15 and 30 W Holmium:YAG Laser Lithotriptor in Ureteroscopic Lithotripsy: Which One Is More Effective and Safe?

Evaluation of pulse modulation settings for optimal pop-dusting efficiency using the Quanta Litho 150 laser: An in vitro study

Purpose

The novel Quanta Litho 150 W (Samarate, Italy) was recently introduced and incorporates new pulsed modulation settings. We sought to analyze ablation rate and efficiency in short pulse (SP), virtual basket (VB), and vapor tunnel (VT) pulsed modulations, in an in vitro pop-dusting simulation across different settings at a fixed power of 30 Watts (W) and fixed periods of time.

Materials and Methods

Seven millimeter BegoStone phantoms were subjected to lithotripsy in a simulated calyx using Holmium: yttrium:aluminum garnet Quanta System 150 W. 30 W was applied at different settings across three pulse modulation modes: SP, VB, and VT. Ablation rate and efficiency were and compared between the three groups.

Results

Maximum ablation efficiency for the VB and VT groups was achieved at VB 2J x 15 Hz and VT at 2.5 J x 12 Hz. Ablation efficiency decreased with higher Joules. VB at 1.5 J x 20 Hz and SP at 2.5 J x 12 Hz were the only settings to obtain 85% ablation at 5 min.

Conclusions

In vitro laser lithotripsy using a BegoStone phantom, VB at 2J x15 Hz and VT at 2.5 J x 12 Hz were the most efficient setting for pop-dusting with the Quanta Litho 150. The highest efficiency (mg/min) was achieved with VB at 2 J x 15 Hz and VT at 2.5 J x 12 Hz at 1:15 min.

The Effect of High- and Low-power Holmium Laser Settings for Transurethral Lithotripsy in the Management of Adults with Ureteral Stone

Since there is insufficient evidence to determine the best treatment of transurethral laser lithotripsy (TLL) in ureteral stones, this study compared the effectiveness and safety of TLL using high-power (HP) (100 W) and low-power (LP) (20 W) laser settings. All patients with maximally sized ureteral stones who were planned for transurethral holmium laser lithotripsy were enrolled in this open study. One of the two laser setting groups-LP or HP-was allocated to each alternate patient. Using IBM SPSS Statistics 24, the treatment groups were compared for operating time, intraoperative and postoperative problems (up to 1 year), and rates of stone-free recovery. Welch tests were employed to compare continuous data, whereas Fisher's exact or Chi-square tests were used to assess categorical variables. At P < 0.05, statistical significance was established. A total of 207 individuals were included and preoperative data were comparable between the two groups. The HP group had a considerably greater ablation rate and a significantly shorter procedure duration (42.61 ± 11.74 min) than the LP group (78.56 ± 25.91 min) ( P = 0.025). The Overactive Bladder Symptom Score and International Prostate Symptom Score were considerably higher in the HP group than in the LP group. Treatment effectiveness was considerably impacted by the location of the ureteral stone, according to univariate and multivariate logistic regression models. A HP laser setting of up to 100 W greatly shortens the duration of the process for treating ureteral stones without raising the risk of problems.

Paediatric kidney stone surgery: state-of-the-art review

While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.

Ureterorenoscopic lithotripsy for pediatric kidney stones using Holmium: YAG laser devices: 15 W versus 30 W

Introduction We aimed to compare the effectiveness of 15Watt (W) and 30 W Holmium: yttrium-aluminum-garnet (Ho: YAG) laser devices used in the treatment of pediatric kidney stones. Methods: Eighty-six consecutive pediatric patients who underwent retrograde intrarenal surgery between February 2010 and August 2020 were enrolled in the study. After exclusion criteria, the data of 79 children were evaluated retrospectively. Patients were divided into two groups according to the laser device power 15W (Group 15: N=30) and 30W (Group 30: N=49). The groups were compared according to demographic, stone feature, and clinical efficacy. Results The age, gender, height, weight, stone characteristics were similar between the groups. The mean operation time was shorter in Group 30. The stone-free rate after the first RIRS session (SF1) was 66.7% in Group 15 and 83.3% in Group 30. SF1 rate after the first RIRS procedure for 20 mm or larger kidney stones was found 0% in Group 15 and 62.5% in Group 30. However, there was no statistically significant difference between the two groups in terms of stone-free rate. Conclusion: In pediatric kidney stone treatment, 30 W Ho:YAG laser devices should be preferred as they shorten the operation time compared to 15 W devices and provide final stone-free with fewer procedures, especially in large kidney stones.