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Tang X, Wu S, Li Z, Wang D, Lei C, Liu T, Wang X, Li S. Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review. BMC Urol 2024; 24:44. [PMID: 38374098 PMCID: PMC10875760 DOI: 10.1186/s12894-024-01419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES To compare the efficacy and safety of thulium fiber laser (TFL) to holmium: YAG (Ho: YAG) laser in ureteroscopic lithotripsy for urolithiasis. METHODS PubMed, Web of Science, Embase, CENTRAL, SinoMed, CNKI database, VIP and Wanfang Database were systematically searched for all relevant clinical trials until September 2023. References were explored to identify the relevant articles. Meta-analysis was carried out for the retrieved studies using RevMan5.4.1 software, and the risk ratio, mean difference and 95% confidence interval were expressed. Statistical significance was set at p < 0.05. The main outcomes of this meta-analysis were stone-free rate (SFR), perioperative outcomes and intraoperative or postoperative complications. RESULTS Thirteen studies, including 1394 patients, were included. According to the results of pooled analysis, TFL was associated with significantly higher stone-free rate (SFR) [0.52, 95% CI (0.32, 0.85), P = 0.009], shorter operation time [-5.47, 95% CI (-8.86, -2.08), P = 0.002], and less stone migration [0.17, 95% CI (0.06, 0.50), P = 0.001]. However, there was no significant difference in terms of the laser time, duration of hospital stay, drop of hemoglobin level, total energy, postoperative ureteral stenting, the incidence of intraoperative complications or postoperative complications between TFL and Ho: YAGs. CONCLUSION The findings of this study demonstrated several advantages of TFL in terms of higher SFR, shorter operative time and less stone migration. TRIAL REGISTRATION The protocol of this systematic review was listed in PROSPERO ( www.crd.york.ac.uk/PROSPERO ) (Protocol number: CRD42022362550).
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Affiliation(s)
- Xiaoyu Tang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shaojie Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Zhilong Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Du Wang
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Cheng Lei
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Sheng Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Sánchez-Puy A, Bravo-Balado A, Diana P, Baboudjian M, Piana A, Girón I, Kanashiro AK, Angerri O, Contreras P, Eisner BH, Balañà J, Sánchez-Martín FM, Millán F, Palou J, Emiliani E. New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2022; 11:jcm11113208. [PMID: 35683595 PMCID: PMC9181640 DOI: 10.3390/jcm11113208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.
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Affiliation(s)
- Antoni Sánchez-Puy
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Department of Surgery, Universistat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Pietro Diana
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, 13005 Marseille, France;
| | - Alberto Piana
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Irene Girón
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Andrés K. Kanashiro
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Oriol Angerri
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Pablo Contreras
- Department of Urology, Hospital Alemán de Buenos Aires, Buenos Aires C1118 AAT, Argentina;
| | - Brian H. Eisner
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Josep Balañà
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Francisco M. Sánchez-Martín
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Félix Millán
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Joan Palou
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Department of Surgery, Universistat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
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Keller EX, Kronenberg P, Tailly T, Corrales M, Juliebø-Jones P, Pietropaolo A, Somani B, De Coninck V. Laser accessories: surgical fibers, strippers, cleavers, and protective glasses. Curr Opin Urol 2022; 32:330-338. [PMID: 35256579 DOI: 10.1097/mou.0000000000000977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides most recent findings and developments relating to surgical laser fibers, strippers, cleavers, and protective glasses. RECENT FINDINGS The smallest core diameter that can be used with Holmium:YAG lasers is 200 μm. Smaller core diameter fibers can be used with the Thulium fiber laser and offer better flexibility and lower risk of fracture, at the risk of greater burnback effect. Misleading discrepancies between the true diameter of laser fibers and their packaging labels must be considered. Fiber tip degradation from the burnback occurs within few minutes, thus questioning the need for time-consuming fiber tip reprocessing with fiber strippers and special cleaving tools. This shortcoming also applies to instrument-protecting ball-tip fibers. Cleavage of fiber tips through their protective jackets ('coated tips') is a cheaper alternative for instrument protection, additionally offering better visual control of the fiber tip. Third-generation side-firing greenlight laser fibers are still prone to rapid deterioration. Laser eyewear does not seem necessary for Holmium:YAG applications, whereas laser-specific protective glasses should be worn for greenlight laser applications. SUMMARY With better understanding of laser accessories, practicing urologists may tailor their practice to reach optimal efficacy and safety for Holmium:YAG, Thulium fiber laser and Greenlight laser applications.
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Affiliation(s)
- Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
| | - Peter Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
| | - Thomas Tailly
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Patrick Juliebø-Jones
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Bhaskar Somani
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
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Jiang P, Brevik A, Clayman RV. The Life and Death of Percutaneous Stone Removal: "Looking Back-Looking Forward". Urol Clin North Am 2021; 49:119-128. [PMID: 34776046 DOI: 10.1016/j.ucl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although percutaneous nephrolithotomy (PCNL) is less morbid than open surgery, it still carries risks of significant complications as well as injury to the renal parenchyma. Flexible ureteroscopic stone removal, although causes no appreciable damage to the renal parenchyma, has limitations, most notably, a lower stone-free rate than PCNL. Advances in our knowledge regarding ureteral physiology combined with technical developments applied to ureteral access sheath deployment and size may well propel retrograde intrarenal surgery to the forefront of kidney stone removal, regardless of stone size or location.
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Affiliation(s)
- Pengbo Jiang
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA.
| | - Andrew Brevik
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
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5
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Jones P, Beisland C, Ulvik Ø. Current status of thulium fibre laser lithotripsy: an up-to-date review. BJU Int 2021; 128:531-538. [PMID: 34273234 DOI: 10.1111/bju.15551] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To perform an up-to-date review to scope the current status of the thulium fibre laser (TFL) in the setting of stone lithotripsy and provide a guide for the clinical urologist. METHODS A review of world literature was performed to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared. RESULTS To date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of miniaturised percutaneous nephrolithotomy (mini-PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, the range of settings has been 0.1-4 J × 7-300 Hz for both URS and mini-PCNL. Stones ranging from 0.4-3.2 and 1.5-3 cm have been treated with URS and mini-PCNL, respectively. The final stone-free rate for TFL has ranged from 66.6% to 100% and 85-100% for URS and mini-PCNL, respectively. The average length of stay ranged from 0.5 to 2.4 days in the URS group, but no studies have been reported this for mini-PCNL. Operative times in all the studies (both URS and mini PCNL) were <60 min. CONCLUSION Initial clinical studies reveal that TFL appears to be efficacious in the setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position, as well as determine the optimal settings for use in clinical practice.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Tzelves L, Somani B, Berdempes M, Markopoulos T, Skolarikos A. Basic and advanced technological evolution of laser lithotripsy over the past decade: An educational review by the European Society of Urotechnology Section of the European Association of Urology. Turk J Urol 2021; 47:183-192. [PMID: 35929871 PMCID: PMC8260082 DOI: 10.5152/tud.2021.21030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/09/2021] [Indexed: 03/19/2024]
Abstract
Laser disintegration of urinary stones is a cornerstone of urolithiasis treatment in the modern era. Despite the wide clinical use of stone lasers, basic and advanced technological achievements and developments are difficult to comprehend and interpret by the average urologist. A descriptive analysis of laser production and stone disintegration mechanisms was performed. We focused on physics of modern types of lithotripters, the construction of laser fibers, laser parameters, new modes, settings, and lithotripsy techniques. The main principle of laser emission remains the same since the first emitting laser was produced. Peak power density and short interaction time lead to photothermal effects responsible for stone disintegration. Modern lithotripters such as Holmium: YAG (low/high power, Moses technology) and thulium fiber laser show basic construction differences with the physical properties of the latter being superior, at least in in vitro studies. By adjusting lasing parameters, a wide spectrum of stone ablation from fragmentation to dusting can be achieved. New technology allows for the production of real dust. Knowledge of laser fiber construction and physical properties are useful in marketing and clinical use. Urologists should understand the physical and physiological background of the lasers used in their everyday practice for stone fragmentation.
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Affiliation(s)
- Lazaros Tzelves
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Bhaskar Somani
- University Hospital, Southampton NHS foundation Trust, Southampton, UK
| | - Marinos Berdempes
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Titos Markopoulos
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
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Lildal SK, Andreassen KH, Baard J, Brehmer M, Bultitude M, Eriksson Y, Ghani KR, Jung H, Kamphuis G, Kronenberg P, Turney B, Traxer O, Ulvik Ø, Osther PJS. Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy. World J Urol 2020; 39:1673-1682. [PMID: 33067728 PMCID: PMC8217045 DOI: 10.1007/s00345-020-03481-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety. Methods A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark. Results and conclusions Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.
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Affiliation(s)
| | - Kim Hovgaard Andreassen
- Department of Urology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne Brehmer
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Matthew Bultitude
- Urology Centre and Stone Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ylva Eriksson
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Helene Jung
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Guido Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Ben Turney
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Palle Jörn Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
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Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O. What is the exact definition of stone dust? An in vitro evaluation. World J Urol 2020; 39:187-194. [PMID: 32270283 DOI: 10.1007/s00345-020-03178-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. METHODS Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. RESULTS All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm. CONCLUSION A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.
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Affiliation(s)
- Etienne Xavier Keller
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Steeve Doizi
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Service d'Urologie, AP-HP, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. .,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
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9
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Traxer O, Keller EX. Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser. World J Urol 2020; 38:1883-1894. [PMID: 30729311 PMCID: PMC7363731 DOI: 10.1007/s00345-019-02654-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/24/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To compare the operating modes of the Holmium:YAG laser and Thulium fiber laser. Additionally, currently available literature on Thulium fiber laser lithotripsy is reviewed. MATERIALS AND METHODS Medline, Scopus, Embase, and Web of Science databases were searched for articles relating to the operating modes of Holmium:YAG and Thulium fiber lasers, including systematic review of articles on Thulium fiber laser lithotripsy. RESULTS The laser beam emerging from the Holmium:YAG laser involves fundamental architectural design constraints compared to the Thulium fiber laser. These differences translate into multiple potential advantages in favor of the Thulium fiber laser: four-fold higher absorption coefficient in water, smaller operating laser fibers (50-150 µm core diameter), lower energy per pulse (as low as 0.025 J), and higher maximal pulse repetition rate (up to 2000 Hz). Multiple comparative in vitro studies suggest a 1.5-4 times faster stone ablation rate in favor of the Thulium fiber laser. CONCLUSIONS The Thulium fiber laser overcomes the main limitations reported with the Holmium:YAG laser relating to lithotripsy, based on preliminary in vitro studies. This innovative laser technology seems particularly advantageous for ureteroscopy and may become an important milestone for kidney stone treatment.
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Affiliation(s)
- Olivier Traxer
- Sorbonne Université, Service d'Urologie, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France.
- Sorbonne Université, Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Hôpital Tenon, 75020, Paris, France.
| | - Etienne Xavier Keller
- Sorbonne Université, Service d'Urologie, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France
- Sorbonne Université, Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Hôpital Tenon, 75020, Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Danilovic A, Cavalanti A, Rocha BA, Traxer O, Torricelli FCM, Marchini GS, Mazzucchi E, Srougi M. Assessment of Residual Stone Fragments After Retrograde Intrarenal Surgery. J Endourol 2019; 32:1108-1113. [PMID: 30398369 DOI: 10.1089/end.2018.0529] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To define the most suitable approach to assess residual stone fragments after retrograde intrarenal surgery (RIRS). METHODS Ninety-two patients (115 renal units) submitted to RIRS for symptomatic kidney stones >5 mm and <20 mm or <15 mm in the lower Calyx diagnosed by noncontrast CT (NCCT) were prospectively studied. Residual fragments were assessed by endoscopic evaluation (END) at the end of the procedure and by NCCT, ultrasonography (US), and kidney, ureter, and bladder radiograph (KUB) on the 90th postoperative day (POD). NCCT was considered the gold standard for the evaluation of residual fragments after RIRS. RESULTS The 90th POD NCCT resulted in stone-free status in 74.8% (86/115), 0-2 mm in 8.7% (10/115), and >2 mm residual fragments in 16.5% (19/115) renal units. Stone-free status by END at the end of RIRS was coincident with NCCT in 93.0% of the cases (40/43). There were no cases of residual fragments >2 mm on NCCT if END resulted in stone-free status. In all cases where END resulted in residual fragments >2 mm, US proved to be correct according to NCCT. Neither US nor KUB was able to identify residual fragments between 0 and 2 mm. KUB had only 31.6% (6/19) sensitivity to detect residual fragments >2 mm and did not add sensitivity or specificity to US. CONCLUSIONS In the follow-up imaging after RIRS, we suggest that if END resulted in residual fragments <2 mm, a 90th POD NCCT should be performed. US may be used if END showed fragments >2 mm.
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Affiliation(s)
- Alexandre Danilovic
- 1 Department of Urology and Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Andrea Cavalanti
- 2 Department of Radiology, Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Bruno Aragão Rocha
- 2 Department of Radiology, Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Olivier Traxer
- 3 Sorbonne Université , GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | | | - Giovanni Scala Marchini
- 1 Department of Urology and Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- 1 Department of Urology and Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Miguel Srougi
- 1 Department of Urology and Hospital das Clinicas, University of Sao Paulo Medical School , Sao Paulo, Brazil
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11
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Kronenberg P, Traxer O. The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 2019; 8:S398-S417. [PMID: 31656746 PMCID: PMC6790412 DOI: 10.21037/tau.2019.08.01] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been the gold-standard for laser lithotripsy over the last 20 years. However, recent reports about a new prototype thulium fiber laser (TFL) lithotripter have revealed impressive levels of performance. We therefore decided to systematically review the reality and expectations for this new TFL technology. This review was registered in the PROSPERO registry (CRD42019128695). A PubMed search was performed for papers including specific terms relevant to this systematic review published between the years 2015 and 2019, including already accepted but not yet published papers. Additionally, the medical sections of ScienceDirect, Wiley, SpringerLink, Mary Ann Liebert publishers, and Google Scholar were also searched for peer-reviewed abstract presentations. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized. The authors adhered to PRISMA guidelines for this review. The TFL emits laser radiation at a wavelength of 1,940 nm, and has an optical penetration depth in water about four-times shorter than the Ho:YAG laser. This results in four-times lower stone ablation thresholds, as well as lower tissue ablation thresholds. As the TFL uses electronically-modulated laser diodes, it offers the most comprehensive and flexible range of laser parameters among laser lithotripters, with pulse frequencies up to 2,200 Hz, very low to very high pulse energies (0.005-6 J), short to very long-pulse durations (200 µs up to 12 ms), and a total power level up to 55 W. The stone ablation efficiency is up to four-times that of the Ho:YAG laser for similar laser parameters, with associated implications for speed and operating time. When using dusting settings, the TFL outperforms the Ho:YAG laser in dust quantity and quality, producing much finer particles. Retropulsion is also significantly reduced and sometimes even absent with the TFL. The TFL can use small laser fibers (as small as 50 µm core), with resulting advantages in irrigation, scope deflection, retropulsion reduction, and (in)direct effects on accessibility, visibility, efficiency, and surgical time, as well as offering future miniaturization possibilities. Similar to the Ho:YAG laser, the TFL can also be used for soft tissue applications such as prostate enucleation (ThuFLEP). The TFL machine itself is seven times smaller and eight times lighter than a high-power Ho:YAG laser system, and consumes nine times less energy. Maintenance is expected to be very low due to the durability of its components. The safety profile is also better in many aspects, i.e., for patients, instruments, and surgeons. The advantages of the TFL over the Ho:YAG laser are simply too extensive to be ignored. The TFL appears to be a real alternative to the Ho:YAG laser and become a true game-changer in laser lithotripsy. Due to its novelty, further studies are needed to broaden our understanding of the TFL, and comprehend the full implications and benefits of this new technology, as well its limitations.
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Affiliation(s)
| | - Olivier Traxer
- Hôpital Tenon, Université Pierre et Marie Curie, Paris VI, Paris, France
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12
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Ho:YAG laser lithotripsy in non-contact mode: optimization of fiber to stone working distance to improve ablation efficiency. World J Urol 2018; 37:1933-1939. [PMID: 30511211 DOI: 10.1007/s00345-018-2589-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate how variable working distances between the laser fiber and the stone influence ablation volume. METHODS A laser fiber was fixed on a robotic arm perpendicular to an artificial stone. A single laser pulse was triggered at different working distances (0-2.0 mm in 0.2 mm increments) between the distal fiber tip and the stone. To achieve a measurable impact, pulse energy was set to 2 and 3 J, with either short or long pulse duration. Ablation volume was calculated with an optical microscope. Experiments were repeated five times for each setting. RESULTS Highest ablation volume was observed with a long pulse of 3 J at a working distance of 0.4 mm between the laser fiber and the stone surface (p value < 0.05). At 2 J, the highest ablation volume was noticed with a short pulse in contact mode. However, ablation volume of the latter was not significantly greater than with a long pulse of 2 J at a working distance of 0.4 mm (p value > 0.05). Compared to lithotripsy in contact mode, triggering a single long pulse at 0.4 mm increased ablation volume by 81% (p value = 0.016) at 2 J and by 89% (p value = 0.034) at 3 J. CONCLUSIONS For Ho:YAG laser lithotripsy, ablation volume may be higher in non-contact mode using long pulses, rather than in direct contact to the stone. Findings of the current study support the need of further studies of lithotripsy in non-contact mode.
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Abstract
PURPOSE OF REVIEW Laser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year. RECENT FINDINGS Variable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and "cleaving only" fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology. Laser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.
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Affiliation(s)
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
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14
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Proietti S, Somani B, Sofer M, Pietropaolo A, Rosso M, Saitta G, Gaboardi F, Traxer O, Giusti G. The "Body Mass Index" of Flexible Ureteroscopes. J Endourol 2017; 31:1090-1095. [PMID: 28835120 DOI: 10.1089/end.2017.0438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the "body mass index" (BMI) (weight and length) of 12 flexible ureteroscopes (digital and fiber optic) along with the light cables and camera heads, to make the best use of our instruments. MATERIALS AND METHODS Twelve different brand-new flexible ureteroscopes from four different manufacturers, along with eight camera heads and three light cables were evaluated. Each ureteroscope, camera head, and light cable was weighted; the total length of each ureteroscope, shaft, handle, flexible end-tip, and cable were all measured. RESULTS According to our measurements (in grams [g]), the lightest ureteroscope was the LithoVue (277.5 g), while the heaviest was the URF-V2 (942.5 g). The lightest fiber optic endoscope was the Viper (309 g), while the heaviest was the Cobra (351.5 g). Taking into account the entirety of the endoscopes, the lightest ureteroscope was the Lithovue and the heaviest was the Wolf Cobra with the Wolf camera "3 CHIP HD KAMERA KOPF ENDOCAM LOGIC HD" (1474 g). The longest ureteroscope was the URF-P6 (101.6 cm) and the shortest was the LithoVue (95.5 cm); whereas the Viper and Cobra had the longest shaft (69 cm) and URF-V had the shortest shaft (67.2 cm). The URF-V2 had the longest flexible end-tip (7.6 cm), while the LithoVue had the shortest end-tip (5.7 cm) in both directions (up/down), while the URF-V had the shortest upward deflection (3.7 cm). CONCLUSIONS Newer more versatile digital endoscopes were lighter than their traditional fiber optic counterparts in their entirety, with disposable endoscope having a clear advantage over other reusable ureteroscopes. Knowing the "BMI" of our flexible ureteroscopes is an important information that every endourologist should always take into consideration.
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Affiliation(s)
- Silvia Proietti
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Bhaskar Somani
- 2 Department of Urology, University Hospitals Southampton NHS Trust , Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Mario Sofer
- 3 Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Amelia Pietropaolo
- 2 Department of Urology, University Hospitals Southampton NHS Trust , Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Marco Rosso
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Giuseppe Saitta
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Franco Gaboardi
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
| | - Olivier Traxer
- 4 Department of Urology, GRC Lithiase (Groupe Recherche Clinique), Université Pierre et Marie Curie-Paris VI , Paris, France
| | - Guido Giusti
- 1 Department of Urology, San Raffaele Hospital , Ville Turro Division, Milan, Italy
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15
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Hernández RP, Caballero Romeu JP, Galiano Baena JF, Montoya Lirola MD, García Tabar PJ, Galán Llopis JA, Gonzálvez Piñera J, Mira Marcelí NA, Budía Alba A. Technical considerations about micro-ureteroscopy in children. J Pediatr Surg 2017; 52:1216. [PMID: 28431736 DOI: 10.1016/j.jpedsurg.2017.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Rebeca Polo Hernández
- Department of Urology, University General Hospital of Alicante, Pintor Baeza 12, Alicante 03010, Spain.
| | | | | | | | - Pedro José García Tabar
- Department of Urology, University General Hospital of Alicante, Pintor Baeza 12, Alicante 03010, Spain
| | - Juan Antonio Galán Llopis
- Department of Urology, University Hospital of Vinalopo, Tonico Sansano Mora 14, Elche, 03293, Alicante, Spain
| | - Jerónimo Gonzálvez Piñera
- Department of Pediatric Surgery, University General Hospital of Alicante, Pintor Baeza 12, Alicante 03010, Spain
| | - Nuria Albertos Mira Marcelí
- Department of Pediatric Surgery, University General Hospital of Alicante, Pintor Baeza 12, Alicante 03010, Spain
| | - Alberto Budía Alba
- Department of Urology, "La Fe" Polytechnic University Hospital in Valencia, Fernando Abril Martorell 106, Valencia 46026, Spain
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16
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Dragos LB, Somani BK, Sener ET, Buttice S, Proietti S, Ploumidis A, Iacoboaie CT, Doizi S, Traxer O. Which Flexible Ureteroscopes (Digital vs. Fiber-Optic) Can Easily Reach the Difficult Lower Pole Calices and Have Better End-Tip Deflection: In Vitro Study on K-Box. A PETRA Evaluation. J Endourol 2017; 31:630-637. [DOI: 10.1089/end.2017.0109] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laurian B. Dragos
- Clinical Emergency County Hospital “Pius Branzeu” Timisoara, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
| | - Bhaskar K. Somani
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- Urology Department, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Emre T. Sener
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- Urology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Salvatore Buttice
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- Urology Department, University of Messina, Messina, Italy
| | - Silvia Proietti
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milano, Italy
| | - Achilles Ploumidis
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- Urology Department, Athens Medical Center, Athens, Greece
| | | | - Steeve Doizi
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- Urology Department, Tenon Hospital, Paris, France
- University Pierre et Marie Curie Paris 6, GRC Lithiase #20, Paris, France
| | - Olivier Traxer
- PETRA—Progress in Endourology, Technology and Research Association, Paris, France
- University Pierre et Marie Curie Paris 6, GRC Lithiase #20, Paris, France
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17
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Comparison of laser fiber passage in ureteroscopic maximum deflection and their influence on deflection and irrigation: Do we really need the ball tip concept? World J Urol 2016; 35:313-318. [DOI: 10.1007/s00345-016-1873-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/02/2016] [Indexed: 12/23/2022] Open
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18
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Lusch A, Heidari E, Okhunov Z, Osann K, Landman J. Evaluation of Contemporary Holmium Laser Fibers for Performance Characteristics. J Endourol 2016; 30:567-73. [DOI: 10.1089/end.2015.0600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Achim Lusch
- Department of Urology, Medical Faculty Dusseldorf, Dusseldorf University, Dusseldorf, Germany
| | - Emon Heidari
- Department of Urology, University of California, Irvine, California
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, California
| | - Kathryn Osann
- Department of Urology, University of California, Irvine, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, California
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19
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Temperature Changes Inside the Kidney: What Happens During Holmium:Yttrium-Aluminium-Garnet Laser Usage? J Endourol 2016; 30:574-9. [DOI: 10.1089/end.2015.0747] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Kronenberg P, Traxer O. Lithotripsy Performance of Specially Designed Laser Fiber Tips. J Urol 2016; 195:1606-1612. [DOI: 10.1016/j.juro.2015.10.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Peter Kronenberg
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Université Paris 6 Pierre et Marie Curie-Hôpital Tenon (OT), Paris, France
| | - Olivier Traxer
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Université Paris 6 Pierre et Marie Curie-Hôpital Tenon (OT), Paris, France
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21
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Wilson CR, Hutchens TC, Hardy LA, Irby PB, Fried NM. A Miniaturized, 1.9F Integrated Optical Fiber and Stone Basket for Use in Thulium Fiber Laser Lithotripsy. J Endourol 2015; 29:1110-4. [DOI: 10.1089/end.2015.0124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher R. Wilson
- Department of Physics and Optical Science, University of North Carolina at Charlotte, North Carolina
| | - Thomas C. Hutchens
- Department of Physics and Optical Science, University of North Carolina at Charlotte, North Carolina
| | - Luke A. Hardy
- Department of Physics and Optical Science, University of North Carolina at Charlotte, North Carolina
| | - Pierce B. Irby
- McKay Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
| | - Nathaniel M. Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, North Carolina
- McKay Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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22
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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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