, Backstop was dissolved using cold saline and URS was performed to the level of the renal pelvis to evaluate any residual stones (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Patient demographics, stone size, location, operative time, stone free rate, the presence of retropulsion, and the need for additional procedures were collected. Stone migration was defined as retropulsion of fragments above BackStop after complete fragmentation of the stone.Ureteral occlusion was accessed to determine the ability of this device to dissolve after lithotripsy. The patency was performed using direct vision after fragmentation. All the patients were stented with a 4.8F multilength ureteral stent after the procedure which was removed two weeks postoperatively.ResultsBackStop was successful in all 7 URS cases; mean age was 42.8 yrs and body mass index was 30.0kg/m2. Mean treated stone size with BackStop was 8.3mm. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows patients demographics. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> illustrates a preoperative CT scan of a patient selected to undergo URS using BackStop. The radio-opaque BackStop catheter injects gel approximately 2cm proximal to the stone under fluoroscopy. Three patients were treated for bilateral stones. Two were managed with separate procedures while another one was treated concomitantly. Five procedures involved multiple ipsilateral stones which increased operative time. Each procedure started distally and worked proximally. In procedure 4, the 4-mm distal stone was removed prior to the application of BackStop because of its small size and location. BackStop was then applied and the 7-mm mid-ureteral stone was treated. The gel was then dissolved and a renal lower pole stone was then successfully removed.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Mean operative time was 47.9min, with all procedures involving exclusively ureteral stones being under one hour (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). There were no intraoperative complications observed such as ureteral injury or migration of the gel. The gel was dispensed without complications. All of the cases except for one utilized laser lithotripsy for stone fragmentation. Retropulsion did not occur in any procedure. Incidentally observed, irrigation with backstop flushes smaller fragments out of the ureter. Only larger fragments required the use of the basket which considerably decreases operative time. In procedure 7, after positioning the gel and initiating flushing, it was observed that no fragmentation was required and the stone was removed intact. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the intra and postoperative outcomes.<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>After complete removal of fragments from the ureter (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), a saline solution was used to dissolve the gel and complete URS of the ureter was performed to evaluate success. One complication (UTI) occurred postoperatively that was treated conservatively with an antibiotic. None of the patients required additional procedures after URS for the treated stones. All of the patients were considered stone free after complete URS.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionThe management of ureteral calculi has changed considerably over the past decade. The improvements in technology and techniques have resulted in higher stone-free rates while decreasing patient morbidity during ureteral lithotripsy.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Kim et al. reported that removal of stones during URS achieved an excellent stone-free rate and a complication rate similar to that of ESWL for treating large (>10mm) proximal ureteral calculi.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> Furthermore, the smaller caliber ureteroscopes and improved intracorporeal lithotripsy technology has made it possible to successfully access and treat virtually any stone within the ureter in an atraumatic fashion.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Stone retropulsion during URS remains a problem as it increases cost, operative time, and potential need for additional procedures. Retropulsion rates for various lithotriptors are as high as 5–48%.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> In order to minimize the risk of retropulsion, several devices have been released such as the stone cone (Boston Scientific, Boston, MA), Cook N-Trap (Cook Urological, Spencer, IN), and PercSys Accordion (Percutaneous System, Palo Alto, CA).<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> The N-Trap is composed of a tightly woven mesh of nitinol wires that essentially consists of the inner wire and the outer radio-opaque carrying catheter. The Stone Cone is a collapsing conical coil that is delivered cystoscopically or ureteroscopically and expanded when above the stone. The Accordion Percutaneous Systems is a hydrophilic microcatheter-based tool with a film occlusion that expands to prevent migration of stones. While these instruments demonstrated effectiveness in retropulsion prevention, they are all mechanical elements with reports of injury to the ureter. The two devices (Stone Cone and N-Trap) had been previously tested and compared for pull-through strength, which is the force required for each device to deploy and release the beads in a structured ureter model. Ouwenga et al. reported statistically significant but clinically insignificant differences as these forces were too low to result in ureteral avulsion.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Evidence exists that the wire of these devices can interfere with the delivery of the laser as well.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>Although mechanical elements have shown potential, developments with viscous gels have been thought to be a valuable alternative. The use of lubricating jelly was studied and indicated that the rate of retropulsion in the study group (4%) represented a reduction compared to the control group (28%). The authors noted that the use of the lidocaine jelly has the potential to impair visibility during URS.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Another viscous gel, BackStop, was evaluated in a randomized controlled multi-center study by Rane et al.,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> on 68 patients with ureteral stone either with or without BackStop. The subjects randomized to the BACKSTOP group experienced a statistically significant (p<0.0002) lower rate of retropulsion (8.8%, 3/34) vs. the control group (52.9%, 18/34). There were no adverse events in the BackStop group and it was successfully dissolved in every subject.ConclusionFrom the best of our knowledge, this is the first single-institution evaluation of retropulsion rates using BackStop. Although our series is limited due to the small caseload, several conclusions can still be made: BackStop is safe with minimal risk to the patient; BackStop is simple and easy to apply; BackStop is effective in avoiding retropulsion as we demonstrated in 100% of our cases; the application of BackStop appears to decrease the OR time as fewer fragments need to be retrieved by the basket. Small fragments tend to be flushed out by the saline irrigation back flow secondary to the obstruction that the BackStop causes, reducing the surgical time. BackStop is a new promising tool to prevent retropulsion during ureteral intracorporeal lithotripsy.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres227327" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec212214" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres227326" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec212213" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Product description" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure description" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec212214" "palabras" => array:3 [ 0 => "Ureteroscopy" 1 => "Retropulsion" 2 => "Intracorporeal lithotripsy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec212213" "palabras" => array:3 [ 0 => "Ureteroscopia" 1 => "Retropulsión" 2 => "Litotricia intracorpórea" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionStone retropulsion during ureteroscopic lithotripsy may lead to additional procedures needed for residual calculi. Several devices have been introduced in an attempt to reduce retropulsion. We set out to report our initial experience utilizing the new polymeric gel, BackStop®. Materials and methodsWe prospectively collected data on 7 ureteroscopy procedures with distal ureteral calculi treated with BackStop®. Perioperative data including stone size, location, operative time, stone free rate, the presence or absence of retropulsion were collected. Success was defined as no residual fragments, no retropulsion, and no additional procedures required. ResultsAll of the patients were rendered stone free after URS and no retropulsion occurred. There were no intraoperative complications nor gel migration or problems with dissolving the gel. ConclusionsBackStop® is a new promising therapy to prevent retropulsion during ureteral intracorporeal lithotripsy. It is safe, easy to apply and very effective in preventing stone fragment migration. BackStop® has the potential to reduce operative time." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa retropulsión de los cálculos durante la litotricia ureteroscópica puede conducir a procedimientos adicionales necesarios para los cálculos residuales. Se han introducido varios dispositivos en un intento de reducir la retropulsión. Nos pusimos en marcha para informar de nuestra experiencia inicial al utilizar el nuevo gel polimérico BackStop®. Material y métodosHemos recogido de forma prospectiva los datos sobre 7 procedimientos de ureteroscopia con cálculos ureterales distales tratados con BackStop®. Se recogieron los datos perioperatorios, tales como tamaño del cálculo, ubicación, tiempo quirúrgico, tasa libre de cálculo, presencia o ausencia de retropulsión. El éxito se definió como la ausencia de fragmentos residuales, de retropulsión y de procedimientos adicionales que se requieren. ResultadosTodos los pacientes quedaron libres de litiasis tras la URS y no se produjo ninguna retropulsión. No hubo complicaciones intraoperatorias ni migración de gel o problemas con la disolución del gel. ConclusionesBackStop® es un nuevo tratamiento prometedor para prevenir la retropulsión durante la litotricia intracorpórea ureteral. Es seguro, fácil de aplicar y muy eficaz en la prevención de la migración de fragmentos de cálculos. Backstop® tiene el potencial para reducir el tiempo quirúrgico." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Molina WR, et al. Uso de un gel p olimérico para evitar retropulsión durnate la litotricia intracorpórea. Actas Urol Esp. 2013;37:188–92." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 597 "Ancho" => 800 "Tamanyo" => 106131 ] ] "descripcion" => array:1 [ "en" => "BackStop catheter injector." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 657 "Ancho" => 1750 "Tamanyo" => 170105 ] ] "descripcion" => array:1 [ "en" => "(A) Guidewire was passed through the stone; (B) BackStop gel was dispensed above the stone (2cm); (C) fragmentation of the stone was performed using holmium laser; (D) removal of the fragments with basket; (E) the gel was dissolved with warm saline; and (F) complete URS was performed." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1195 "Ancho" => 2505 "Tamanyo" => 258178 ] ] "descripcion" => array:1 [ "en" => "Preoperative CT demonstrating an 8-mm distal ureteral left stone. BackStop dispensed under fluoroscopy. Observe the tip of the catheter that was radiopaque which facilitate its positioning." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 690 "Ancho" => 800 "Tamanyo" => 88120 ] ] "descripcion" => array:1 [ "en" => "Complete removal of the fragments and dissolving of the gel with saline." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">ASA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Side \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8mm, 10mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9mm, 12mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4mm<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>, 10mm, 7mm<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal, mid, lower pole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7mm, 8mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5mm, 6mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab338912.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Stones not treated with the use of BackStop." ] ] ] "descripcion" => array:1 [ "en" => "Patient demographics." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">ORT (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Laser time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Retropulsion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stone free \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5:17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5:46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0:40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2:04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2:25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UTI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3:58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0:00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab338913.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Intra and postoperative outcomes." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => 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Use of a polymeric gel to prevent retropulsion during intracorporeal lithotripsy

Uso de un gel polimérico para evitar retropulsión durante la litotricia intracorpórea

W.R. Molina

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wilson.molina@dhha.org

Corresponding author.

, A. Pompeo, D. Sehrt, G. Pohlmann, F.J. Kim

Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO, USA

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Both the American Urological Association and the European Association of Urology recommend ureteroscopy &#40;URS&#41; as one of the first-line treatment modalities for ureteral calculi&#46; Advances in technique and instrument technology have encouraged urologists to choose URS rather than extracorporeal shockwave lithotripsy &#40;SWL&#41; for ureteral stones&#46; Despite these advances&#44; urologists continue to seek effective means of addressing the problem of retrograde stone migration &#40;retropulsion&#41; during URS and intracorporeal laser lithotripsy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Retropulsion occurs in 5&#8211;40&#37; of all URS cases&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The location&#44; source of energy&#44; and stone size influence these rates&#46; Retropulsion has been reported in 3&#8211;15&#37; of distal ureteral stones<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and 28&#8211;48&#37; of proximal stones&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Pneumatic and electrohydraulic lithotriptors cause more retropulsion than holmium laser lithotripsy&#59; and smaller stones are more likely to undergo retropulsion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Retropulsion may increase the need for additional procedures such as flexible URS&#44; shock wave lithotripsy&#44; or even percutaneous nefrolithotomy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Additional fragmentation can lead to increased hospital visits and surgical cost&#46; If left untreated&#44; these fragments can cause persistent infection and renal colic&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several devices have been developed to address retropulsion such as the stone cone &#40;Boston Scientific&#44; Boston&#44; MA&#41;&#44; Cook N-Trap &#40;Cook Urological&#44; Spencer&#44; IN&#41;&#44; and the PercSys Accordion &#40;Percutaneous System&#44; Palo Alto&#44; CA&#41;&#46; While these devices achieve some level of effectiveness&#44; they all have mechanical elements with the potential to cause direct injury to the ureter&#46; Moreover&#44; they may interfere with the energy delivered by the laser source&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> BackStop is a new generation tool to prevent retropulsion and it is a polymeric thermo reversible gel that is dispensed proximally to the stone using a catheter&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">From the best of our knowledge&#44; we present the first single-center experience using BackStop to prevent retropulsion during URS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Product description</span><p id="par0025" class="elsevierStylePara elsevierViewall">BackStop is a water soluble viscous liquid at room temperature that forms a plug when introduced into the ureter to prevent stone migration&#46; It is injected using a 3 Fr radiopaque tipped catheter and it is dissolved using cold saline following stone extraction&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure description</span><p id="par0030" class="elsevierStylePara elsevierViewall">Beginning November 2011&#44; a prospective data analysis of our initial experience was performed using BackStop collected from 7 procedures&#46; Three patients had bilateral ureteral stones while 1 patient had unilateral ureterolithiasis&#46; Preoperative imaging included non-contrast computed tomography&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">URS and stone fragmentation were performed with the patient in the lithotomy position under general anesthesia&#46; An 8&#46;5 Fr digital flexible or 7&#46;5 Fr semirigid ureteroscope &#40;Olympus Corp&#44; Tokyo&#44; Japan&#41; was used depending on stone location&#46; Irrigation with saline was performed using a single action pump &#40;Boston Scientific&#44; Boston&#44; MA&#41;&#46; Cystoscopy was routinely performed and a wire was passed to the renal pelvis under fluoroscopy&#46; The stone was accessed and BackStop was dispensed approximately 2<span class="elsevierStyleHsp" style=""></span>cm proximal to the stone under fluoroscopy&#46; Lithotripsy was performed using a Holmium laser with a power of 10<span class="elsevierStyleHsp" style=""></span>W&#46; Larger fragments were removed using a basket while smaller fragments were flushed out by the saline backflow developed secondary to the BackStop plug&#46; Following complete stone removal&#44; Backstop was dissolved using cold saline and URS was performed to the level of the renal pelvis to evaluate any residual stones &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Patient demographics&#44; stone size&#44; location&#44; operative time&#44; stone free rate&#44; the presence of retropulsion&#44; and the need for additional procedures were collected&#46; Stone migration was defined as retropulsion of fragments above BackStop after complete fragmentation of the stone&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ureteral occlusion was accessed to determine the ability of this device to dissolve after lithotripsy&#46; The patency was performed using direct vision after fragmentation&#46; All the patients were stented with a 4&#46;8F multilength ureteral stent after the procedure which was removed two weeks postoperatively&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">BackStop was successful in all 7 URS cases&#59; mean age was 42&#46;8 yrs and body mass index was 30&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Mean treated stone size with BackStop was 8&#46;3<span class="elsevierStyleHsp" style=""></span>mm&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows patients demographics&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> illustrates a preoperative CT scan of a patient selected to undergo URS using BackStop&#46; The radio-opaque BackStop catheter injects gel approximately 2<span class="elsevierStyleHsp" style=""></span>cm proximal to the stone under fluoroscopy&#46; Three patients were treated for bilateral stones&#46; Two were managed with separate procedures while another one was treated concomitantly&#46; Five procedures involved multiple ipsilateral stones which increased operative time&#46; Each procedure started distally and worked proximally&#46; In procedure 4&#44; the 4-mm distal stone was removed prior to the application of BackStop because of its small size and location&#46; BackStop was then applied and the 7-mm mid-ureteral stone was treated&#46; The gel was then dissolved and a renal lower pole stone was then successfully removed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Mean operative time was 47&#46;9<span class="elsevierStyleHsp" style=""></span>min&#44; with all procedures involving exclusively ureteral stones being under one hour &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; There were no intraoperative complications observed such as ureteral injury or migration of the gel&#46; The gel was dispensed without complications&#46; All of the cases except for one utilized laser lithotripsy for stone fragmentation&#46; Retropulsion did not occur in any procedure&#46; Incidentally observed&#44; irrigation with backstop flushes smaller fragments out of the ureter&#46; Only larger fragments required the use of the basket which considerably decreases operative time&#46; In procedure 7&#44; after positioning the gel and initiating flushing&#44; it was observed that no fragmentation was required and the stone was removed intact&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the intra and postoperative outcomes&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">After complete removal of fragments from the ureter &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; a saline solution was used to dissolve the gel and complete URS of the ureter was performed to evaluate success&#46; One complication &#40;UTI&#41; occurred postoperatively that was treated conservatively with an antibiotic&#46; None of the patients required additional procedures after URS for the treated stones&#46; All of the patients were considered stone free after complete URS&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The management of ureteral calculi has changed considerably over the past decade&#46; The improvements in technology and techniques have resulted in higher stone-free rates while decreasing patient morbidity during ureteral lithotripsy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Kim et al&#46; reported that removal of stones during URS achieved an excellent stone-free rate and a complication rate similar to that of ESWL for treating large &#40;&#62;10<span class="elsevierStyleHsp" style=""></span>mm&#41; proximal ureteral calculi&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Furthermore&#44; the smaller caliber ureteroscopes and improved intracorporeal lithotripsy technology has made it possible to successfully access and treat virtually any stone within the ureter in an atraumatic fashion&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Stone retropulsion during URS remains a problem as it increases cost&#44; operative time&#44; and potential need for additional procedures&#46; Retropulsion rates for various lithotriptors are as high as 5&#8211;48&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> In order to minimize the risk of retropulsion&#44; several devices have been released such as the stone cone &#40;Boston Scientific&#44; Boston&#44; MA&#41;&#44; Cook N-Trap &#40;Cook Urological&#44; Spencer&#44; IN&#41;&#44; and PercSys Accordion &#40;Percutaneous System&#44; Palo Alto&#44; CA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> The N-Trap is composed of a tightly woven mesh of nitinol wires that essentially consists of the inner wire and the outer radio-opaque carrying catheter&#46; The Stone Cone is a collapsing conical coil that is delivered cystoscopically or ureteroscopically and expanded when above the stone&#46; The Accordion Percutaneous Systems is a hydrophilic microcatheter-based tool with a film occlusion that expands to prevent migration of stones&#46; While these instruments demonstrated effectiveness in retropulsion prevention&#44; they are all mechanical elements with reports of injury to the ureter&#46; The two devices &#40;Stone Cone and N-Trap&#41; had been previously tested and compared for pull-through strength&#44; which is the force required for each device to deploy and release the beads in a structured ureter model&#46; Ouwenga et al&#46; reported statistically significant but clinically insignificant differences as these forces were too low to result in ureteral avulsion&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Evidence exists that the wire of these devices can interfere with the delivery of the laser as well&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although mechanical elements have shown potential&#44; developments with viscous gels have been thought to be a valuable alternative&#46; The use of lubricating jelly was studied and indicated that the rate of retropulsion in the study group &#40;4&#37;&#41; represented a reduction compared to the control group &#40;28&#37;&#41;&#46; The authors noted that the use of the lidocaine jelly has the potential to impair visibility during URS&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Another viscous gel&#44; BackStop&#44; was evaluated in a randomized controlled multi-center study by Rane et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on 68 patients with ureteral stone either with or without BackStop&#46; The subjects randomized to the BACKSTOP group experienced a statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41; lower rate of retropulsion &#40;8&#46;8&#37;&#44; 3&#47;34&#41; vs&#46; the control group &#40;52&#46;9&#37;&#44; 18&#47;34&#41;&#46; There were no adverse events in the BackStop group and it was successfully dissolved in every subject&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">From the best of our knowledge&#44; this is the first single-institution evaluation of retropulsion rates using BackStop&#46; Although our series is limited due to the small caseload&#44; several conclusions can still be made&#58; BackStop is safe with minimal risk to the patient&#59; BackStop is simple and easy to apply&#59; BackStop is effective in avoiding retropulsion as we demonstrated in 100&#37; of our cases&#59; the application of BackStop appears to decrease the OR time as fewer fragments need to be retrieved by the basket&#46; Small fragments tend to be flushed out by the saline irrigation back flow secondary to the obstruction that the BackStop causes&#44; reducing the surgical time&#46; BackStop is a new promising tool to prevent retropulsion during ureteral intracorporeal lithotripsy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            0 => "Resumen"
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            0 => "Ureteroscopy"
            1 => "Retropulsion"
            2 => "Intracorporeal lithotripsy"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Ureteroscopia"
            1 => "Retropulsi&#243;n"
            2 => "Litotricia intracorp&#243;rea"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stone retropulsion during ureteroscopic lithotripsy may lead to additional procedures needed for residual calculi&#46; Several devices have been introduced in an attempt to reduce retropulsion&#46; We set out to report our initial experience utilizing the new polymeric gel&#44; BackStop<span class="elsevierStyleSup">&#174;</span>&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We prospectively collected data on 7 ureteroscopy procedures with distal ureteral calculi treated with BackStop<span class="elsevierStyleSup">&#174;</span>&#46; Perioperative data including stone size&#44; location&#44; operative time&#44; stone free rate&#44; the presence or absence of retropulsion were collected&#46; Success was defined as no residual fragments&#44; no retropulsion&#44; and no additional procedures required&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All of the patients were rendered stone free after URS and no retropulsion occurred&#46; There were no intraoperative complications nor gel migration or problems with dissolving the gel&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">BackStop<span class="elsevierStyleSup">&#174;</span> is a new promising therapy to prevent retropulsion during ureteral intracorporeal lithotripsy&#46; It is safe&#44; easy to apply and very effective in preventing stone fragment migration&#46; BackStop<span class="elsevierStyleSup">&#174;</span> has the potential to reduce operative time&#46;</p>"
      ]
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La retropulsi&#243;n de los c&#225;lculos durante la litotricia ureterosc&#243;pica puede conducir a procedimientos adicionales necesarios para los c&#225;lculos residuales&#46; Se han introducido varios dispositivos en un intento de reducir la retropulsi&#243;n&#46; Nos pusimos en marcha para informar de nuestra experiencia inicial al utilizar el nuevo gel polim&#233;rico BackStop<span class="elsevierStyleSup">&#174;</span>&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hemos recogido de forma prospectiva los datos sobre 7 procedimientos de ureteroscopia con c&#225;lculos ureterales distales tratados con BackStop<span class="elsevierStyleSup">&#174;</span>&#46; Se recogieron los datos perioperatorios&#44; tales como tama&#241;o del c&#225;lculo&#44; ubicaci&#243;n&#44; tiempo quir&#250;rgico&#44; tasa libre de c&#225;lculo&#44; presencia o ausencia de retropulsi&#243;n&#46; El &#233;xito se defini&#243; como la ausencia de fragmentos residuales&#44; de retropulsi&#243;n y de procedimientos adicionales que se requieren&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes quedaron libres de litiasis tras la URS y no se produjo ninguna retropulsi&#243;n&#46; No hubo complicaciones intraoperatorias ni migraci&#243;n de gel o problemas con la disoluci&#243;n del gel&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">BackStop<span class="elsevierStyleSup">&#174;</span> es un nuevo tratamiento prometedor para prevenir la retropulsi&#243;n durante la litotricia intracorp&#243;rea ureteral&#46; Es seguro&#44; f&#225;cil de aplicar y muy eficaz en la prevenci&#243;n de la migraci&#243;n de fragmentos de c&#225;lculos&#46; Backstop<span class="elsevierStyleSup">&#174;</span> tiene el potencial para reducir el tiempo quir&#250;rgico&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Molina WR&#44; et al&#46; Uso de un gel p olim&#233;rico para evitar retropulsi&#243;n durnate la litotricia intracorp&#243;rea&#46; Actas Urol Esp&#46; 2013&#59;37&#58;188&#8211;92&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">BackStop catheter injector&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Guidewire was passed through the stone&#59; &#40;B&#41; BackStop gel was dispensed above the stone &#40;2<span class="elsevierStyleHsp" style=""></span>cm&#41;&#59; &#40;C&#41; fragmentation of the stone was performed using holmium laser&#59; &#40;D&#41; removal of the fragments with basket&#59; &#40;E&#41; the gel was dissolved with warm saline&#59; and &#40;F&#41; complete URS was performed&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Preoperative CT demonstrating an 8-mm distal ureteral left stone&#46; BackStop dispensed under fluoroscopy&#46; Observe the tip of the catheter that was radiopaque which facilitate its positioning&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ASA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Side&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Size&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>mm&#44; 10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9<span class="elsevierStyleHsp" style=""></span>mm&#44; 12<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#44; 10<span class="elsevierStyleHsp" style=""></span>mm&#44; 7<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&#44; mid&#44; lower pole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7<span class="elsevierStyleHsp" style=""></span>mm&#44; 8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mm&#44; 6<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab338912.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Stones not treated with the use of BackStop&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient demographics&#46;</p>"
        ]
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      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ORT &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Laser time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Retropulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Stone free&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#58;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#58;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UTI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#58;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#58;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Intra and postoperative outcomes&#46;</p>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of a novel reverse thermosensitive polymer to prevent ureteral stone retropulsion during intracorcoral lithotripsy&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Rane"
                            1 => "A&#46; Bradoo"
                            2 => "P&#46; Rao"
                            3 => "S&#46; Shivde"
                            4 => "M&#46; Elhilali"
                            5 => "M&#46; Anidjar"
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                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2009.12.023"
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                        "tituloSerie" => "J Urol"
                        "fecha" => "2010"
                        "volumen" => "183"
                        "paginaInicial" => "1417"
                        "paginaFinal" => "1423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20171695"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
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            1 => array:3 [
              "identificador" => "bib0010"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Dretler Stone Cone&#8482;&#58; a device to prevent ureteral stone migration&#8212;the initial clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Desai"
                            1 => "S&#46;B&#46; Patel"
                            2 => "M&#46;M&#46; Desai"
                            3 => "R&#46; Kukreja"
                            4 => "R&#46;B&#46; Sabnis"
                            5 => "R&#46;M&#46; Desai"
                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "J Urol"
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                        "paginaInicial" => "1985"
                        "paginaFinal" => "1988"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11956424"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "The Stone Cone&#8482;&#58; a new generation of basketry"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;P&#46; Dretler"
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                    0 => array:1 [
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                        "tituloSerie" => "J Urol"
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                        "paginaFinal" => "1596"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11342924"
                            "web" => "Medline"
                          ]
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                      ]
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                  "referenciaCompleta" => "PercSys Accordian Stone Management Device document&#46; Available from&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.percsys.com/pdfs/PercSys%20Accordion%20Stone%20Management%20Device%2090-0750-01%20rB%2008-07.pdf">http&#58;&#47;&#47;www&#46;PercSys&#46;com&#47;pdfs&#47;PercSys&#37;20Accordion&#37;20Stone&#37;20Management&#37;20Device&#37;2090-0750-01&#37;20rB&#37;2008-07&#46;pdf</a> &#91;accessed 02&#46;02&#46;09&#93;&#46;"
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              "identificador" => "bib0025"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "In vitro evaluation of ureteral perforation forces"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Pedro"
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                            2 => "D&#46; Weiland"
                            3 => "A&#46; Ramani"
                            4 => "T&#46;S&#46; K&#246;hler"
                            5 => "J&#46;K&#46; Anderson"
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                      "doi" => "10.1016/j.urology.2007.04.050"
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                        "fecha" => "2007"
                        "volumen" => "70"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17905132"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Stone retropulsion during holmium&#58; YAG lithotripsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Lee"
                            1 => "T&#46; Ryan"
                            2 => "J&#46;M&#46; Teichman"
                            3 => "J&#46; Kim"
                            4 => "B&#46; Choi"
                            5 => "N&#46;V&#46; Arakeri"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/01.ju.0000046367.49923.c6"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2003"
                        "volumen" => "169"
                        "paginaInicial" => "881"
                        "paginaFinal" => "885"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12576805"
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                0 => array:2 [
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                      "titulo" => "Clinical efficacy of combined lithoclast and Lithovac stone removal during ureteroscopy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;C&#46; Delvecchio"
                            1 => "R&#46;L&#46; Kuo"
                            2 => "G&#46;M&#46; Preminger"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "164"
                        "paginaInicial" => "40"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10840420"
                            "web" => "Medline"
                          ]
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                ]
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
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                0 => array:1 [
                  "referenciaCompleta" => "FDA MAUDE database online&#46; Available from&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/TextSearch.cfm">http&#58;&#47;&#47;www&#46;accessdata&#46;fda&#46;gov&#47;scripts&#47;cdrh&#47;cfdocs&#47;cfMAUDE&#47;TextSearch&#46;cfm</a> &#91;accessed 08&#46;07&#46;07&#93;&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preventing stone migration during ureteroscopy&#58; the Stone Cone&#8482; &#8220;rules&#8221;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;P&#46; Dretler"
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                      "Revista" => array:4 [
                        "tituloSerie" => "Contemp Urol"
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                        "volumen" => "18"
                        "paginaInicial" => "57"
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              "identificador" => "bib0050"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ureteroscopic management of lower ureteric calculi&#58; a 15-year single center experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46;M&#46; Elashry"
                            1 => "A&#46;K&#46; Elgamasy"
                            2 => "M&#46;A&#46; Sabaa"
                            3 => "M&#46; Abo-Elenien"
                            4 => "M&#46;A&#46; Omar"
                            5 => "H&#46;H&#46; Eltatawy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2008.07747.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2008"
                        "volumen" => "102"
                        "paginaInicial" => "1010"
                        "paginaFinal" => "1017"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18485033"
                            "web" => "Medline"
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            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between rigid ureteroscopic stone removal &#40;URS&#41; and extracorporeal shock wave lithotripsy &#40;ESWL&#41; for large &#40;&#62;10<span class="elsevierStyleHsp" style=""></span>mm&#41; upper ureteral stones"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Kim"
                            1 => "L&#46;H&#46; Sung"
                            2 => "C&#46;H&#46; Noh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Korean J Urol"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "933"
                        "paginaFinal" => "937"
                      ]
                    ]
                  ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Dretler Stone Cone&#8482;&#58; a device to prevent ureteral stone migration &#8211; the initial clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Desai"
                            1 => "S&#46;B&#46; Patel"
                            2 => "M&#46;M&#46; Desai"
                            3 => "R&#46; Kukreja"
                            4 => "R&#46;B&#46; Sabnis"
                            5 => "R&#46;M&#46; Desai"
                          ]
                        ]
                      ]
                    ]
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Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2012.04.017

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Year/Month	Html	Pdf	Total

2023 March	1	0	1
2021 May	1	0	1
2018 March	1	0	1
2018 February	13	1	14
2018 January	23	0	23
2017 December	23	1	24
2017 November	31	0	31
2017 October	38	3	41
2017 September	26	3	29
2017 August	25	3	28
2017 July	41	3	44
2017 June	35	12	47
2017 May	40	6	46
2017 April	44	8	52
2017 March	27	16	43
2017 February	38	3	41
2017 January	18	6	24
2016 December	49	11	60
2016 November	51	11	62
2016 October	65	11	76
2016 September	88	8	96
2016 August	28	6	34
2016 July	23	4	27
2016 June	27	4	31
2016 May	44	19	63
2016 April	42	6	48
2016 March	37	8	45
2016 February	42	14	56
2016 January	30	13	43
2015 December	25	15	40
2015 November	31	7	38
2015 October	40	10	50
2015 September	31	5	36
2015 August	40	6	46
2015 July	38	2	40
2015 June	18	2	20
2015 May	34	6	40
2015 April	18	8	26
2015 March	26	7	33
2014 September	1	0	1
2014 August	1	0	1
2014 July	1	0	1
2014 June	1	0	1
2014 May	3	1	4
2014 April	2	0	2
2014 January	3	2	5
2013 December	11	2	13
2013 November	15	5	20
2013 October	11	6	17
2013 September	10	4	14
2013 August	2	0	2

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