November 2015, Volume 33, Issue 11, pp 1847–1853The vacuum cleaner effect in minimally invasive percutaneous nephrolitholapaxyOriginal ArticleFirst Online: 02 April 2015Received: 22 January 2015Accepted: 16 March 2015DOI: 10.1007/s00345-015-1541-4Cite this article as: Nicklas, A.P., Schilling, D., Bader, M.J. et al. World J Urol (2015) 33: 1847. Percutaneous stone removal increasingly plays an important role among the different approaches of interventional stone therapy, particularly since the development of miniaturized instruments is resulting in lower morbidity for the patients. One major drawback of smaller instruments is the increased difficulty of stone retrieval after disintegration due to the reduced tract diameter. This results in longer operation time and the need of additional tools such as disposable retrieval baskets. One of the key factors in the development of minimally invasive percutaneous nephrolitholapaxy (MIP) was the design of an Amplatz sheath which provides a built-in vacuum cleaner effect for stone retrieval.

MethodsA series of flow analyses with the gauges and shapes of the most commonly used nephroscopes and sheaths in percutaneous nephrolitholapaxy was performed by computational fluid dynamics. Flow velocity and direction in front of the nephroscope were computed and visualized by the software. In our study, the vacuum cleaner effect developed exclusively when a round-shaped nephroscope was used (Nagele Miniature Nephroscope System, Karl Storz GmbH & Co. KG) and depended on the relation between nephroscope diameter and inner sheath diameter. The strongest effect was observed with a 12 F nephroscope and an inner sheath diameter of 15 F. It did not develop when an oval- or crescent-shaped nephroscope was used. In front of the distal end of the round-shaped nephroscope, a slipstream develops, induced by the excursive change of width of the fluid flow on the outlet of the flushing canal. This allows the adhesion of a stone fragment in the eddy while the fluid flow is circulating around the stone.

ConclusionThis study illustrates and explains the vacuum cleaner effect which has been detected in the development of the Nagele Miniature Nephroscope System used in MIP. It combines the reduced morbidity of smaller kidney puncture diameters with the benefit of quick and complete stone removal.westpoint vacuum cleaner wf-103X Order with Free Shippinghoover continuum co180b2 cordless vacuum cleaner review Free Shipping on Orders of $50+dirt devil handheld vacuum cleaner m0105 With Free Shipping, your order will be delivered by Standard Ground or Truck Freight. Expedited Shipping does not qualify. Free Shipping is available to addresses in the contiguous 48 U.S. states.

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