Comptes Rendus Chimie

Jean-Luc Ansel

Jean-François Butaud

Phila Raharivelomanana

Principaux taxons ligneux de la cosmétopée tropicale : une analyse bibliographique

Antonios Tribalis

George Tsilomelekis

Soghomon Boghosian

Molecular structure and reactivity of titania-supported transition metal oxide catalysts synthesized by equilibrium deposition filtration for the oxidative dehydrogenation of ethane

CV3 - Editorial Board - English

Dominique Bazin

Jean Philippe Haymann

Emmanuel Letavernier

C. R. Chimie 19 (2016) 1388
lable at ScienceDirectContents lists avaiComptes Rendus Chimie
www.sciencedirect.comForeword/Avant-proposFrom urolithiasis to pathological calcifications: A journey at the
interface between physics, chemistry, and medicine. A tribute to
Michel DaudonForeword
Michel Daudon is aworldwide recognized biologist who
performed several major breakthroughs in the field of
urolithiasis. It is indeed difficult to address his outstanding
personality and his great contributions to urolithiasis.
Michel Daudon studied many aspects of urolithiasis, from
urine crystals to kidney stone morphoconstitutional anal-
ysis. He is the author of more than 500 scientific articles on
urolithiasis, and more generally on pathological calcifica-
tions, including several books and nice articles in the New
England Journal of Medicine, The Lancet, Kidney Interna-
tional, among many others. Michel Daudon is not only a
prolific writer; his broad fields of interests range from
chemistry to biology or renal pathology, but also clinical
bedside subjects explain his success and his attractive way
of explaining pathophysiological processes. He has already
given more than 300 lectures, in France as abroad.
Among his numerous findings, he developed 25 years
ago a novel characterization and classification of kidney
stones according to morphology, combined with infrared
analysis, allowing one to diagnose a specific origin such as
genetics, diet disorders, infections, or drug-related stones.
Michel Daudon is an exemplary biologist and an example to
all younger generations, as he dedicated himself to the
improvement of knowledge and has been particularly
involved in the training of technicians, biologists, and
physicians. He has created a famous French University
course dedicated to urolithiasis more than 15 years ago,
and has been organizing a multidisciplinary urolithiasis
congress called “Confrontations clinico-biologiques sur la
lithiase urinaire” for now 20 years.
To illustrate the major findings relevant to clinical prac-
tice, we can mention the identification of calcium oxalate
kidney stoneswith Icmorphology, assessing the diagnosis of
primary hyperoxaluria type I and calcium phosphate stones
with IVa2 morphology, revealing distal tubular acidosis.
Another strikingpoint andsignificantexample taken from
his research is related to adenine phosphoribosyltransferasehttp://dx.doi.org/10.1016/j.crci.2016.10.001
1631-0748/© 2016 Académie des sciences. Published by Elsevier Masson SAS.
creativecommons.org/licenses/by-nc-nd/4.0/).deficiency. This pathology is a rare autosomal recessive dis-
order characterized by 2,8-dihydroxyadenine crystalluria.
Without treatment, the kidney function can decline and lead
to end-stage renal disease. Although this pathology is almost
completely ignored inother countries (less than10caseshave
been reported in theUnited States and inGermany), between
1978 and 2014 his laboratory identified this disease in 67
patients from 56 families: 27 pediatric cases and 40 adult
cases. Many of these diagnoses were performed through the
development of new infrared microscopic analyses allowing
one to characterize crystalline phases in kidney biopsies.
In conclusion, for this under-recognized and treatable
monogenic disease aswell as for urolithiasis in general,Michel
Daudon has been developing original morphoconstitutional
approaches to characterize pathological calcifications.
Appendix A. Supplementary data
The comprehensive list of the publications by Michel
Daudon can be found at http://dx.doi.org/10.1016/j.crci.
2016.10.001.
Dominique Bazin*
Laboratoire de physique des solides, UMR 8502, bâtiment 510,
91405 Orsay, France
Jean Philippe Haymann
INSERM U 489, Universite Paris-6 and Association
Claude-Bernard, Explorations fonctionnelles multidisciplinaires,
Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
E-mail address: jean-philippe.haymann@tnn.aphp.fr
Emmanuel Letavernier
Explorations fonctionnelles multidisciplinaires, HôpitalTenon,
4, rue de la Chine, 75020 Paris, France
E-mail address: emmanuel.letavernier@tnn.aphp.fr
 Corresponding author.
E-mail address: bazin@lps.u-psud.fr
Available online 28 October 2016This is an open access article under the CC BY-NC-ND license (http://


From urolithiasis to pathological calcifications: A journey at the interface between physics, chemistry, and medicine. A tribute to Michel Daudon

Arnaud Lionet

Marie Haeck

Antoine Garstka

Viviane Gnemmi

Jean-Philippe Haymann

Christian Noel

Michel Daudon

First investigation on microcrystalline pathologies of kidney allografts through cellular scale physicochemical techniques

David Portehault

Frederik Tielens

Jacques Livage

Christian Bonhomme

Laure Bonhomme

Ali Abou-Hassan

Guillaume Laffite

Vincent Frochot

Urolithiasis: What can we learn from a Nature which dysfunctions?

Roberto Castañeda-Argáiz

Jonathan Cloutier

Luca Villa

Olivier Traxer

lable at ScienceDirect
C. R. Chimie 19 (2016) 1590e1596Contents lists avaiComptes Rendus Chimie
www.sciencedirect.comAccount/RevueEvolution of endourology and flexible ureterorenoscopy,
can they be useful to urologists to clarify stone composition
and morphology?
Roberto Casta~neda-Argaiz, Jonathan Cloutier, Luca Villa, Olivier Traxer*
Department of Urology, Tenon University Hospital, Assitance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, Francea r t i c l e i n f o
Article history:
Received 9 December 2014
Accepted 2 February 2015
Available online 8 September 2016
Keywords:
Flexible
Ureterorenoscopy
Stones* Corresponding author.
E-mail address: olivier.traxer@tnn.aphp.fr (O. Tr
http://dx.doi.org/10.1016/j.crci.2015.02.001
1631-0748/© 2015 Académie des sciences. Publish
creativecommons.org/licenses/by-nc-nd/4.0/).a b s t r a c t
Introduction: During the last two decades, there has been great advancement in the tech-
nology and performance of flexible ureterorenoscopy. Endoscopes are smaller and the new
digital technology offers a fantastic endoscopic definition. This manuscript is a state-of-the-
art describing the endoscopic equipment evolution and usefulness. Moreover, we raise the
interest to perform a better description of the endoscopic stone appearance according to
different stone compositions, in order to offer a better morpho-constitutional analysis.
Methods and results: A revision of the literature was performed to describe the evolution
of the endoscopic equipment used in flexible ureterorenoscopy. Currently, there is no data
that evaluate the usefulness of endoscopic stone pictures, video and description during
flexible ureterorenoscopy to evaluate if there is an advantage in the final morpho-
constitutional analysis.
Conclusion: Urologists should know the development in the field of flexible ureter-
orenoscopy and the equipment available to accommodate them during the procedures.
Clinical trials are needed in order to evaluate the role of endoscopic evaluation or video
during flexible ureterorenoscopy in determining the morpho-constitutional analysis of
stones, which could be associated with specific metabolic anomalies.
© 2015 Académie des sciences. Published by Elsevier Masson SAS. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).1. Introduction
The awareness of stone composition and a metabolic
evaluation grants a better understanding of urolithiasis
prognosis, recurrence risks, as well as improvements in
their medical and surgical management. For instance, stone
free rates regarding shockwave lithotripsy (SWL) rely on
the stone burden and composition, with calcium oxalate
monohydrate stones being the hardest and with less stone
free rates [1,2]. Also within the same type of stone
composition, the efficacy of different treatments can differ.axer).
ed by Elsevier Masson SAS.Such is the case of cystine stones regarding its treatment
with SWL or retrograde intrarenal surgery (RIRS) [3].
Flexible ureterorenoscopy (F-URS) has had significant
advancements in the matter of technology and image
quality during the last two decades. Today, more and more
urologists have integrated this technique in their daily
practice (Fig. 1).
The literature confirming the effectiveness and safety of
F-URS in the treatment of renal stones is more and more
abundant [4]. The smaller size, durability and maneuver-
ability of the ureterorenoscope are continuing to evolve
thus facilitating the operator to increase the effectiveness
of this treatment. One of the limitations of F-URS is that the
stone analysis is often performed only on a limited number
of small fragments retrieved, without any informationThis is an open access article under the CC BY-NC-ND license (http://
Fig. 1. Digital flexible ureterorenoscopy with an endoscopic high-quality vision of a kidney stone.
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e1596 1591considering the location of these fragments within the
stone. Considering that much of the stones have mixed
compositions [5], important details of the stone composi-
tion could be missed if there are no more characteristics
transmitted with the stone fragment.
In the near future, we hope that macroscopic stone
evaluation during F-URS through the image quality could
aid the assessment of stone composition, morphology and
metabolic evaluation. The aim of the manuscript is to
describe the advances in endourology and F-URS, and to
discuss what is known on endoscopy per-operative evalu-
ation of stones.Fig. 3. Active 270-degree deflection during an F-URS of a complex lower
renal pole in a horseshoe kidney patient.2. Advances in endourology and flexible
ureterorenoscopy
2.1. Ureterorenoscopes
Bagley et al. described the first flexible ureter-
orenoscope in 1983. It consisted of a flexible tip endoscope
with 160e90 degrees of maximumdeflection [6]. Since that
time, the technology advancement of the F-URS has pro-
gressed at a remarkable pace (Fig. 2).
2.1.1. Old generation flexible ureterorenoscope
Standard ureterorenoscopes (old generation) are 70 cm
long with a disk-shaped distal extremity of 7.4 F, which
progressively grows until 9 F on its proximal site. Aworking
channel of 3.6 F will allow the use of instruments through itFig. 2. Contemporary fiber optic and digital flexible ureterorenoscopes.
Fig. 4. “Semi-flexible” ureterorenoscopes' rigidity (top) compared to con-
ventional flexible ureterorenoscopes (bottom).
Fig. 5. Comparison between fiber optic and digital flexible ureterorenoscopy image quality in stones (left) and ureteropelvic junction stenosis (right).
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e15961592until 3.2 F, including laser fibers and nitinol baskets for
stone retrieval. Two or three fiber optic bundles are
responsible for the illumination and for image trans-
mission. The angle of the view of this ureterorenoscope is
0 with a field of view of 90.
These old generation flexible ureterorenoscopes have an
active deflection of 180 downward and upward and were
used until 2001, when improvement in image quality,
handling ergonomics and more deflexion degrees were
achieved for the new generation ureterorenoscopes.
2.1.2. New generation flexible ureterorenoscope
One of the advantages of new generation ureter-
orenoscopes is the possibility of achieving an active
deflection up to 270 (Fig. 3). The image quality has little
variations between companies, which depends on the
number of fiber optic bundles used for illumination and
image transmission.
These ureterorenoscopy images have a “honeycomb”
effect, which would decrease as the number of fiber optic
bundles increases. Nevertheless, the more and smaller the
fiber optic bundles are, the more prone to damage they will
be.
In order to increase the strength of the flexible ureter-
orenoscopes, as well as to facilitate the renal cavity access
and endoscope control, the newest endoscopes have
become more rigid or better-called “semi-flexible ureter-
orenoscopes” (Fig. 4). Studies are still waiting to demon-
strate if there is an interest or improvement during the F-
URS when using this type of ureteroscope.
Despite the technological progression in these ureter-
orenoscopes, they remain fragile. The mean number ofFig. 6. Continuous irrigation with a manual hand pump to incrcases performed with a fiber optic ureterorenoscope before
their repair ranged between 3.2e14.4 procedures [7], while
that with digital endoscopes ranged from 21e135 pro-
cedures [8]. In spite of this, some authors have reported up
to 100 cases and more than 74 h performance with fiber
optic endoscopes and 107 h for digital endoscopes [9,10].
2.1.3. New digital generation flexible ureterorenoscope
Since 2006, the digital technology has represented the
next step in the development of endoscopy with a distal
sensor. Many studies have showed that a better image
quality provides a higher precision for diagnosis, treatment
and a shorter procedure time. The digital ureter-
orenoscopes use a Complementary Metal Oxide Semi-
conductor (CMOS) or charge-coupled device (CCD) imaging
sensor as the digital camera and a light-emitting diode
(LED) as the light source.
The principal disadvantagewith the digital generation is
the distal tip diameters that are slightly greater than those
of the equivalent standard fiber optic ureterorenoscope.
This digital generation is now considered the gold standard
for image quality (Fig. 5).
2.1.4. Disposable flexible ureterorenoscope
In 2009, the PolyScope by Lumenis became available.
This is a disposable, modular flexible ureterorenoscope
with a 70 cmworking length and a distal tip size of 9.6 F. It
has a single-side active deflection of 180, and the working
channel is 3.6 F. Currently, more studies are needed to
demonstrate the efficiency and cost-effectiveness of this
device, which is more difficult to manipulate than the usual
flexible ureterorenoscopes.ease the irrigation while needed (TraxerFlow, Rocamed).
Fig. 7. Ureteral access sheath (ReTrace, Coloplast). The external sheath ap-
pears in orange and the internal dilator in gray.
Fig. 8. Insertion of a UAS over a guidewire under fluoroscopic guidance.
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e1596 15932.2. Irrigation
Irrigation during F-URS is essential in order to work in
the urinary tract. It allows renal cavity dilation and better
visibility by cleaning the urinary tract. Special attention
should be paid regarding the irrigation fluid pressure, in
order to avoid over increase in intrarenal pressure (Fig. 6).Fig. 9. A Holmium-YAG 30W lasThere are several irrigation dispositives, which allow
working with a continuous fluid irrigation, and when
needed, the irrigation can be transitorily increased to offer
better visibility with the manual hand pump. Moreover, a
ureteral access sheath (UAS) has been developed in order to
reduce the intrarenal pressure during F-URS.2.3. Ureteral access sheath (UAS)
The UAS consists of a device with two hydrophilic
pieces: the sheath and an internal dilator (Fig. 7). It is
inserted over a guidewire under fluoroscopic guidance
(Fig. 8). The use of the UAS has been proven to help during
F-URS since it allows us to engage easily the ureter, to
perform more stone retrieval movements, it dilates the
ureter, improves vision by facilitating the outflow of irri-
gation fluid, lowers the intrarenal pressure and also pro-
tects the ureterorenoscope while giving it more stability
which enhances the control of the scope in the renal cav-
ities. Besides, the UAS may reduce the operating time and
costs [11]. A UAS is not mandatory during F-URS and its use
is according to the surgeon’s preference.2.4. Lithotripter
The lithotripter of choice in F-URS is the Holmium-
Yttrium-Aluminium-Garnet crystal (Holmium-YAG) laser.
This laser wavelength is well absorbed in water (1 mm in
depth) with tissue penetration of only 0.5 mm (Figs. 9)[12].
Holmium-YAG laser setting can be settled for stone
fragmentation using high energy (1e2 J) and low frequency
(3e5 Hz) or stone dusting using low energy (0.2e0.5 J) and
high frequency (10e20 Hz). Stone fragmentation would
allow the removal of small stone fragments, which could be
subsequently analyzed (Fig. 10). Stone dusting on the other
hand would create a lower rate of significant fragments,
which would be eventually expelled by the patient (Fig. 11).er lithotripter (Rocamed).
Fig. 10. Small stone fragment retrieval using a tipless nitinol basket.
Fig. 13. Comparative images of macroscopic and endoscopic “in situ”
morpho-constitutional aspects of the 5 commonest stone types.
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e159615943. Discussion
Pak et al. in 1980 published that the metabolic evalua-
tion for urolithiasis should be simple, economically viable
and should provide enough information towards a selective
and rational therapy [13]. Today, most of the first time stone
formers would have a basic metabolic evaluation and a
stone composition analysis, since their recurrence risk is
50% within the next 10 years [14].
Despite this, in some scenarios stone composition
analysis is not available leaving only the option of a meta-
bolic analysis to determine the type of stone. Although
some metabolic disorders are associated with stone types,Fig. 11. Kidney stone dusting. Initial asp
Fig. 12. Endoscopic morpho-constitutional aspectssuch as metabolic syndrome and uric acid stones [15], it
still remains unknown whether these findings could
strongly predict the stone type. Xu et al. collected data from
1164 patients who were admitted in a urology department
and were assessed for blood serum electrolyte analysis, but
no differences were found between stone former and non-
stone former patients [16]. Urinalysis on the other hand has
been a widely used tool for metabolic evaluation of stone
formers, but its efficacy remains controversial. Moreira et al
confirmed the role of 24-h urinalysis in predicting the stone
types, however the accuracy of 24-h urinalysis alone was
only 64% [17].ect (left) and final results (right).
of the most frequent types of uinary stones.
Fig. 14. “In situ” morpho-constitutional analysis of calcium oxalate dihydrate (left) and uric acid (right) stones, endoscopic and macroscopic views.
Fig. 15. Macroscopic differences of the outer and inner layers within the
same stone.
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e1596 1595Therefore, in some cases a combination of metabolic
assessment and 24-h urinalysis may not be enough for
predicting the stone type. Thus a combination assessment
of metabolic, urinalysis, radiological and advanced tech-
niques in endourology may improve the accuracy in
determining the morpho-constitutional stone analysis of
patients.Fig. 16. Endoscopic and macroscopic views of the surface aWith technological advancements in image quality in F-
URS, such as the incorporation of an optical chip like CMOS
or CCD along with a distal LED light and image processing
capabilities, urologists may now be able to define the
macroscopic characteristics of urolithiasis (Fig. 12). These
improvements on the last generation of digital F-URS are
now very useful to ensure a diagnosis and even to spare
time during stone photovaporization [10].
The macroscopic characteristics of stones include their
size assessment, stone colors and surface variations, as well
as the outer and inner stone layer characteristics while
performing lithotripsy, stone hardness and even the scent
during lithotripsy as happens with cystine stones.
When comparing known diameters of safety guide-
wires, laser fibers and UAS with the stones, urologists can
accurately perform stone size assessment [18]. Despite
there are no high-level evidence studies in the literature,
we believe that the macroscopic aspect and color of stones
may raise the likehood of their composition (Fig. 13). For
instance, calcium oxalate monohydrate may appear in dark
colors and rounded shapes, while calcium oxalate dihy-
drate and cystine stones emerge in yellow/golden “star”nd sections of a calcium oxalate monohydrate stone.
R. Casta~neda-Argaiz et al. / C. R. Chimie 19 (2016) 1590e15961596shapes and uric acid stones in yellow rounded shapes
(Fig. 14).
As previously mentioned, the outer and inner stone
layers might have a different composition and macroscopic
aspect during F-URS, but out of a 15mmkidney stone only a
small fragment is analyzed which could bias the result of
stone analysis. Moreover, laser lithotripsy may raise the
suspicions of different stone compositions while perform-
ing it, since the core and outer layers of stones may be
harder or softer than each other regarding their composi-
tion (Figs. 15 and 16).
To date, there is no scientific evidence regarding the
advantages of endoscopic stone morpho-constitutional
evaluation. However, further studies analyzing the accu-
racy of the endoscopic stone evaluation are needed to
better know if it might improve the final description of the
morpho-constitutional stone type. This interest of the
technology advancement could counterbalance the fact
that F-URSmost of the time allows to send only a small part
of the stone burden for the analysis.
4. Conclusion
Technological advancements in the field of F-URS may
be an important tool in the assessment of stone
morphology and composition. It is very important for
urologists to know the development in this field and the
equipment available to accommodate them during all the
procedures.
New prospective and randomized trials are needed in
order to evaluate the role of endoscopic evaluation or video
during F-URS in determining the morpho-constitutional
analysis of the stone that could also be associated with
specific metabolic anomalies [19].
Disclosure statement
One of the authors is a consultant for Coloplast,
Rocamed, Olympus and AMS.No competing financial interest exists.Acknowledgments
None.References
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Principaux taxons ligneux de la cosmétopée tropicale : une analyse bibliographique