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Zeinelabden KM, El-Shazly M, Elsheerif E, Kandeel H, Aziz M. The optimal Holmium laser settings for disintegration of cystine and calcium oxalate monohydrate stones: In vitro study. Arab J Urol 2024; 22:138-144. [PMID: 38818259 PMCID: PMC11136462 DOI: 10.1080/20905998.2024.2304521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/06/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Disintegrating cystine and calcium oxalate monohydrate stones present a formidable challenge owing to their hardness and distinct composition. This study aimed to establish optimal laser settings for these hard stones lithotripsy. Patients and Methods Cystine and calcium oxalate monohydrate stones were extracted from two patients. Two experiments were conducted in vitro by utilizing a 272 μm laser fiber with variable settings to disintegrate the cystine and calcium oxalate monohydrate stones. In the first experiment, energy was adjustable while frequency was constant, whereas the second experiment involved constant energy with adjustable frequency on each type of stone and each experiment was repeated three times to ensure robustness and reliability. Results Our findings indicated that for cystine stones, use of higher total power with high energy and low frequency proved to be effective. Conversely, for calcium oxalate monohydrate stones, settings involving higher total power with low energy and high frequency demonstrated superior efficacy and safety. Conclusion Holmium (Ho: YAG) laser settings with higher total power, high energy, and low frequency effectively disintegrate cystine stones despite increased heat, which was measured by a thermometer with a thermocouple. For calcium oxalate monohydrate stones, higher total power, high frequency, and low energy settings are recommended and safe.
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Affiliation(s)
- Khaled M. Zeinelabden
- Urology department, faculty of medicine, Kafrelsheikh University, Kafr Al Sheikh, Egypt
| | - Mohamed El-Shazly
- Urology department, faculty of medicine, Menoufia University, Shibin el Kom, Egypt
| | - Eid Elsheerif
- Urology department, faculty of medicine, Menoufia University, Shibin el Kom, Egypt
| | - Hossam Kandeel
- Urology department, faculty of medicine, Menoufia University, Shibin el Kom, Egypt
| | - Mohammed Aziz
- Urology department, faculty of medicine, Menoufia University, Shibin el Kom, Egypt
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2
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Kaygısız O, Aydın YM, Çiçek MÇ, Polat R, Coşkun B, Ocakoğlu G, Kılıçarslan H. The predictive factors that total laser energy consumed during retrograde intrarenal surgery (RIRS): stone area and density. Lasers Med Sci 2023; 38:128. [PMID: 37233820 DOI: 10.1007/s10103-023-03792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Holmium: YAG (Ho: YAG) laser lithotripsy with flexible ureterorenoscopy can be used with high stone-free and low complication rates for renal stones. This study aimed to determine the factors affecting the total laser energy in cases with provided stone-free status after a single session of retrograde intrarenal surgery (RIRS). Data of 222 patients who underwent RIRS between October 2017 and March 2020 were evaluated retrospectively. After exclusion criteria, the study was carried out with 184 stone-free cases. All cases were performed without using a ureteral access sheath (UAS), and dusting was preferred as the lithotripsy method. The effects of age, gender, body mass index (BMI), previous RIRS history, previous shock wave lithotripsy (SWL) history, stone localization, number of stones, stone surface area, and stone density on total laser energy were analyzed. There was no significant correlation between total laser energy with gender, BMI, previous RIRS history, previous SWL history, stone localization, and the number of stones (p:0.347, p:0.482, p:0.119, p:0.167, p:0.907, p:0.933 respectively). There was a significant correlation between age and total laser energy (p = 0.032), but it was not observed when the effect of the stone surface area was removed (p = 0.354). There were significant correlations between total laser energy and stone surface area, stone density, and total laser time (p<0.001, p<0.001, and p <0.001, respectively). Stone area and stone density affect the total energy consumed during laser lithotripsy. Urologists should consider the stone area, stone density, and the power of the laser device to determine which surgical technic to prefer.
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Affiliation(s)
- Onur Kaygısız
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | | | | | - Rıdvan Polat
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | - Burhan Coşkun
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | - Gökhan Ocakoğlu
- Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
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Rice P, Somani BK, Nagele U, Herrmann TRW, Tokas T. Generated temperatures and thermal laser damage during upper tract endourological procedures using the holmium: yttrium-aluminum-garnet (Ho:YAG) laser: a systematic review of experimental studies. World J Urol 2022; 40:1981-1992. [PMID: 35355103 DOI: 10.1007/s00345-022-03992-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To perform a review on the latest evidence related to generated temperatures during Ho:YAG laser use, and present different tools to maintain decreased values, and minimize complication rates during endourological procedures. METHODS We performed a literature search using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were URS, RIRS, ureteroscopy, percutaneous, PCNL, and laser. RESULTS Thermal dose (t43) is an acceptable tool to assess possible thermal damage using the generated temperature and the time of laser exposure. A t43 value of more than 120 min leads to a high risk of thermal tissue injury and at temperatures higher than 43 °C Ho:YAG laser use becomes hazardous due to an exponentially increased cytotoxic effect. Using open continuous flow, or chilled irrigation, temperatures remain lower than 45 °C. By utilizing high-power (> 40 W) or shorter laser pulse, temperatures rise above the accepted threshold, but adding a ureteral access sheath (UAS) helps to maintain acceptable values. CONCLUSIONS Open irrigation systems, chilled irrigation, UASs, laser power < 40 W, and shorter on/off laser activation intervals help to keep intrarenal temperatures at accepted values during URS and PCNL.
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Affiliation(s)
- Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
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Zhang P, Han XW, Zhang X, Zhu XH, Li T, Li YS, Chen YH, Li G. Clinical Observation of UreTron Single-Probe Ultrasonic Intracorporeal Lithotripter for Ureteral Calculi. Int J Gen Med 2021; 14:4229-4237. [PMID: 34393502 PMCID: PMC8355551 DOI: 10.2147/ijgm.s325306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aimed to observe and discuss the effectiveness and safety of the UreTron single-probe ultrasonic intracorporeal lithotripter in ureteroscopic lithotripsy. Methods The clinical data of patients with unilateral solitary ureteral calculi treated with ureteroscopic lithotripsy who were hospitalized at the Department of Urology (West District) of Beijing Chaoyang Hospital between March 2016 and August 2020 were selected for retrospective analysis. The patients were divided into the UreTron group (group U) and holmium laser group (group H) according to the lithotripsy method adopted. The operation duration, length of hospital stay, stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and complications were compared between the groups. Results There was no statistical difference between the groups in terms of the general characteristics, operation duration, or length of hospital stay (P > 0.05). Regarding the stone clearance rate (group U=93.5%; group H=75%), proportion of patients requiring flexible ureteroscopy-assisted lithotripsy (group U=6.5%; group H=27.8%), and incidence of surgical complications (group U=1 case; group H=9 cases), group U was superior to group H, and the differences between the groups were statistically significant (P < 0.05). However, the differences in other complications (cardiocerebral complications and lower extremity thrombosis) were not statistically significant between the groups (P > 0.05). Conclusion The UreTron system is a new lithotripsy apparatus that is safe and effective for ureteroscopic lithotripsy and has certain advantages in terms of the stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and surgical complications, making it worthy of clinical application.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xiu-Wu Han
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xu-Hui Zhu
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Tao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yan-Sheng Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yuan-Hao Chen
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Gao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
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Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery-Comparative Study in Pig Model. MATERIALS 2021; 14:ma14082000. [PMID: 33923581 PMCID: PMC8073520 DOI: 10.3390/ma14082000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Background: The aim of this study was to evaluate the usefulness of a thulium-doped fiber laser and a diode laser in zero ischemia kidney surgery, by carrying out a comparative study in a pig model. Material and methods: Research was carried out on 12 pigs weighing 30 kg each. A thulium-doped fiber laser (TDFL) and a diode laser (DL) operating at wavelengths of 1940 and 1470 nm, respectively, were used. The cut sites were assessed both macroscopically and microscopically. The zone of thermal damage visible in the histopathological preparations was divided into superficial and total areas. Results: During partial nephrectomy, moderate to minimal bleeding was observed, which did not require additional hemostatic measures. All animals survived the procedure. On day 0, the total thermal damage depth was 837.8 µm for the TDFL and 1175.0 µm for the DL. On day 7, the depths were 1556.2 and 2301.7 µm, respectively. On day 14, the overall thermal damage depth for the DL was the greatest (6800 µm). The width of the superficial zone was significantly reduced on days 7 and 14 after TDFL application. Conclusion: Both lasers are suitable for partial wedge nephrectomy without ischemia in pigs. The TDFL produced similar or better hemostasis than the DL, with a smaller zone of thermal damage and, therefore, seems more suitable for application in human medicine.
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Minimally invasive percutaneous nephrolithotomy with SuperPulsed Thulium-fiber laser. Urolithiasis 2021; 49:485-491. [PMID: 33655346 DOI: 10.1007/s00240-021-01258-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
We aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (PCNL) with SuperPulsed Thulium-fiber laser (SP TFL) using different frequency settings. 125 patients with solitary kidney calculi of up to 55 mm in the maximum diameter underwent mini-PCNL with the SP TFL. Stone-free rate, laser-on time, ablation efficacy, energy consumption, ablation speed and complications were all analyzed. Negative low-dose computed tomography scan or asymptomatic patients with stone fragments < 2 mm were the criteria for assessing the stone-free status. In 36 patients (28.8%) low frequency regimens were used (LF: 3-19 Hz-0.5-6 J), in 75 patients (60%) high frequency regimens were chosen (HF: 20-49 Hz-0.2-2 J) and in 14 (11.2%) patients higher frequency (HRF: 50-200 Hz-0.1-0.5 J) regimens were preferred. The mean age was 52 ± 1.8 years. Median stone diameter and median stone volume were larger at low frequency regimens compared to high frequency regimens. Ablation efficacy (J/mm3) was lower at low rather than at high frequency regimens. Ablation speed (mm3/sec) was higher at low compared to high frequency regimens. Surgeons reported minimal and absent retropulsion at higher frequency regimens. The best visibility was observed at high frequency regimens. The overall stone free rate (SFR) at 3 months was 85%. The majority of the postoperative complications were classified between Clavien grades I-II. SP TFL is an effective and safe tool for performing mini-PCNL regardless of the laser settings.
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Ersoz C, Ilktac A, Dogan B, Kalkan S, Danacioglu YO, Silay MS. The optimal settings of holmium YAG laser in treatment of pediatric urolithiasis. Lasers Med Sci 2021; 37:317-321. [PMID: 33479867 DOI: 10.1007/s10103-021-03251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
The aim of this study is to present our experience on the use of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatric patients for pediatric urolithiasis and describe the optimal settings. A total of 116 children who underwent urolithiasis treatment (percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), retrograde intrarenal surgery (RIRS)) were included. The mean age of the patients was 8.4 ± 5.2 years (1-18). The mean follow-up was 26 ± 8.8 months (9-45). There was no difference between the mean stone sizes of PNL and RIRS patients (p = 0.816). Operations were performed with 200, 272, and 365-μm fibers. In mini-URS, stone fragmentation was achieved with the energy settings set between 0.5 and 1 J and frequency set to > 8 Hz. In RIRS, fragmentation was achieved with the setting of 0.5-0.8 J at 10-20 Hz. Stone fragmentation was performed with energy settings of 0.8 to 2 J between 5 and 15 Hz for PNL. There was no significant difference between the stone-free rates of the PNL and RIRS (p = 0.150). Four postoperative complications occurred (Clavien II), which included febrile urinary infections in two patients who underwent mini-URS, one patient who underwent PNL, and one patient who underwent RIRS. Our results confirmed that Ho-YAG laser can be effectively used in children for stone treatment by using low-energy high-frequency settings for URS and RIRS and a high energy setting for PNL.
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Affiliation(s)
- Cevper Ersoz
- Department of Urology, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı, Vatan Caddesi, 34093, Istanbul, Fatih, Turkey.
| | - Abdullah Ilktac
- Department of Urology, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı, Vatan Caddesi, 34093, Istanbul, Fatih, Turkey
| | - Bayram Dogan
- Department of Urology, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı, Vatan Caddesi, 34093, Istanbul, Fatih, Turkey
| | - Senad Kalkan
- Department of Urology, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı, Vatan Caddesi, 34093, Istanbul, Fatih, Turkey
| | - Yavuz Onur Danacioglu
- Department of Urology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mesrur Selcuk Silay
- Department of Pediatric Urology, Biruni University & Istanbul Memorial Hospital, Istanbul, Turkey
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8
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Jongjitaree K, Chotikawanich E. Vaporizing Effect of the Popcorn Technique for Laser Lithotripsy: Comparing the Different Settings of High Energy in a Caliceal Model. J Endourol 2019; 33:809-813. [PMID: 31418300 DOI: 10.1089/end.2019.0370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the effectiveness of laser lithotripsy in different holmium:yttrium aluminum garnet (Ho-YAG) laser settings with a wide range of energies, frequencies, and power. Materials and Methods: Two types of phantom stones were utilized, including soft stone, which mimics uric acid stone, and hard stone, which mimics calcium oxalate monohydrate stone. The stones were made into a round shape measuring 10 mm in diameter. The lithotripsy settings were 1 J × 20 Hz, 2 J × 10 Hz, 1.5 J × 20 Hz, 3 J × 10 Hz, and 2 J × 20 Hz. The lithotripsy was conducted in a caliceal model with a 2-mm filter. All stone vanishing from the artificial calix was an end point of the experiment. All fragments that passed through the filter of each setting were dried and weighed to calculate the vaporizing effect as well as to compare among the different settings. Laser fiber degradation was compared by using these settings. Results: Disintegration efficiency was determined by time consumption and the amount of vaporized stone. The best time consumption was 8 min 51 sec for 2 J × 20 Hz for hard stone and 5 min 13 sec for this setting for soft stone. The most vaporizing effect for hard stone was 92.19% for 2 J × 20 Hz and 87.30% for this setting for soft stone. The most fiber tip degradation was 28 mm for 3 J × 10 Hz for hard stone and 4 mm for 1.5 J × 20 Hz for soft stone. Conclusion: The study revealed that the best setting for hard stone was 2 J × 20 Hz, which was the fastest for achieving maximum vaporization, whereas fiber degeneration was comparable to others. For soft stone, there was no difference among the settings.
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Affiliation(s)
- Kantima Jongjitaree
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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9
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Esposito C, Masieri L, Bagnara V, Tokar B, Golebiewski A, Escolino M. Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. J Pediatr Urol 2019; 15:391.e1-391.e7. [PMID: 31182399 DOI: 10.1016/j.jpurol.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population. OBJECTIVE This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. STUDY DESIGN The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder. RESULTS Stones were treated with dusting technique in all cases. The median stone size was 10.3 mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8 min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (P = 0.001). DISCUSSION This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective. CONCLUSION The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location.
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Affiliation(s)
- C Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.
| | - L Masieri
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - V Bagnara
- Division of Pediatric Urology, Morgagni Policlinico Hospital, Catania, Italy
| | - B Tokar
- Division of Pediatric Surgery, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - A Golebiewski
- Division of Pediatric Urology, Medical University in Gdansk, Pomerania, Poland
| | - M Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 2019; 38:497-503. [PMID: 31055626 DOI: 10.1007/s00345-019-02785-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE A superpulse (500 W peak power) thulium fiber laser operating at a 1940 nm wavelength, suitable for lithotripsy, has recently been developed. The goal of this study was to compare stone fragmentation and dusting performance of the prototype superpulse thulium fiber laser with leading commercially available, high-power holmium:YAG lithotripters (wavelength 2100 nm) in a controlled in vitro environment. METHODS Two experimental setups were designed for investigating stone ablation rates and retropulsion effects, respectively. In addition, the ablation setup enabled water temperature measurements during stone fragmentation in the laser-stone interaction zone. Human uric acid (UA) and calcium oxalate monohydrate (COM) stones were used for ablation experiments, whereas standard BegoStone phantoms were utilized in retropulsion experiments. The laser settings were matched in terms of pulse energy, pulse repetition rate, and average power. RESULTS At equivalent settings, thulium fiber laser ablation rates were higher than those for holmium:YAG laser in both dusting mode (threefold for COM stones and 2.5-fold for UA stones) and fragmentation mode (twofold for UA stones). For single-pulse retropulsion experiments, the threshold for onset of stone retropulsion was two to four times higher for thulium fiber laser. The holmium:YAG laser generated significantly stronger retropulsion effects at equal pulse energies. The water temperature elevation near the laser-illuminated volume did not differ between the two lasers. CONCLUSIONS Distinctive features of the thulium fiber laser (optimal wavelength and long pulse duration) resulted in faster stone ablation and lower retropulsion in comparison to the holmium:YAG laser.
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El-Nahas AR, Almousawi S, Alqattan Y, Alqadri IM, Al-Shaiji TF, Al-Terki A. Dusting versus fragmentation for renal stones during flexible ureteroscopy. Arab J Urol 2019; 17:138-142. [PMID: 31285926 PMCID: PMC6600060 DOI: 10.1080/2090598x.2019.1601002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/23/2022] Open
Abstract
Objectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi. Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3–0.5 J and 15–20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1–1.2 J and 6–10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared. Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients’ demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244). Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures. Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath
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Affiliation(s)
- Ahmed R El-Nahas
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Shabir Almousawi
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Yaqoub Alqattan
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Imad M Alqadri
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Tariq F Al-Shaiji
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait
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12
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Lee JW, Park MG, Cho SY. How to perform the dusting technique for calcium oxalate stone phantoms during Ho:YAG laser lithotripsy. BMC Urol 2018; 18:103. [PMID: 30424765 PMCID: PMC6234550 DOI: 10.1186/s12894-018-0417-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the most efficacious setting of Holmium:yttrium-aluminum-garnet (Ho:YAG) laser with a maximum power output of 120 W with in vitro phantom-stone dusting technique. METHODS A laser was used to treat two 4 × 3 × 3 mm3 sized phantom stones in 5 mL syringes with 1 mm-sized holes at the bottom. According to the pulse width (short 500, middle 750, long pulse 1000 μsec), maximal pulse repetition rates from 50 to 80 Hz were tested with pulse energy of 0.2, 0.4, 0.5, and 0.8 J. Six times of the mean dusting times were measured at each setting. Dusting was performed at continuous firing of the laser until the stones become dusts < 1 mm. RESULTS The mean Hounsfield unit of phantom stones was 1309.0 ± 60.8. The laser with long pulse generally showed shorter dusting times than short or middle pulse width. With increasing the pulse energy to 0.5 J, the dusting time decreased. However, the pulse energy of 0.8 J showed longer dusting times than those of 0.5 J. On the post-hoc analysis, the pulse energy of 0.5 J, long pulse width, and the repetition rates of 70 Hz demonstrated significantly shorter dusting times than other settings. CONCLUSIONS The results suggest that long pulse width with 0.5 J and 70 Hz would be the most efficacious setting for dusting techniques of plaster stone phantoms simulating calcium oxalate stones using the 120 W Ho:YAG laser.
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Affiliation(s)
- Jeong Woo Lee
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-773, Republic of Korea
| | - Min Gu Park
- Department of Urology, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul, 100-032, Republic of Korea
| | - Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-Gil, Dongjak-gu, Seoul, 156-707, Republic of Korea.
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Tracey J, Gagin G, Morhardt D, Hollingsworth J, Ghani KR. Ureteroscopic High-Frequency Dusting Utilizing a 120-W Holmium Laser. J Endourol 2018; 32:290-295. [DOI: 10.1089/end.2017.0220] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James Tracey
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Galina Gagin
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Duncan Morhardt
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Khurshid R. Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
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14
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Gómez-Núñez JG. Editorial Comment on: Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction by Matlaga et al. J Endourol 2018; 32:7-9. [DOI: 10.1089/end.2017.0814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joel Gustavo Gómez-Núñez
- Departamento de Urología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, México
- Urólogo/Endourólogo, Hospital General Regional (HGR) 180, Instituto Mexicano del Seguro Social (IMSS) Delegación Jalisco, Tlajomulco de Zúñiga, Jalisco, México
- Departamento de Urología, Urólogo/Endourólogo, Instituto Jalisciense de Cancerología, Secretaría de Salud Jalisco, Guadalajara, Jalisco, México
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15
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Schoenthaler M, Hein S, Seitz C, Türk C, Danuser H, Vach W, Miernik A. The stone surgeon in the mirror: how are German-speaking urologists treating large renal stones today? World J Urol 2017; 36:467-473. [PMID: 29218404 DOI: 10.1007/s00345-017-2148-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/01/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To elucidate the current treatment strategies of LRS in German-speaking Europe. Little is known about the treatment of large renal stones (LRS > 3 cm) in daily urological practice. LRS therapy can be, however, challenging and hazardous. MATERIALS AND METHODS A 39 item web-based survey was performed among urologists listed by the German, Austrian and Swiss Associations of Urology, addressing professionals treating LRS "on their own" and working in a German-speaking country. Uniparametric descriptions indicated as absolute numbers and percentages without p values, simple linear associations and bubble plots without arithmetic means or bar charts with standard deviation between targeted parameters and percentages were used. RESULTS 266 of the 6586 responding urologists claimed to treat urinary stones on a regular basis. The majority of them were male (90.2%) and over 50 years old (42.9%). Most stones are treated in non-university hospitals (69.5%). 81.9% of all the institutions treat more than 150 cases/y. Open surgery is still performed in 45.5% of the centres, laparoscopy in 32%. Percutaneous nephrolithotomy (PNL) is the primary treatment option. Antimicrobial strategies vary considerably. Serious complications seem to be rare. However, quite a few responders reported treatment-related deaths. The main limitation is the absolute number of urologists performing LRS treatment, which is unknown. CONCLUSIONS The German-speaking urologist treating LRS is a male and over 50. Although he performs PNL primarily, he is not averse to open surgery and SWL. He applies guidelines and employs modern equipment. Only antimicrobial strategies are out of line with the international standards.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christian Seitz
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Türk
- Department of Urology/Stone Centre, Hospital Rudolfstiftung, Ziehrerplatz 7/7, 1030, Vienna, Austria
| | - Hansjörg Danuser
- Department of Urology, Kantonsspital, 6000, Lucerne 16, Switzerland
| | - Werner Vach
- Centre for Medical Biometry and Medical Informatics, University of Freiburg, Stefan-Meier Str. 26, 79104, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Centre-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Abstract
Since the introduction of ESWL, PNL and URS during the early 1980s the application rate of ESWL has declined while those of PNL and URS have increased. This is mainly due to the facts that instruments and techniques for Intracorporeal Lithotripsy (IL) have made a continuous progress. This review shows that today an array of options for IL within the entire urinary tract is available to treat stones in a perfect minimal invasive way. At the same time further improvements of IL are already visible.
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17
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Thorburn F, Lancaster A, McDaniel S, Cook G, Kar AK. 5.9 GHz graphene based q-switched modelocked mid-infrared monolithic waveguide laser. OPTICS EXPRESS 2017; 25:26166-26174. [PMID: 29041277 DOI: 10.1364/oe.25.026166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/08/2017] [Indexed: 06/07/2023]
Abstract
A high repetition rate Q-switched modelocked ~2.1 µm monolithic waveguide laser is reported. Ultrafast laser inscription is used to fabricate 3D depressed cladding channel waveguides in holmium doped yttrium aluminium garnet. This results in a transversely single mode waveguide laser. With the use of a graphene based saturable output coupler, Q-switched modelocking was achieved with a pulse repetition frequency of 5.9 GHz and up to 170 mW of average output power. This first demonstration of multi-GHz repetition rate operation from a Ho3+:YAG laser provides a compact and convenient source for a number of applications.
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18
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Bell JR, Penniston KL, Nakada SY. In VitroComparison of Stone Fragmentation When Using Various Settings with Modern Variable Pulse Holmium Lasers. J Endourol 2017; 31:1067-1072. [DOI: 10.1089/end.2017.0351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Roger Bell
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristina L. Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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Aldoukhi AH, Roberts WW, Hall TL, Ghani KR. Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust? Front Surg 2017; 4:57. [PMID: 29067287 PMCID: PMC5649137 DOI: 10.3389/fsurg.2017.00057] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Abstract
Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.
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Affiliation(s)
- Ali H Aldoukhi
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, MI, United States
| | - William W Roberts
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Khurshid R Ghani
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, MI, United States
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20
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Goates AJ, Kung RW, Tracy CR, Hoffman HT. Intraductal Laser Fiber Tip Fracture and Retrieval During Sialendoscopic Laser-Assisted Lithotripsy. Ann Otol Rhinol Laryngol 2017; 126:774-777. [PMID: 28895432 DOI: 10.1177/0003489417728736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fragmentation of flexible laser fiber tips has been reported to occur during therapeutic bronchoscopy and urologic stone treatment. We report fragmentation of 200-µm single-use silica-based fibers during sialendoscopy-controlled Holmium:YAG laser treatment of a parotid and a submandibular stone. The technique employed to successfully retrieve the fiber tips is described in the context of identifying this potential complication from endoscopic management of sialolithiasis.
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Affiliation(s)
- Andrew J Goates
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Raymond W Kung
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Chad R Tracy
- 2 Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Henry T Hoffman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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21
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The In Vivo Effect of Ytterbium-Doped Fiber Laser on Rat Buccal Mucosa as a Simulation of Its Effect on the Urinary Tract: A Preclinical Histopathological Evaluation. Int Neurourol J 2017; 21:S17-23. [PMID: 28446013 PMCID: PMC5426434 DOI: 10.5213/inj.1734858.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/02/2017] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study was to perform a histological analysis of the effect of a ytterbium-doped fiber (YDF) laser on oral buccal mucosa tissue in vivo to simulate its effect on the mucosa of the lower urinary tract. Methods A total of 90 8-week-old Sprague-Dawley rats were anesthetized with urethrane (1.2 g/kg intraperitoneally). A prespecified inner buccal mucosal site was irradiated with a YDF master-oscillator power amplifier (MOPA) system for 60 seconds, with output power settings of 0.5, 1, and 2 W, respectively, in 3 treatment groups. Specimens of irradiated tissue were harvested at 2 hours, 24 hours, 2 weeks, and 4 weeks after irradiation. The tissue specimens were stained with hematoxylin and eosin for histological analysis. Results In the group treated with 0.5 W, basal cell elongation and vacuolization were observed at 2 hours and 24 hours after treatment, respectively. No evident injury was observed after 2 or 4 weeks. The group treated with 1 W presented partial basal layer separation, and even complete epidermal ablation, within 2 hours. At 24 hours after laser treatment, new capillaries on an edematous background of fibroblasts and myofibroblasts, as well as profuse infiltration of the neutrophils to the basal layer, were observed. Collagen deposition and reepithelization were observed in specimens taken 2 weeks and 4 weeks after treatment. The group treated with 2 W presented bigger and deeper injuries at 2 hours after irradiation. Meanwhile, subepidermal bullae with full-thickness epidermal necrosis and underlying inflammatory infiltrate were observed 24 hours after treatment. The presence of fibrous connective tissue and collagen deposition were observed 2 weeks and 4 weeks after the treatment. Conclusions To our knowledge, this is the first report regarding the effect of a YDF laser on living tissue. Our study demonstrated that the typical histological findings of the tissue reaction to the YDF MOPA apparatus were very similar to those associated with thermal injuries. The extent and degree of tissue damage increased proportionally to the output power.
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22
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Klaver P, de Boorder T, Rem AI, Lock TMTW, Noordmans HJ. In vitro comparison of renal stone laser treatment using fragmentation and popcorn technique. Lasers Surg Med 2017; 49:698-704. [DOI: 10.1002/lsm.22671] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Paul Klaver
- Department of Medical Technology and Clinical Physics; University Medical Center Utrecht; Utrecht Netherlands
| | - Tjeerd de Boorder
- Department of Medical Technology and Clinical Physics; University Medical Center Utrecht; Utrecht Netherlands
| | - Alex I. Rem
- Department of Medical Technology and Clinical Physics; University Medical Center Utrecht; Utrecht Netherlands
| | - Tycho M. T. W. Lock
- Department of Urology; University Medical Center Utrecht; Netherlands
- Department of Urology; Central Military Hospital; Utrecht Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics; University Medical Center Utrecht; Utrecht Netherlands
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23
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Chang KC, Chen WM, Wei KL. Endoscopic treatment of Bouverets syndrome in an extremely elderly patient with Holmium: YAG laser. Ann Saudi Med 2016; 36:436-439. [PMID: 27920418 PMCID: PMC6074207 DOI: 10.5144/0256-4947.2016.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
UNLABELLED Bouveret's syndrome is a rare presentation of duodenal obstruction or gastric outlet obstruction caused by a large gallstone migrating through a cholecystoduodenal or choledochoduodenal fistula. Most patients are elderly and often have underlying comorbidities, complicating surgery. Endoscopic therapy should be used as first-line treatment for these patients who are not good surgical candidates. We report a case of a 98-year-old Chinese female who presented with vomiting for three days. Esophagogastroduodenoscopy and computed tomography confirmed the diagnosis of Bouveret's syndrome. The patient successfully underwent endoscopic lithotripsy with the Holmium: Yttrium- Aluminum-Garnet (Ho: YAG) laser. Ho: YAG laser lithotripsy has been used to treat Bouveret's syndrome in four case reports. It can be recommended in patients with Bouveret's syndrome who are poor candidates for surgery. SIMILAR CASES PUBLISHED 4.
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Affiliation(s)
- Kao-Chi Chang
- Dr. Kuo-Liang Wei, Internal Medicine,, Chang Gung Memorial Hospital Chiayi Branch,, 6 Section West,, Chia-Po Road, Putz City,, Chia-Yi 613, Puzi 61363,, Taiwan, T: 886-5-362-1000, F: 886-5-362-3002,
| | | | - Kuo-Liang Wei
- Dr. Kuo-Liang Wei, Internal Medicine,, Chang Gung Memorial Hospital Chiayi Branch,, 6 Section West,, Chia-Po Road, Putz City,, Chia-Yi 613, Puzi 61363,, Taiwan, T: 886-5-362-1000, F: 886-5-362-3002,
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24
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Evaluation of dusting versus basketing - can new technologies improve stone-free rates? Nat Rev Urol 2016; 13:726-733. [PMID: 27698400 DOI: 10.1038/nrurol.2016.172] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past two decades, the management of upper-tract urinary stones has dramatically changed towards an increase in the use of ureteroscopic treatment. This change has been driven by technological advances such as the creation of flexible ureteroscopes with reduced calibre (which now have digital, disposable and dual flexion capability) and holmium lasers with increased power. Two basic principles exist when treating stones ureteroscopically: either creating stone dust and small fragments (<1-2 mm) to theoretically enable spontaneous passage of the small particles or stone fragmentation that enables safe extraction of the stone pieces with a basket or grasper in an efficient manner. Each method has unique advantages and disadvantages, but, ultimately, surgeon preference, stone size, composition, location and intrarenal and/or ureteral anatomy determine which technique is used. To date, clinical trials comparing these two techniques are lacking.
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25
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Peplinski B, Faaborg D, Miao E, Alsyouf M, Myklak K, Kelln W, Baldwin DD. The Effect of Laser Fiber Cleave Technique and Lithotripsy Time on Power Output. J Endourol 2016; 30:678-84. [DOI: 10.1089/end.2015.0835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brandon Peplinski
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Daniel Faaborg
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Edna Miao
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Kristene Myklak
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Wayne Kelln
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
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26
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Kallidonis P, Kamal W, Panagopoulos V, Vasilas M, Amanatides L, Kyriazis I, Vrettos T, Fligou F, Liatsikos E. Thulium Laser in the Upper Urinary Tract: Does the Heat Generation in the Irrigation Fluid Pose a Risk? Evidence from an In Vivo Experimental Study. J Endourol 2016; 30:555-9. [DOI: 10.1089/end.2015.0768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
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27
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Kallidonis P, Amanatides L, Panagopoulos V, Kyriazis I, Vrettos T, Fligou F, Kamal W, Liatsikos EN. Does the Heat Generation by the Thulium:Yttrium Aluminum Garnet Laser in the Irrigation Fluid Allow Its Use on the Upper Urinary Tract? An Experimental Study. J Endourol 2016; 30:422-7. [DOI: 10.1089/end.2015.0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
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28
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Vassantachart JM, Lightfoot M, Yeo A, Maldonado J, Li R, Alsyouf M, Martin J, Lee M, Olgin G, Baldwin DD. Laser Fiber Cleaving Techniques: Effects on Tip Morphology and Power Output. J Endourol 2015; 29:84-9. [DOI: 10.1089/end.2014.0175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Michelle Lightfoot
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Alexander Yeo
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Jonathan Maldonado
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Roger Li
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Jacob Martin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Michael Lee
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Gaudencio Olgin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
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29
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Kronenberg P, Traxer O. Update on lasers in urology 2014: current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 2014; 33:463-9. [PMID: 25185524 DOI: 10.1007/s00345-014-1395-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the study was to review the existing literature on holmium:yttrium-aluminum-garnet laser lithotripsy regarding lithotripter settings and laser fibers. METHODS An online search of current and past peer-reviewed literature on holmium laser lithotripsy was performed on several databases, including PubMed, SciElo, and Google Scholar. Relevant studies and original articles about lithotripter settings and laser fibers were examined, and the most important information is summarized and presented here. RESULTS We examine how the choice of lithotripter settings and laser fibers influences the performance of holmium laser lithotripsy. Traditional laser lithotripter settings are analyzed, including pulse energy, pulse frequency, and power levels, as well as newly developed long-pulse modes. The impact of these settings on ablation volume, fragment size, and retropulsion is also examined. Advantages of small- and large-diameter laser fibers are discussed, and controversies are highlighted. Additionally, the influence of the laser fiber is examined, specifically the fiber tip preparation and the lithotripter settings' influence on tip degradation. CONCLUSIONS Many technical factors influence the performance of holmium laser lithotripsy. Knowing and understanding these controllable parameters allows the urologist to perform a laser lithotripsy procedure safely, efficiently, and with few complications.
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