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Kose E, Bostanci Y, Gulsen M, Sahin F, Kalayci O, Ozden E, Yakupoglu YK, Sarikaya S. Monitoring Intrarenal temperature changes during Ho: YAG laser lithotripsy in patients undergoing retrograde intrarenal surgery: a novel pilot study. Urolithiasis 2024; 52:86. [PMID: 38869637 DOI: 10.1007/s00240-024-01592-1] [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: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
Ho: YAG laser lithotripsy is widely used for urinary stone treatment, but concerns persist regarding its thermal effects on renal tissues. This study aimed to monitor intrarenal temperature changes during kidney stone treatment using retrograde intrarenal surgery with Ho: YAG laser. Fifteen patients were enrolled. Various laser power settings (0.8 J/10 Hz, 1.2 J/12 Hz) and irrigation modes (10 cc/min, 15 cc/min, 20 cc/min, gravity irrigation, and manual pump irrigation) were used. A sterile thermal probe was attached to a flexible ureterorenoscope and delivered into the calyceal system via the ureteral access sheath. Temperature changes were recorded with a T-type thermal probe with ± 0.1 °C accuracy. Laser power significantly influenced mean temperature, with a 4.981 °C difference between 14 W and 8 W laser power (p < 0.001). The mean temperature was 2.075 °C higher with gravity irrigation and 2.828 °C lower with manual pump irrigation (p = 0.038 and p = 0.005, respectively). Body mass index, laser power, irrigation model, and operator duty cycle explained 49.5% of mean temperature variability (Adj. R2 = 0.495). Laser power and operator duty cycle positively impacted mean temperature, while body mass index and specific irrigation models affected it negatively. Laser power and irrigation rate are critical for intrarenal temperature during Ho: YAG laser lithotripsy. Optimal settings and irrigation strategies are vital for minimizing thermal injury risk. This study underscores the need for ongoing research to understand and mitigate thermal effects during laser lithotripsy.
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Affiliation(s)
- Ertugrul Kose
- Department of Urology, Gazi State Hospital, Ilkadım, Samsun, Turkey.
| | - Yakup Bostanci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Gulsen
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Fevzi Sahin
- Department of Mechanical Engineering, Faculty of Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Onur Kalayci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ender Ozden
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Saban Sarikaya
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Li Z, Wu S, Liu T, Li S, Wang X. Optimal parameter settings of thulium fiber laser for ureteral stone lithotripsy: a comparative study in two different testing environments. Urolithiasis 2024; 52:78. [PMID: 38801419 DOI: 10.1007/s00240-024-01585-0] [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: 04/03/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
This study aims to identify optimal parameters for using Thulium fiber lasers (TFL) in ureteral stone lithotripsy to ensure laser safety and maximize efficacy. Our goal is to improve the outcomes of single-use semi-rigid ureteroscopy for treating stones located in the proximal ureter. A clinically relevant thermal testing device was designed to investigate heating effects during TFL stone fragmentation. The device was utilized to identify safe power thresholds for TFL at various irrigation rates. Three other devices were used to assess varying pulse energy effects on stone fragmentation efficiency, dusting, retropulsion, and depth of tissue vaporization. Comparative experiments in fresh porcine renal units were performed to validate the efficacy and safety of optimal TFL parameters for semi-rigid ureteroscopy in proximal ureteral stone procedures. Our study found that the improved device generated a higher thermal effect. Furthermore, the safe power threshold for laser lithotripsy increased as the irrigation rate was raised. At an irrigation rate of 40 ml/min, it is safe to use an average power of less than 30 watts. Although increasing pulse energy has a progressively lower effect on fragmentation and dust removal efficiency, it did lead to a linear increase in stone displacement and tissue vaporization depth. Thermal testing showed 20 W (53.87 ± 2.67 °C) indicating potential urothelial damage. In our study of laser lithotripsy for proximal ureteral stones, the group treated with 0.3 J pulses had several advantages compared to the 0.8 J group: Fewer large fragments (> 4 mm): 0 vs. 1.67 fragments (1-2.25), p = 0.002, a lower number of collateral tissue injuries: 0.50 (0-1.25) vs. 2.67 (2-4), p = 0.011, and lower stone retropulsion grading: 0.83 (0.75-1) vs. 1.67 (1-2), p = 0.046. There was no significant difference in operating time between the groups (443.33 ± 78.30 s vs. 463.17 ± 75.15 s, p = 0.664). These findings suggest that TFL irradiation generates a greater thermal effect compared to non-irradiated stones. Furthermore, the thermal effect during laser lithotripsy is influenced by both power and irrigation flow rate. Our study suggests that using a power below 15 W with an irrigation flow rate of 20 ml/min is safe. Moreover, a pulse energy of 0.3 J appears to be optimal for achieving the best overall stone fragmentation effect.
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Affiliation(s)
- Zhilong Li
- Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Shaojie Wu
- Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Tongzu Liu
- Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Sheng Li
- Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Xinghuan Wang
- Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
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Yu S, Liu L, Li Y, Zhou L, Chen J, Li H, Wang K. Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts? Asian J Urol 2024; 11:156-168. [PMID: 38680593 PMCID: PMC11053312 DOI: 10.1016/j.ajur.2023.11.001] [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: 01/31/2023] [Accepted: 11/24/2023] [Indexed: 05/01/2024] Open
Abstract
Objective Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety. Methods We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction. Results We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency. Conclusion While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.
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Affiliation(s)
- Simin Yu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Marom R, Dau JJ, Ghani KR, Hall TL, Roberts WW. Assessing renal tissue temperature changes and perfusion effects during laser activation in an in vivo porcine model. World J Urol 2024; 42:197. [PMID: 38530484 DOI: 10.1007/s00345-024-04896-4] [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: 09/09/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION High fluid temperatures have been seen in both in vitro and in vivo studies with laser lithotripsy, yet the thermal distribution within the renal parenchyma has not been well characterized. Additionally, the heat-sink effect of vascular perfusion remains uncertain. Our objectives were twofold: first, to measure renal tissue temperatures in response to laser activation in a calyx, and second, to assess the effect of vascular perfusion on renal tissue temperatures. METHODS Ureteroscopy was performed in three porcine subjects with a prototype ureteroscope containing a temperature sensor at its tip. A needle with four thermocouples was introduced percutaneously into a kidney with ultrasound guidance to allow temperature measurement in the renal medulla and cortex. Three trials of laser activation (40W) for 60 s were conducted with an irrigation rate of 8 ml/min at room temperature in each subject. After euthanasia, three trials were repeated without vascular perfusion in each subject. RESULTS Substantial temperature elevation was observed in the renal medulla with thermal dose in two of nine trials exceeding threshold for tissue injury. The temperature decay time (t½) of the non-perfused trials was longer than in the perfused trials. The ratio of t½ between them was greater in the cortex than the medulla. CONCLUSION High-power laser settings (40W) can induce potentially injurious temperatures in the in vivo porcine kidney, particularly in the medullary region adjacent to the collecting system. Additionally, the influence of vascular perfusion in mitigating thermal risk in this susceptible area appears to be limited.
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Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA.
| | - Julie J Dau
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William W Roberts
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Wanderling C, Saxton A, Phan D, Doersch KM, Shepard L, Schuler N, Hassig S, Quarrier S, Osinski T, Ghazi A. Getting hot in here! Comparison of Holmium vs. thulium laser in an anatomic hydrogel kidney model. Urolithiasis 2024; 52:49. [PMID: 38520506 DOI: 10.1007/s00240-024-01541-y] [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: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024]
Abstract
As laser technology has advanced, high-power lasers have become increasingly common. The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has long been accepted as the standard for laser lithotripsy. The thulium fiber laser (TFL) has recently been established as a viable option. The aim of this study is to evaluate thermal dose and temperature for the Ho:YAG laser to the TFL at four different laser settings while varying energy, frequency, operator duty cycle (ODC). Utilizing high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system (PCS) with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Ho:YAG laser or TFL. At a standard power (40W) and irrigation (17.9 ml/min), we evaluated four different laser settings with ODC variations with different time-on intervals. Temperature was measured at two separate locations. In general, the TFL yielded greater cumulative thermal doses than the Ho:YAG laser. Thermal dose and temperature were typically greater at the stone when compared away from the stone. Regarding the TFL, there was no general trend if fragmentation or dusting settings yielded greater thermal doses or temperatures. The TFL generated greater temperatures and thermal doses in general than the Ho:YAG laser with Moses technology. Temperatures and thermal doses were greater closer to the laser fiber tip. It is inconclusive as to whether fragmentation or dusting settings elicit greater thermal loads for the TFL. Energy, frequency, ODC, and laser-on time significantly impact thermal loads during ureteroscopic laser lithotripsy, independent of power.
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Affiliation(s)
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Dennis Phan
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen M Doersch
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren Shepard
- Johns Hopkins Brady Institute of Urologic Surgery, Baltimore, MD, USA
| | - Nathan Schuler
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen Hassig
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Osinski
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Johns Hopkins Brady Institute of Urologic Surgery, Baltimore, MD, USA
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Wanderling C, Saxton A, Phan D, Doersch K, Shepard L, Schuler N, Osinski T, Quarrier S, Ghazi A. WATTS happening? Evaluation of thermal dose during holmium laser lithotripsy in a high-fidelity anatomic model. World J Urol 2024; 42:157. [PMID: 38483596 DOI: 10.1007/s00345-024-04821-9] [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: 08/20/2023] [Accepted: 01/16/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE To evaluate the thermal profiles of the holmium laser at different laser parameters at different locations in an in vitro anatomic pelvicalyceal collecting system (PCS) model. Laser lithotripsy is the cornerstone of treatment for urolithiasis. With the prevalence of high-powered lasers, stone ablation efficiency has become more pronounced. Patient safety remains paramount during surgery. It is well recognized that the heat generated from laser lithotripsy has the potential to cause thermal tissue damage. METHODS Utilizing high-fidelity, 3D printed hydrogel models of a PCS with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations-at the stone and away from the stone. RESULTS Temperatures were highest closest to the laser tip with a decrease away from the laser. Fluid temperatures increased with longer laser-on times and higher ODCs. Thermal doses were greater with increased ODCs and the threshold for thermal injury was reached for ODCs of 75% and 100%. CONCLUSION Temperature generation and thermal dose delivered are greatest closer to the tip of the laser fiber and are not dependent on power alone. Significant temperature differences were noted between four laser settings at a standardized power (40 W). Temperatures can be influenced by a variety of factors, such as laser-on time, operator duty cycle, and location in the PCS.
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Affiliation(s)
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Dennis Phan
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen Doersch
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren Shepard
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Nathan Schuler
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Osinski
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
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Ballesta Martinez B, Magee DS, Tsaturyan A, Tatanis V, Peteinaris A, Tancabel C, Chau M, Van der Werf S, Saluja MS, Aw I, Yuminaga Y, Lozinskiy M, Lee S, Rosenberg M, Liatsikos E, Kallidonis P. Radiological Density, Atomic Numbers, and Stone Fragmentation of Bego Stones Used for Research in Endourology: Comparison to Real Urinary Stones. J Endourol 2024; 38:179-185. [PMID: 37933899 DOI: 10.1089/end.2023.0091] [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] [Indexed: 11/08/2023] Open
Abstract
Objective: The aim of the study was to characterize artificial stones used for research in endourology in terms of radiological properties and hardness, based on stone fragmentation, and to compare them with real stones. Materials and Methods: We built artificial stones using BegoStone Plus™ powder (BEGO, Lincoln, RI), with powder (g)-water (mL) ratios ranging from 15:03 to 15:12. The CT Gemstone Spectral Imaging Software® (GE Medical Systems, LLC, Waukesha, WI) was used to evaluate the radiological density in HU and spectral properties. Stone fragmentation was assessed in an in vitro experimental setting. These properties of artificial stones were compared with real urinary calculi. Results: Regarding radiological density in terms of HUs, 15:03 artificial calculi showed similar results when compared with real stones comprising calcium oxalate and calcium phosphate. The 15:03 and 15:04 artificial stones showed similar spectral property results to calcium pyrophosphate stones. The 15:11 artificial stones showed similar stone fragmentation results to real stones comprising uric acid, and 15:03 artificial calculi showed similar results to apatite and cystine stones. Conclusions: Artificial stones are useful for research in endourology. Stones with a powder (g)-water (mL) ratio of 15:03 proved to mimic real hard stones in terms of HUs, atomic number, and stone fragmentation in our study and could be used as artificial hard stones, and 15:11 stones showed similar stone fragmentation to uric acid stones. Our study might suggest that standard Bego stones are useful to investigate different areas in endourology, but not radiological properties because radiological homogeneity is not ensured unless more sophisticated mixing methods are used.
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Affiliation(s)
- Begoña Ballesta Martinez
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Urology, University of Patras, Patras, Greece
- University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Daniel Savio Magee
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | | | | | - Clare Tancabel
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Matthew Chau
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Steven Van der Werf
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Manmeet S Saluja
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ivan Aw
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yuigi Yuminaga
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Mikhail Lozinskiy
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sunny Lee
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Melanie Rosenberg
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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He Z, Xun Y, Wang S. Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro. World J Urol 2024; 42:62. [PMID: 38285266 DOI: 10.1007/s00345-023-04705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/01/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE To evaluate the cooling effect and other advantages of a novel circulation system for ureteroscopic holmium laser lithotripsy (URSL) in a standardized in vitro model. MATERIALS AND METHODS The novel circulation system was assembled by connecting a 4Fr ureteral catheter and a filter. Trails were divided into a new URSL group and a conventional URSL group. First, different power settings (18-30 W) of the holmium laser and irrigation flow rates (20-50 mL/min) were used to evaluate the thermal effect on the lithotripsy site of all groups. Then, renal pelvic temperature and pressure were assessed during URSL at a power of 1.5 J/20 Hz and irrigation flow rates of (20-50 mL/min). Finally, the whole process of lithotripsy was performed at 1.5 J/20 Hz (operator duty cycle ODC: 50%) with an irrigation flow rate of 30 mL/min. The time required for lithotripsy, visual field clarity, and stone migration were observed. RESULTS Temperature of the lithotripsy point was significantly lower in the new URSL group than in the conventional group (P < 0.05) with irrigation rates (20, 30 mL/min). The renal pelvic pressure of the new group was significantly lower than that of the conventional group in which intrarenal hypertension developed at an irrigation rate of 50 ml/min. The new group had better visual clarity and lesser stone upward migration when lithotripsy was performed at 1.5 J/20 Hz and 30 ml/min. CONCLUSION The novel circulation system is more effective in reducing the thermal effects of URSL, pelvic pressure, stone upward migration, and improving the visual clarity of the operative field.
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Affiliation(s)
- Zonghai He
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, People's Republic of China
- Department of Urology, Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, People's Republic of China.
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, People's Republic of China.
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Corrales M, Panthier F, Solano C, Candela L, Traxer O. Laser safety, warnings, and limits in retrograde intrarenal surgery. Actas Urol Esp 2024; 48:19-24. [PMID: 37356576 DOI: 10.1016/j.acuroe.2023.06.009] [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: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the thulium fiber laser (TFL). METHODS Narrative overview of the most relevant articles published in MEDLINE and Scopus databases about this subject. RESULTS TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions. CONCLUSION The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy. In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL.
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Affiliation(s)
- M Corrales
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France.
| | - F Panthier
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - C Solano
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - L Candela
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France; Division de Oncología Experimental/Unidad de Urología, URI, IRCCS Hospital San Raffaele, Milán, Italy
| | - O Traxer
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
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10
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Chen J, Mishra A, Medairos R, Antonelli J, Preminger GM, Lipkin ME, Zhong P. In vitro investigation of stone ablation efficiency, char formation, spark generation, and damage mechanism produced by thulium fiber laser. Urolithiasis 2023; 51:124. [PMID: 37917225 PMCID: PMC10880548 DOI: 10.1007/s00240-023-01501-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
To investigate stone ablation characteristics of thulium fiber laser (TFL), BegoStone phantoms were spot-treated in water at various fiber tip-to-stone standoff distances (SDs, 0.5 ~ 2 mm) over a broad range of pulse energy (Ep, 0.2 ~ 2 J), frequency (F, 5 ~ 150 Hz), and power (P, 10 ~ 30 W) settings. In general, the ablation speed (mm3/s) in BegoStone decreased with SD and increased with Ep, reaching a peak around 0.8 ~ 1.0 J. Additional experiments with calcium phosphate (CaP), uric acid (UA), and calcium oxalate monohydrate (COM) stones were conducted under two distinctly different settings: 0.2 J/100 Hz and 0.8 J/12 Hz. The concomitant bubble dynamics, spark generation and pressure transients were analyzed. Higher ablation speeds were consistently produced at 0.8 J/12 Hz than at 0.2 J/100 Hz, with CaP stones most difficult yet COM and UA stones easier to ablate. Charring was mostly observed in CaP stones at 0.2 J/100 Hz, accompanied by strong spark-generation, explosive combustion, and diminished pressure transients, but not at 0.8 J/12 Hz. By treating stones in parallel fiber orientation and leveraging the proximity effect of a ureteroscope, the contribution of bubble collapse to stone ablation was found to be substantial (16% ~ 59%) at 0.8 J/12 Hz, but not at 0.2 J/100 Hz. Overall, TFL ablation efficiency is significantly better at high Ep/low F setting, attributable to increased cavitation damage with less char formation.
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Affiliation(s)
- Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Robert Medairos
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Jodi Antonelli
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Michael E Lipkin
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA.
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11
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Marom R, Dau JJ, Hall TL, Ghani KR, Louters MM, Kim HJ, Khajeh NR, Roberts WW. Thermal Safety Boundaries for Laser Power and Irrigation Rate During Ureteroscopy: In Vivo Porcine Assessment With a Ho:YAG Laser. Urology 2023; 180:81-85. [PMID: 37482102 DOI: 10.1016/j.urology.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To map thermal safety boundaries during ureteroscopy (URS) with laser activation in two in vivo porcine subjects to better understand the interplay between laser power, irrigation rate, and fluid temperature in the collecting system. METHODS URS was performed in two in vivo porcine subjects with a prototype ureteroscope containing a thermocouple at its tip. Up to 6 trials of 60 seconds laser activation were carried out at each selected power setting and irrigation rate. Thermal dose was calculated for each trial, and laser power-irrigation rate parameter pairs were categorized based on number of trials that exceeded a thermal dose of 120 equivalent minutes. RESULTS The collecting fluid temperature was increased with greater laser power and slower irrigation rate. In the first porcine subject, 25 W of laser power could safely be applied if irrigation was at least 15 mL/min, and 48 W with at least 30 mL/min. Intermediate values followed a linear curve between these bounds. For the second subject, where the calyx appeared larger, 15 W laser power required 9 mL/min irrigation, 48 W required 24 mL/min, and intermediate points also followed a near-linear curve. CONCLUSION This study validates previous bench research and provides a conceptual framework for selection of safe laser lithotripsy settings and irrigation rates during URS with laser lithotripsy. Additionally, it provides insight and guidance for future development of thermal mitigation strategies and devices.
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Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | | | | | - Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, South Korea
| | | | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
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12
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Wang J, Wang X, Zhong H, Xie W, Xi Q. Prospective observational study on the prognosis of ureteral lesions caused by impacted stones via dual-energy spectral computed tomography. Asian J Urol 2023; 10:534-540. [PMID: 38024436 PMCID: PMC10659980 DOI: 10.1016/j.ajur.2022.05.007] [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: 06/03/2021] [Revised: 10/29/2021] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture. On this basis, the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture. Methods This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019. They underwent an abdominal scan on a dual-energy spectral computed tomography. During surgery, the operator used ureteroscopy to identify ureteral lesions, which were classified into four categories: edema, polyps, pallor, and hardening. Seven months later, 90 patients were reviewed for the degree of hydronephrosis. Results Endoscopic observations revealed 38 (41%) cases of ureteral edema, 20 (22%) cases of polyps, 13 (14%) cases of pallor, and 22 (24%) cases of hardening. There were significant differences in hydronephrosis, the period of impaction, the calcium concentration of the ureter, and the slope of the spectral Hounsfield unit curve between the four groups. After that, we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening. Receiver operating characteristic curve analysis showed that 5.3 mg/cm³ calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening. The result of follow-up showed that 80 patients had complete remission of hydronephrosis, with a complete remission rate of 61.9% (13/21) in the hardening group and 97.1% (67/69) in the non-hardening group (p<0.001). Conclusion Calcium concentration of the ureter is an independent predictor of ureteral hardening. Patients with ureteral hardening have more severe hydronephrosis after ureteroscopic lithotripsy. When the calcium concentration of the ureter is less than 5.3 mg/cm³, ureteral lesions should be actively treated.
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Affiliation(s)
- Junjie Wang
- Department of Urology, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haozhou Zhong
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wengui Xie
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qilin Xi
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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13
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Wu Z, Wei J, Sun C, Huangfu Q, Wang B, Huang G, Qi K, Jiang Z, Zhu W, Wen J. Temperature changes of renal calyx during high-power flexible ureteroscopic Moses holmium laser lithotripsy: a case analysis study. Int Urol Nephrol 2023:10.1007/s11255-023-03611-3. [PMID: 37145376 DOI: 10.1007/s11255-023-03611-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve. METHODS The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80 Hz/0.3 J and 32 W, 80 Hz/0.4 J) were performed for each patient with room temperature (25 °C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80 Hz/0.3 J, 32 W, 80 Hz/0.4 J and 40 W, 80 Hz/0.4 J) with warmed (37 °C) and room temperature (25 °C) irrigation. RESULTS Twenty-two patients were enrolled in our study. With 30 ml/min or 60 ml/min irrigation, the local temperature of the renal calyx did not reach 43 °C in any patient under 25 °C irrigation after 60 s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25 °C. Under the irrigation of 37 °C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43 °C at the setting of 32 W, 30 ml/min and 40 W, 30 ml/min after continuing laser activation. CONCLUSION In the irrigation of 60 ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32 W or higher power holmium laser in the renal calyces for more than 60 s in the limited irrigation of 30 ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
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Affiliation(s)
- Zhiyue Wu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jingchao Wei
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chengfang Sun
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Huangfu
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bohan Wang
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangyi Huang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Kai Qi
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Zeping Jiang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Wuan Zhu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jiaming Wen
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
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14
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Tokas T, Rice P, Seitz C, Gauhar V, Somani B. Temperature change during laser upper-tract endourological procedures: current evidence and future perspective. Curr Opin Urol 2023; 33:108-115. [PMID: 36226721 DOI: 10.1097/mou.0000000000001048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW To examine the most recent data on temperatures produced during laser lithotripsy and to provide several strategies for maintaining lower values and reducing the risk of complications during endourological treatment. RECENT FINDINGS Endourologists have access to a wide range of alternatives with the help of the holmium: yttrium-aluminum-garnet (Ho:YAG), thulium: yttrium-aluminum-garnet (TM:YAG), and thulium fiber laser (TFL) that compose a robust and adaptable laser lithotripsy armamentarium. Nevertheless, the threat of thermal damage increases as the local temperature rises with high total power. Most endourologists are not familiar with normal and pathological temperature ranges, how elevated temperatures affect perioperative problems, or how to avoid them. SUMMARY Increased temperatures experienced during laser lithotripsy may affect the course of the healing process. All lasers display a safe temperature profile at energies below 40 W. At equal power settings, Ho:YAG, Tm:YAG, and TFL lasers change the temperature comparably. Shorter on/off laser activation intervals, chilled irrigation, open irrigation systems, and UASs all aid in maintaining acceptable temperatures.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Austria
| | - Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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15
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Yamashita S, Inoue T, Imai S, Maruyama Y, Iwahashi Y, Deguchi R, Kohjimoto Y, Fujisawa M, Hara I. Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study. J Clin Med 2023; 12:jcm12041409. [PMID: 36835944 PMCID: PMC9961509 DOI: 10.3390/jcm12041409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
The differences in dynamic thermal changes during laser lithotripsy between various laser pulse modes are unclear. We used thermography to evaluate the temporal changes in high-temperature areas during laser activation in order to compare different laser pulse modes. An unroofed artificial kidney model was used for the experiments. The laser fired for 60 s with a laser setting of 0.4 J/60 Hz in the following four different laser pulse modes without saline irrigation: short pulse mode (SPM), long pulse mode (LPM), virtual basket mode (VBM) and Moses mode (MM). Using the first 30 s of moving images, we compared the ratio of a high-temperature area of >43 °C to the total area every 5 seconds. The dynamic changes in fluid temperatures were shown to be different between the laser pulse modes. The extent of the high-temperature areas during the laser activation was large in the LPM and MM compared with the SPM and VBM. While the high-temperature areas expanded in an anterior direction in the early laser irradiation period using the LPM, they spread in a posterior direction in the early laser activation period using the MM. Although only the temperature profile in one specific plane was investigated, these results are considered useful for preventing thermal injuries during retrograde intrarenal surgeries.
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Affiliation(s)
- Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
- Correspondence: ; Tel.: +81-73-441-0637; Fax: +81-73-444-8085
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, 5-7-17 Kitanagasadori, Chuo-ku, Kobe City 650-0012, Japan
- Department of Urology, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City 650-0017, Japan
| | - Satoshi Imai
- Department of Urology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-ku, Kobe City 658-0064, Japan
| | - Yohei Maruyama
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
| | - Yuya Iwahashi
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
| | - Ryusuke Deguchi
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City 650-0017, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0012, Japan
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16
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Taguchi M, Kinoshita H. Comparison of Empower and M-arm for One-surgeon Basketing in Ureteroscopic Lithotripsy: A Simulator Study by Non-doctors. Urology 2023; 172:44-48. [PMID: 36400268 DOI: 10.1016/j.urology.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the Empower and M-arm for stone retrieval during ureteroscopic lithotripsy in a simulator. METHODS We used flexible ureteroscopy to compare use of the Empower and use of the M-arm, both of which are one-surgeon basketing techniques. LithoVue and ZeroTip stone extraction devices were used. All participants were nurses who had never handled a ureteroscope. They retrieved 3 stones in the simulator using the Empower or M-arm. We compared the stone retrieval time, number of times the retrieval device was opened and closed, number of times the line of sight was removed from the endoscope monitor, number of times the participant lost sight of a stone, and participants' subjective evaluations. RESULTS The stone retrieval time was significantly shorter with the Empower than M-arm (10.0 vs. 19.9 min, respectively; P = .02). The mean number of times the retrieval device was opened and closed and the mean number of times the line of sight was removed from the endoscope monitor were significantly lower with the Empower (24 vs. 53 times, P = .01 and 3.1 vs. 51.5 times, P < .001, respectively). The mean number of times the participant lost sight of a stone tended to be lower with the Empower (9.4 vs. 25.3, P = .06). All participants indicated that the Empower is better for stone retrieval by beginners. CONCLUSION The Empower reduces the stone retrieval time compared with the M-arm. We consider that the Empower has the potential to be useful in ureteroscopic lithotripsy.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation Inc., Osaka, Japan; Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Dean NS, Krambeck AE. Endourologic Procedures of the Upper Urinary Tract and the Effects on Intrarenal Pressure and Temperature. J Endourol 2023; 37:191-198. [PMID: 36266997 DOI: 10.1089/end.2022.0630] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Endourologic procedures, including ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL), are associated with an elevation in intrarenal pressures (IRPs) and irrigation temperatures. Recent research has focused on methods to reduce IRP and irrigation temperatures, with the ultimate goal to limit the consequences associated with these deviations. The purpose of our study is to provide a narrative review on the effects of endourologic procedures on pressure and temperature and provide recommendations to minimize these changes. Methods: A literature review was performed using PubMed. The search was limited to English human and nonhuman studies. Abstracts were reviewed for inclusion in our narrative review. Results: Human and animal models suggest that URS and PCNL are associated with peak IRPs above a "safe" threshold. Strategies to minimize pressures focus on minimizing irrigation flow into the upper tract and maximizing flow out of the system. High IRP has been associated with postoperative pain and infectious complications. Elevated irrigation temperatures are associated with high-power lasers during URS. Strategies to minimize irrigation temperatures focus on maximizing irrigation flow during laser activation and minimizing thermal energies associated with lithotripsy. Conclusions: Rises in pressure and irrigation temperatures associated with endourologic procedures are becoming increasingly recognized in the urologic community. Human studies examining "safe" thresholds for IRP and irrigation temperatures are limited. Temperature- and pressure-sensing technologies will aid in identifying the clinical consequences of elevated IRPs and irrigation temperatures, resulting in strategies to minimize them.
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Affiliation(s)
- Nick S Dean
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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18
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Assessing critical temperature dose areas in the kidney by magnetic resonance imaging thermometry in an ex vivo Holmium:YAG laser lithotripsy model. World J Urol 2023; 41:543-549. [PMID: 36543945 PMCID: PMC9947089 DOI: 10.1007/s00345-022-04255-1] [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: 03/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We aimed to assess critical temperature areas in the kidney parenchyma using magnetic resonance thermometry (MRT) in an ex vivo Holmium:YAG laser lithotripsy model. METHODS Thermal effects of Ho:YAG laser irradiation of 14 W and 30 W were investigated in the calyx and renal pelvis of an ex vivo kidney with different laser application times (tL) followed by a delay time (tD) of tL/tD = 5/5 s, 5/10 s, 10/5 s, 10/10 s, and 20/0 s, with irrigation rates of 10, 30, 50, 70, and 100 ml/min. Using MRT, the size of the area was determined in which the thermal dose as measured by the Cumulative Equivalent Minutes (CEM43) method exceeded a value of 120 min. RESULTS In the calyx, CEM43 never exceeded 120 min for flow rates ≥ 70 ml/min at 14 W, and longer tL (10 s vs. 5 s) lead to exponentially lower thermal affection of tissue (3.6 vs. 21.9 mm2). Similarly at 30 W and ≥ 70 ml/min CEM43 was below 120 min. Interestingly, at irrigation rates of 10 ml/min, tL = 10 s and tD = 10 s CEM43 were observed > 120 min in an area of 84.4 mm2 and 49.1 mm2 at tD = 5 s. Here, tL = 5 s revealed relevant thermal affection of 29.1 mm2 at 10 ml/min. CONCLUSION We demonstrate that critical temperature dose areas in the kidney parenchyma were associated with high laser power and application times, a low irrigation rate, and anatomical volume of the targeted calyx.
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19
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Sierra A, Corrales M, Kolvatzis M, Panthier F, Piñero A, Traxer O. Thermal Injury and Laser Efficiency with Holmium YAG and Thulium Fiber Laser-An In Vitro Study. J Endourol 2022; 36:1599-1606. [PMID: 35793107 DOI: 10.1089/end.2022.0216] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To evaluate using an inanimate model the thermal injury and laser efficiency on high frequency, high energy, and its combination in hands of junior and experienced urologists during holmium YAG (Ho:YAG) and Thulium fiber laser (TFL) lithotripsy. Methods: A Cyber: Ho 150 WTM and Fiber Dust TFL (Quanta System) with 200 μm core-diameter laser fibers (LF) were used in a saline in vitro ureteral model. Each participant (five junior and five experienced urologists) performed 32 sessions of 5-minute lasering (125 mm3 phantom BegoStones™), comparing four modes (3 J/5 Hz [1.5 W], 0.3 J/20 Hz [6 W], 1.2 J/5 Hz [6 W], and 1.2 J/20 Hz [24 W]). Transparent tip and cleaved LF, and digital and fiberoptic ureteroscopes were also compared. Ureteral damage was classified in a scale (0-5) according to the burns and holes seen in the ureteral model's surface. Results: High-power (HP) setting (24 W) was associated with higher delivered energy and higher ablation rates (ARs) in both lasers (p < 0.001). For the same power setting (6 W), there was no difference in delivered energy or stone ARs. Regardless the settings, a higher AR was observed with TFL than with Ho:YAG (0.5Δ mg/s ± 0.33 vs 0.39 Δmg/s ± 0.31, p = 0.002) laser. Higher mean AR was found with cleaved tip vs transparent tip (p = 0.03) in TFL. For both lasers, higher ureteral damage was observed in the 24 W group (p = 0.006) and in the junior urologists (p = 0.03). Between 6 W groups, different types of lesions were found and junior urologist have more lesions when high frequency was used, for both Ho:YAG (p = 0.05) and TFL (p = 0.04). Conclusion: More stone ARs and reduced operative time are observed in HP settings; however, more ureteral thermic-related damage is produced. When comparing the same power, higher energy or frequency does not modify the AR. Nonetheless, more ureteral thermic-related thermal damage is observed in high-frequency settings in unexperienced hands.
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Affiliation(s)
- Alba Sierra
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Mariela Corrales
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Merkourios Kolvatzis
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Frederic Panthier
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Adrià Piñero
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Olivier Traxer
- Sorbonne University, GRC Urolithiasis No. 20, Tenon Hospital, Paris, France.,Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France
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20
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Louters MM, Kim HJ, Dau JJ, Hall TL, Ghani KR, Roberts WW. Characterization of Fluid Dynamics and Temperature Profiles During Ureteroscopy with Laser Activation in a Model Ureter. J Endourol 2022; 36:1593-1598. [PMID: 35904397 DOI: 10.1089/end.2022.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Ureteral thermal injury has been reported in patients following ureteroscopy with laser lithotripsy due to overheating of fluid within the ureter. Proper understanding of this risk necessitates knowing the volume of fluid available to absorb laser energy. This can be approximated as the volume of fluid that mixes during laser activation, since energy transfer through fluid is dominated by convection. Objectives of this study were to determine the volume of fluid that mixes during laser activation at different irrigation rates and to characterize the temporal/spatial temperature distribution in a model ureter. Methods: The model ureter consisted of a plastic tube-160 mm length and 5.3 mm inner diameter. Irrigation was first applied with clear, then dyed, deionized water at rates from 8 to 40 mL/min. The laser was activated at 20 W (0.5 J/40 Hz). The distances the dyed fluid propagated were measured and volumes calculated. Temperatures were recorded from six thermocouples-five embedded within the tube and one affixed to the ureteroscope. Thermal dose was calculated using the Dewey and Sapareto methodology. Results: The volume of total fluid mixing in the model ureter was ≤1.26 ± 0.10 cm3, consistent with a sharp temperature increase after laser activation from -5 to 25 mm from the ureteroscope tip. With irrigation rates ≤12 mL/min, calculated thermal dose within the model ureter exceeded the threshold of tissue injury and extended greater distances along the ureter with lower irrigation rates. Conclusion: The volume of total fluid mixing within the model ureter was found to be small thus conferring a greater risk of ureteral thermal injury. A thermocouple positioned near the tip of the ureteroscope reasonably approximates temperature in front of the ureteroscope. Until temperature sensors are incorporated into ureteroscopic systems, laser power settings should be carefully selected to minimize risk of ureteral thermal injury.
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Affiliation(s)
- Marne M Louters
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyung Joon Kim
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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21
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Dau JJ, Hall TL, Matzger AJ, Louters MM, Khajeh NR, Ghani KR, Roberts WW. Laser Heating of Fluid With and Without Stone Ablation: In Vitro Assessment. J Endourol 2022; 36:1607-1612. [PMID: 35904398 DOI: 10.1089/end.2022.0199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Laser lithotripsy can cause excessive heating of fluid within the collecting system and lead to tissue damage. To better understand this effect, it is important to determine the percentage of applied laser energy that is converted to heat and the percentage used for stone ablation. Our objective was to calculate the percentage of laser energy used for stone ablation based on the difference in fluid temperature measured in an in vitro model when the laser was activated without and with stone ablation. Methods: Flat BegoStone disks (15:5) were submerged in 10 mL of deionized water at the bottom of a vacuum evacuated double-walled glass Dewar. A Moses 200 D/F/L laser fiber was positioned above the surface of the stone at a distance of 3.5 mm for control (no stone ablation) or 0.5 mm for experimental (ablation) trials. The laser was activated and scanned at 3 mm/second across the stone in a preprogrammed pattern for 30 seconds at 2.5 W (0.5 J × 5 Hz) for both short-pulse (SP) and Moses distance (MD) modes. Temperature of the fluid was recorded using two thermocouples once per second. Results: Control trials produced no stone ablation, while experimental trials produced a staccato groove in the stone surface, simulating efficient lithotripsy. The mean temperature increase for SP was 1.08°C ± 0.04°C for control trials and 0.98°C ± 0.03°C for experimental trials, yielding a mean temperature difference of 0.10°C ± 0.06°C (p = 0.0005). With MD, the mean temperature increase for control trials was 1.03°C ± 0.01°C and for experimental trials 0.99°C ± 0.06°C, yielding a smaller mean temperature difference of 0.04°C ± 0.06°C (p = 0.09). Conclusions: Even under conditions of energy-efficient stone ablation, the majority of applied laser energy (91%-96%) was converted to heat.
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Affiliation(s)
- Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam J Matzger
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marne M Louters
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nikta R Khajeh
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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22
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Peteinaris A, Tsaturyan A, Pantazis L, Farsari E, Martinez BB, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P. Factors affecting the irrigation fluid temperature during laser lithotripsy: in vitro experimental study. Urology 2022; 170:53-59. [PMID: 36115430 DOI: 10.1016/j.urology.2022.07.060] [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: 03/14/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To investigate the effect of the diameter of laser fiber, pelvis volume, presence and type of the stone on irrigation fluid temperature rise. MATERIAL AND METHODS A 20ml syringe, 12/14 ureteral access sheath(UAS), a dual-lumen catheter and a thermocouple were used. The 12/14Fr UAS(Cook Ireland Ltd., Limerick, Ireland) and the Thermocouple(SE001, Pico Technologies, Cambridgeshire, UK) were inserted in the syringe. The syringe was closed allowing outflow from the UAS with rate at 10ml/min. The Quanta Ho 150W(Quanta System, Samarate, Italy) laser was used and fired with 10W(2Jx5Hz), 20W(2 × 10 Hz), 40W(2 × 20 Hz), 60W(2 × 30 Hz). These power settings were tested in different conditions: fibers(200µm, 365µm and 550µm), volumes(5ml, 10ml and 20ml) and artificial stones(soft, hard). The laser was activated for 30 seconds and reactivation was performed when the temperature reached below 26 0C. RESULTS For all trials 60W of energy resulted in higher temperature rise. No differences were observed when different fibers were used. The highest temperatures (up to 80 0C) for 60W were reported in 5ml syringe and the lowest (<45 0C) with 20ml. The maximal temperature of >59°C was recorded for the power of 60W(1Jx60Hz). The temperature exceeded 43 0C when power settings >40W were applied. CONCLUSION Increasing the overall power, increases the irrigation fluid temperature significantly. The smaller the volume of the pelvis, the greater the temperature elevation. The fiber size did not affect the temperature increase pattern. The presence of artificial stones was associated with the absorption of energy emitted by the laser.
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Affiliation(s)
| | | | | | - Ergina Farsari
- Plasma Technology Laboratory, Department of Chemical Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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23
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Moses and Moses 2.0 for Laser Lithotripsy: Expectations vs. Reality. J Clin Med 2022; 11:jcm11164828. [PMID: 36013067 PMCID: PMC9409732 DOI: 10.3390/jcm11164828] [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: 08/01/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Moses technology was born with the aim of controlling the Moses effect present in every single Ho:YAG laser lithotripsy. The capacity to divide the energy pulse into two sub-pulses gained popularity due to the fact that most of the energy would be delivered in the second pulse. However, is this pulse modulation technique really better for endocorporeal laser lithoripsy? A review of the literature was performed and all relevant clinical trials of Moses 1.0 and 2.0, as well as the lab studies of Moses 2.0 carried out up to June 2022 were selected. The search came back with 11 clinical experiences (10 full-text clinical trials and one peer-reviewed abstract) with Moses 1.0 and Moses 2.0, and three laboratory studies (peer-reviewed abstracts) with Moses 2.0 only. The clinical experiences confirmed that the MT (1.0) has a shorter lasing time but lower laser efficacy, because it consumes more J/mm3 when compared with the LP Ho:YAG laser (35 W). This gain in lasing time did not provide enough savings for the medical center. Additionally, in most comparative studies of MT (1.0) vs. the regular mode of the HP Ho:YAG laser, the MT did not have a significant different lasing time, operative time or stone-free rate. Clinical trials with Moses 2.0 are lacking. From what has been published until now, the use of higher frequencies (up to 120 Hz) consumes more total energy and J/mm3 than Moses 1.0 for similar stone-free rates. Given the current evidence that we have, there are no high-quality studies that support the use of HP Ho:YAG lasers with MT over other lasers, such as LP Ho:YAG lasers or TFL lasers.
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24
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Rezakahn Khajeh N, Hall TL, Ghani KR, Roberts WW. Determination of Irrigation Flowrate During Flexible Ureteroscopy: Methods for Calculation Using Renal Pelvis Pressure. J Endourol 2022; 36:1405-1410. [PMID: 35974664 DOI: 10.1089/end.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Proper control of irrigation flowrate during ureteroscopy is important to manage thermal and pressure risks. This task is challenging because flowrate is not directly measured by commercially available ureteroscopic or fluid management systems. However, flowrate can be calculated using a hydrodynamic relationship based on measurable values during ureteroscopy. Objectives of this in vitro study were to 1) calculate inflow resistance for different working channel conditions and then using these values 2) calculate irrigation flowrate and determine its accuracy across a range of renal pelvis pressures. MATERIALS AND METHODS A 16 Liter container was filled with deionized water and connected by irrigation tubing to a 9.6Fr single-use ureteroscope. Inflow resistance was determined by plotting flowrate (mass of fluid collected from ureteroscope tip in 60 seconds) versus irrigation pressure (range 0-200 cmH2O). Next, the tip of the ureteroscope was inserted into the renal pelvis of a silicone kidney-ureter model and renal pelvis pressure was measured. In conjunction with the previously determined inflow resistance and known irrigation pressure values, flowrate was calculated and compared to experimentally measured values. All trials were performed in triplicate for working channel conditions: empty, 200µm laser fiber, 365µm laser fiber, and 1.9Fr stone basket. RESULTS Flowrate was linearly dependent on irrigation pressure for each working channel condition. Inflow resistance was determined to be 5.0 cmH2O/(ml/min) with the 200µm laser fiber in the working channel and calculated flowrates were within 1 ml/min of measured flowrates. Similar results were seen with a 365µm laser fiber, and 1.9Fr basket. CONCLUSIONS Utilizing renal pelvis pressure measurements, flowrate was accurately calculated across a range of working channel conditions and irrigation pressures. Incorporation of this methodology into future ureteroscopic systems that measure intrarenal pressure, could provide a real-time readout of flowrate for the urologist and thereby enhance safety and efficiency of laser lithotripsy.
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Affiliation(s)
- Nikta Rezakahn Khajeh
- University of Michigan, Urology, Ann Arbor, Michigan, United States.,William Beaumont Hospitals Corp, Urology, Royal Oak, Michigan, United States;
| | - Timothy L Hall
- University of Michigan, Biomedical Engineering, 2200 Bonisteel Blvd, Ann Arbor, Michigan, United States, 48109;
| | - Khurshid R Ghani
- University of Michigan, Urology, 3448 Riverbend Drive, Ann Arbor, Michigan, United States, 48105.,University of Michigan, Ann Arbor, Michigan, United States, 48109-1382;
| | - William W Roberts
- University of Michigan, Urology, 3879 Taubman Center, 1500 East Medical Center Dr,, Ann Arbor, Michigan, United States, 48109-5330.,University of Michigan, Biomedical Engineering, Ann Arbor, Michigan, United States;
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25
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Lange B, Ozimek T, Wießmeyer JR, Kramer M, Merseburger A, Brinkmann R. Theoretical and experimental evaluation of the distance dependence of fiber-based fluorescence and reflection measurements for laser lithotripsy. Biomed Phys Eng Express 2022; 8. [PMID: 35858536 DOI: 10.1088/2057-1976/ac82c7] [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: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES In laser lithotripsy, a green aiming beam overlying the infrared (IR) treatment radiation gives rise to reflection and fluorescence signals that can be measured via the treatment fiber. While stone autofluorescence is used for target detection, the condition of the fiber can be assessed based on its Fresnel reflection. For good applicability, fluorescence detection of stones should work even when the stone and fiber are not in direct contact. Fiber breakage detection, on the other hand, can be falsified if surfaces located in front of the fiber reflect light from the aiming laser back into it. For both applications, therefore, a fundamental investigation of the dependence of the signal amplitude on the distance between fiber and surface is important. METHODS Calculations of the signal drop of fluorescence or diffuse and specular reflection with increasing fiber distance were performed using ray tracing based on a simple geometric model for different fiber core diameters. Reflection signals from a mirror, diffuse reflector, human calculi, and porcine renal tissue placed in water were measured at varying distances (0 - 5 mm). For human calculi, fluorescence signals were recorded simultaneously. RESULTS The calculations showed a linear signal decrease down to ~60% of the maximum signal (fiber in contact). The distance z at which the signal drops to for example 50% depends linearly on the diameter of the fiber core. For fibers used in lithotripsy and positioned in water,z50%ranges from 0.55 mm (200 µm core diameter) to 2.73 mm (1 mm core diameter). The calculations were in good agreement with the experimental results. CONCLUSIONS The autofluorescence signals of stones can be measured in non-contact mode. Evaluating the Fresnel signal of the end face of the fiber to detect breakage is possible unless the fiber is situated less than some millimeters to reflecting surfaces.
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Affiliation(s)
- Birgit Lange
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, Lubeck, 23562, GERMANY
| | - Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Judith Riccarda Wießmeyer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Mario Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, Lubeck, 23562, GERMANY
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26
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Sierra Del Rio A, Corrales M, Kolvatzis M, Daudon M, Traxer O. Thulium fiber laser's dust for stone composition analysis: Is it enough? J Endourol 2022; 36:1468-1474. [PMID: 35801672 DOI: 10.1089/end.2022.0244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: We aimed to evaluate if the biochemical composition of urinary stones can be determined by analyzing the stone dust only, and whether a photo taken during the surgery could be useful for completing the morpho-constitutional analysis. Materials and methods: 20 patients went through a retrograde intrarenal surgery (RIRS) for renal stone treatment with TFL (Fiber Dust, Quanta, 2020) using 150 µm silica core laser fibers. After laser lithotripsy, residual fragments (RF) were removed with a basket (ZeroTip, Boston Scientific) and spontaneously floating stones particles were considered stone dust and were aspirated through the working channel. Pairs of RF and stone dust were labelled and sent to analysis by scanning electron microscopy and Fourier transform infrared spectroscopy (FTIR). Photos of the stone (surface and section) were taken from videos recorded during the surgery. Results: A total of 20 patients were included in the study. Mean age was 49,8 years old with metabolic and genetic disorders. Mean stone volume was 750 mm3 for ureteral stones and 2334 mm3 for renal stones. Mean stone density was 1187 HU. Positive urine culture was found in 25% patients. In 2/20 (10%) the biochemistry differed only in the relative proportions of each constituent, whilst 5/20 (25%) only one component was missing. Laser crystalline conversion was found in 3/20 (15%). Whewellite and weddellite layers were found in photos thus adding missing information from dust stone analysis. Conclusion: Analyzing aspirated dust through the ureteroscope's working channel by physical techniques, we can understand the lithogenic process of the urinary stone, without needing to analyze the stone fragment. Morphological analysis, given by a proper stone picture, adds missing information in specific cases.
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Affiliation(s)
- Alba Sierra Del Rio
- Hospital Clínic de Barcelona, 16493, Urology, Villarroel 170, Barcelona, Spain, 08036;
| | - Mariela Corrales
- Hospital Tenon, 55705, Urology, 4 Rue de la Chine, Paris, Île-de-France, France, 75020;
| | - Merkourios Kolvatzis
- General Hospital of Thessaloniki Papageorgiou, 37794, Urology, Ring Road, 56429 Nea Efkarpia, Thessaloniki, Greece, Thessaloniki, Greece, 56429.,Ring Road, 56429 Nea Efkarpia, Thessaloniki, GreeceGreece;
| | - Michel Daudon
- Tenon Hospital, Pierre and Marie Curie University, Unit of functionnal explorations, Paris, France;
| | - Olivier Traxer
- Tenon Hospital, Assitance Publique-Hopitaux De Paris. Pierre Et Marie Curie University, Paris 6, Urology, 4 rue de la Chine, Paris, France, 75020;
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Peteinaris A, Pagonis K, Vagionis A, Adamou C, Tsaturyan A, Ballesta Martínez B, Karpetas G, Farsari E, Liatsikos E, Kallidonis P. What is the impact of pulse modulation technology, laser settings and intraoperative irrigation conditions on the irrigation fluid temperature during flexible ureteroscopy? An in vivo experiment using artificial stones. World J Urol 2022; 40:1853-1858. [PMID: 35366109 DOI: 10.1007/s00345-022-04002-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/18/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the effect of different combinations of laser power settings and irrigation conditions using the pulse modulation technology of Quanta™ on irrigation fluid temperature (IFT) during FURS (flexible ureteroscopy) on an in-vivo porcine model with artificial stones. MATERIALS AND METHODS A female pig was used. Following the insertion of artificial stones (Begostone™, BEGO USA, Lincoln, RI), a K-type thermocouple was fixed to the created percutaneous access tract. Real-time recordings of IFT during FURS were performed without UAS (ureteral access sheath), with 10/12 UAS, 12/14 UAS and 14/16 UAS. Stone fragmentation was achieved using Quanta Litho Cyber Ho 150 W™ (Samarate, Italy). The IFT was recorded for 30 s, during laser activation, with power settings of 20, 40, 60, 75 and 100 W under both manual pump and gravity irrigation. RESULTS The IFT rise above 54 °C was recorded above a power of 40 W when gravity irrigation was used. The use of UAS prolonged the time for IFT to reach high values, although high power settings increase IFT within seconds from the laser activation. Under pump irrigation, only the 100 W power setting without the use of UAS resulted in dangerous IFT after approximately 10 s. CONCLUSION The high-power Ho:YAG laser can cause a damaging thermal effect to the kidney exceeding the threshold of 54 °C, under gravity irrigation. Lower power settings (up to 40 W) can be used with safety. According to our experiment, when using high power settings, the use of UAS and manual pump irrigation, is the safest combination regarding renal thermal damage.
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Affiliation(s)
| | | | | | | | | | | | - Georgios Karpetas
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Ergina Farsari
- Department of Chemical Engineering, University of Patras, 26504, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Medical University of Vienna, Vienna, Austria
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Pauchard F, Ventimiglia E, Corrales M, Traxer O. A Practical Guide for Intra-Renal Temperature and Pressure Management during Rirs: What Is the Evidence Telling Us. J Clin Med 2022; 11:jcm11123429. [PMID: 35743499 PMCID: PMC9224584 DOI: 10.3390/jcm11123429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION One of the main limitations of Ho:YAG lithotripsy is represented by its advancement speed. The need for faster lithotripsy has led to the introduction of high-power laser equipment. This general trend in increasing Ho:YAG lithotripsy power has certain points that deserve to be considered and analyzed. The objective is to carry out a narrative review on intrarenal temperature and pressure during ureteroscopy. METHODS A literature search using PUBMED database from inception to December 2021 was performed. The analysis involved a narrative synthesis. RESULTS Using more power in the laser correlates with an increase in temperature that can be harmful to the kidney. This potential risk can be overcome by increasing either the irrigation inflow or outflow. Increasing irrigant flow can lead to high intrarenal temperature (IRP). The factors that allow the reduction of intrarenal pressure are a low irrigation flow, the use of a ureteral access sheath of adequate diameter according to the equipment used, and the occupation of the working channel by the laser or basket. CONCLUSION To maintain a safe temperature profile, it has been proposed to use chilled irrigation fluid, intermittent laser activation or to increase irrigation flow. This last recommendation can lead to increased IRP, which can be overcome by using a UAS. Another option is to use low power laser configurations in order to avoid temperature increases and not require high irrigation flows.
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Affiliation(s)
- Felipe Pauchard
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar 2520000, Chile;
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Mariela Corrales
- Groupe de Recherche Cliniques sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France;
| | - Olivier Traxer
- Groupe de Recherche Cliniques sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France;
- Service d’Urologie, Assitance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- Correspondence: ; Tel.: +33-1-56-01-61-53; Fax: +33-1-56-01-63-77
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Yilmaz M, Heuring CEM, Dressler FF, Suarez-Ibarrola R, Gratzke C, Miernik A, Hein S. Temperature assessment study of ex vivo holmium laser enucleation of the prostate model. World J Urol 2022; 40:1867-1872. [PMID: 35614278 PMCID: PMC9236967 DOI: 10.1007/s00345-022-04041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose There isscarce evidence to date on how temperature develops during holmium laser enucleation of the prostate (HoLEP). We aimed to determine the potential heat generation during HoLEP under ex vivo conditions. Methods We developed two experimental setups. Firstly, we simulated HoLEP ex vivo using narrow-neck laboratory bottles mimicking enucleation cavities and a prostate resection trainer. Seven temperature probes were placed at different locations in the experimental setup, and the heat generation was measured separately during laser application. Secondly, we simulated high-frequency current-based coagulation of the vessels using a roller probe. Results We observed that the larger the enucleated cavity, the higher the temperature rises, regardless of the irrigation flow rate. The highest temperature difference with an irrigation flow was approximately + 4.5 K for a cavity measuring 100ccm and a 300 ml/min irrigation flow rate. The higher flow rate generates faster removal of the generated heat, thus cooling down the artificial cavity. Furthermore, the temperature differences at different irrigation flow rates (except at 0 ml/min) were consistently below 5 K. Within the resection trainer, the temperature increase with and without irrigation flow was approximately 0.5 K and 3.0 K, respectively. The mean depth of necrosis (1084 ± 176 µm) achieved by the roller probe was significantly greater when using 144 W energy. Conclusion Carefully adjusted irrigation and monitoring during HoLEP are crucial when evacuating the thermal energy generated during the procedure. We believe this study of ours provides evidence with the potential to facilitate clinical studies on patient safety. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04041-z.
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Affiliation(s)
- Mehmet Yilmaz
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Cäcilia Elisabeth Maria Heuring
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Franz Friedrich Dressler
- Faculty of Medicine, Institute of Pathology, University Medical Center Schleswig Holstein Lübeck Campus, Ratzeburger Allee, 23538, Lübeck, Germany
| | - Rodrigo Suarez-Ibarrola
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Simon Hein
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
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De Coninck V, Defraigne C, Traxer O. Watt determines the temperature during laser lithotripsy. World J Urol 2022; 40:1257-1258. [PMID: 34599675 DOI: 10.1007/s00345-021-03848-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Claire Defraigne
- Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Traxer
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 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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Tsaturyan A, Peteinaris A, Pantazis L, Farsari E, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P. The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study. World J Urol 2022; 40:1873-1878. [PMID: 35445335 DOI: 10.1007/s00345-022-04000-8] [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: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate the effect of prolonged laser activation on irrigation fluid temperature by varying the power settings flow rate (10-30 ml/min). MATERIALS AND METHODS An experimental study using a 20 ml syringe, 12/14 ureteral access sheath, a dual-lumen catheter and a thermocouple was performed. The laser was fired with 12 W (0.3 J × 40 Hz), 40 W (1 J × 40 Hz), 60 W (1.5 J × 40 Hz) using Quanta Ho 150 W (Quanta System, Samarate, Italy). All trials were performed with fluid outflow rate of 10, 20 and 30 ml/min with the fixed fluid volume at 10 ml. RESULTS Continuous laser activation for 10 min with the outflow rate of 10 ml/min using only 12 W resulted to continuous temperature rise to as high as 83 °C. Similar rise of temperatures were observed for 40 W and 60 W with 10 ml/min outflow rate with intermittent laser activation. With 20 and 30 ml/min outflow rates the maximum temperatures for all power settings were below the threshold (< 43 °C). However, the time to reach the same total emitted energy was 60% and 40% shorter 60 W and 40 W, respectively. CONCLUSION Our study found that continuous laser activation with as less as 12 W using 10 ml/min outflow rate increased the irrigation fluid temperature above the threshold only after 1 min. In the current experimental setup, with the fluid outflow rate of 20 and 30 ml/min safe laser activation with 60 W and 40 W (temperature < 43 °C) can be achieved reaching the same total emitted energy as with 12 W in significantly shorter time period.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Lampros Pantazis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Ergina Farsari
- Plasma Technology Laboratory, Department of Chemical Engineering, University of Patras, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
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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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Brevik A, Peta A, Okhunov Z, Afyouni AS, Bhatt R, Karani R, Xie L, Arada RB, Limfueco L, Sung JM, Jefferson FA, Parkhomenko E, Lama D, Safiullah S, Jiang P, Patel RM, Landman J. Prospective, Randomized Comparison of Dual Lumen Versus Single Lumen Flexible Ureteroscopes in Proximal Ureteral and Renal Stone Management. J Endourol 2022; 36:921-926. [PMID: 35262401 DOI: 10.1089/end.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We sought to compare the safety, efficacy, efficiency and surgeon experience during upper urinary tract stone management with single-lumen versus dual-lumen flexible ureteroscopes. MATERIALS AND METHODS Seventy-nine patients with proximal ureteral or renal stone burden < 2 cm were randomized to a single-lumen or dual-lumen flexible ureteroscopy. We recorded times for ureteroscopy, laser lithotripsy, stone basketing, as well as intraoperative and postoperative complications. The rate of stone clearance and stone free status were calculated using computed tomography imaging. Surgeons completed a survey after each procedure rating various metrics regarding ureteroscope performance. RESULTS Thirty-five patients from the single-lumen group and forty-four patients from the dual-lumen group had comparable median ureteroscopy time (37 vs 35 minutes, p=0.984) and basketing time (12 vs 19 min; p=0.584). Median lithotripsy time was decreased in the dual-lumen group (single: 6 vs dual: 2 min, p=0.017). The stone clearance rate was superior in the dual-lumen group (single: 3.7 vs dual: 7.1 mm3/min, p=0.025). The absolute stone-free rate was superior for the dual-lumen group (single: 26% vs dual: 48%, p=0.045). No differences in intraoperative (single: 0% vs dual: 2%; p=0.375) and postoperative complications (single: 7% vs dual: 11%, p=0.474) were observed. Surgeons' ratings of the dual-lumen ureteroscope was superior for visibility, comfort, ease of use, and overall performance. CONCLUSIONS The use of the dual-lumen ureteroscope in patients with renal and proximal ureteral stones < 2 cm provided shorter lithotripsy time, higher stone clearance rates, improved stone free rate and superior surgeon ratings when compared to single-lumen flexible ureteroscopes.
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Affiliation(s)
- Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,UC Irvine Health, California, United States;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Irvine, California, United States, 92868;
| | - Zhamshid Okhunov
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, 29 Prairie Grass, Irvine, California, United States, 92603;
| | - Rohit Bhatt
- University of California Irvine, 8788, Urology, 20697 Hanford Drive, Cupertino, California, United States, 95014;
| | - Rajiv Karani
- University of California Irvine, 8788, Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Lillian Xie
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Luke Limfueco
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W Suite 2100, Orange, California, United States, 92868;
| | - John M Sung
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Francis A Jefferson
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, #2100, Orange, California, United States, 92697-3950;
| | - Egor Parkhomenko
- Boston University Medical Center, 1836, One boston medical place, Boston, Massachusetts, United States, 02118;
| | - Daniel Lama
- University of Cincinnati College of Medicine, 12303, Surgery, Division of Urology, 231 Albert Sabin Way ML 0589, Cincinnati, Cincinnati, Ohio, United States, 45267;
| | - Shoaib Safiullah
- University of Missouri Health Care, 4139, Surgery, 1 Hospital Drive, Columbia, Missouri, United States, 65212-0001.,University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, Irvine, California, United States, 92697-3950;
| | - Pengbo Jiang
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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Li X, Qiao J, Xiong S, Wang J, Wang Q, Li Z, Guan H, Huang Y, Yang K, Li X, Zhou L. The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experience. Asian J Surg 2022; 45:2713-2718. [DOI: 10.1016/j.asjsur.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/17/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
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35
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Laser operator duty cycle effect on temperature and thermal dose: in-vitro study. World J Urol 2022; 40:1575-1580. [DOI: 10.1007/s00345-022-03967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
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Deng X, Xie D, Huang X, Huang J, Song L, Du C. Suctioning Flexible Ureteroscopy with Automatic Control of Renal Pelvic Pressure versus Mini PCNL for the Treatment of 2-3-cm Kidney Stones in Patients with a Solitary Kidney. Urol Int 2022; 106:1293-1297. [PMID: 35220314 DOI: 10.1159/000521373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to compare the treatment outcomes between suctioning flexible ureteroscopic lithotomy (SF-URL) with automatic control of renal pelvic pressure and minimally invasive percutaneous nephrolithotomy (MPCNL) for the management of 2-3-cm renal stones in patients with a solitary kidney. MATERIALS AND METHODS A total of 127 patients with a solitary kidney who underwent SF-URL (n = 57) or MPCNL (n = 70) for large renal stones (>2 cm) between June 2015 and October 2020 were consecutively analyzed. The stone characteristics, operative times, stone-free rate (SFR), hospital stays, and incidences of complications were compared. RESULTS There was a significantly shorter operative time with MPCNL than with SF-URL (43.4 ± 18.9 min vs. 61.8 ± 21.1 min, p = 0.012). SFR at 30 days were 80.7% (46/57) and 90.0% (63/70) for SF-URL and MPCNL, respectively (p > 0.05). The SFR at the 3-month follow-up was comparable in both groups (91.2% vs. 95.7%, p > 0.05). The hemoglobin decline value, hospital stay, serum cystatin C, and percentage of patients requiring blood transfusions in the SF-URL group were obviously better than those in the MPCNL group: (0.8 ± 0.4) versus (3.9 ± 2.7) g/dL (p = 0.007), (3.6 ± 1.5) versus (6.9 ± 3.1) days (p = 0.013), (1.02 ± 0.48) versus (2.54 ± 0.69) mg/L (p = 0.011), and 0 (0.0%) versus 7 (10.0%) (p = 0.016), respectively. The percentages of patients with thrombosis and perirenal hematoma in the MPCNL group were higher than those in the SF-URL group, but the difference was not statistically significant (p > 0.05). CONCLUSION For the treatment of 2-3-cm renal stones in patients with a solitary kidney, both SF-URL and MPCNL are effective. MPCNL has the advantage of a shorter operation time. However, SF-URL is characterized by less bleeding, shorter hospital stay, and less damage to kidney function.
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Affiliation(s)
- Xiaolin Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China,
| | - Donghua Xie
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Xin Huang
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Jianrong Huang
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Chuance Du
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
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Anan G, Hattori K, Hatakeyama S, Ohyama C, Sato M. Efficacy of one-surgeon basketing technique for stone extraction during flexible ureteroscopy for urolithiasis. Arab J Urol 2021; 19:447-453. [PMID: 34881060 PMCID: PMC8648003 DOI: 10.1080/2090598x.2021.1889943] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of using one-surgeon basketing technique by a solo surgeon for stone extraction during flexible ureteroscopy (f-URS) for urolithiasis. Patients and methods: This retrospective study enrolled patients with urinary calculus who underwent f-URS at two institutions in Japan between September 2014 and March 2020. A total of 100 patients were operated by one experienced surgeon using the one-surgeon basketing technique. With this approach, the f-URS apparatus was manipulated with the non-dominant hand and the basket catheter was manipulated with the dominant hand. We retrospectively examined the perioperative results, complications, and stone-free rate [with ‘stone free’ defined as ≤2 mm with kidney–ureter–bladder (KUB) at 1 month after f-URS] to estimate the safety and efficacy for comparison with the results of conventional retrieval basketing technique. Results: Among our study population, the median stone size was 14 mm and median operative time was 74 min. A stone-free status was achieved in 91 patients (91%). The median stone fragmentation time was 15 min and stone retrieval time was 30 min. All included patients were treated using the one-surgeon basketing technique. Complications related to stone retrieval were identified in two patients (2%); the degree of ureteral injury was classified as Clavien–Dindo Grade IIIa. Conclusion: The one-surgeon basketing technique is safe and effective for the extraction of stone fragments during f-URS for urolithiasis. This technique does not require assistance for basketing; therefore, f-URS with active retrieval basketing can be completed by a solo surgeon. Abbreviations: BMI: body mass index; KUB: kidney–ureter–bladder; SFR: stone-free rate; UAS: ureteral access sheath; f-URS: flexible ureteroscopy
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Affiliation(s)
- Go Anan
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Urology, St. Luke's International Hospital, Tokyo, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Makoto Sato
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Lai L, Zhang W, Zheng F, Wang T, Bai P, Liu Z, Zheng J, Shao Z, Duan B, Wang H, Xing J, Chen H, Huang Y, Chen B. Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi. Front Surg 2021; 8:707022. [PMID: 34646858 PMCID: PMC8503526 DOI: 10.3389/fsurg.2021.707022] [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: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.
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Affiliation(s)
- Longhui Lai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wenzhao Zhang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Fangjian Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhengsheng Liu
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiqiang Shao
- Xiamen University Laboratory Animal Center, Xiamen University, Xiamen, China
| | - Bo Duan
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jinchun Xing
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Huixin Chen
- Department of Urology Surgery, Zhangzhou Hospital of Traditional Chinese Medicine, Zhangzhou, China
| | - Yushan Huang
- Department of Urology Surgery, Anxi County Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Bin Chen
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Dau JJ, Rezakahn Khajeh N, Hall TL, Roberts WW. Chilled irrigation for control of temperature elevation during ureteroscopic laser lithotripsy: in vivo porcine model. J Endourol 2021; 36:403-409. [PMID: 34569294 DOI: 10.1089/end.2021.0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multiple studies have shown significant heating of fluid within the urinary collecting system with high-power laser settings. Elevated fluid temperatures may cause thermal injury and tissue damage unless appropriately mitigated. A previous in vitro study demonstrated that chilled (4 °C) irrigation slowed temperature rise, decreased plateau temperature, and lowered thermal dose during laser activation with high-power settings. We sought to evaluate the thermal effects of chilled, room temperature, and warmed irrigation during ureteroscopy with laser activation in an in vivo porcine model. MATERIALS AND METHODS Seven female Yorkshire cross pigs (45-55 kg) were anesthetized and positioned supine. Retrograde ureteroscopy was performed with a thermocouple affixed 5 mm from the distal end of the ureteroscope. In two pigs a holmium:YAG laser was activated for 60 seconds at irrigation rates of 8 ml/min, 12 ml/min, and 15 ml/min with chilled, room temperature, or warmed irrigation. In five pigs core body temperature was recorded for one hour with or without continuous chilled irrigation at 15 ml/min. RESULTS At irrigation rates ≥ 12 ml/min, temperature curves appeared uniformly offset, warmed > room temperature > chilled irrigation. The threshold of thermal tissue injury was reached during laser activation for all irrigation temperatures at 8 ml/min. The threshold was not reached with chilled irrigation at 12 ml/min or 15 ml/min, or with room temperature irrigation at 15 ml/min. The threshold was exceeded at all irrigation rates with warmed irrigation. There was no significant change in core body temperature after delivering chilled irrigation at 15 ml/min compared with no irrigation for 60 minutes. CONCLUSION Irrigation with chilled saline solution during ureteroscopic laser lithotripsy slows temperature rise, lowers peak temperature, and lengthens the time to thermal injury compared to irrigation with room temperature or warmed saline solutions. Core body temperature was not significantly impacted by chilled irrigation.
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Affiliation(s)
- Julie J Dau
- University of Michigan, 1259, Urology, 4432 Medical Sciences Bldg I, 1301 Catherine St, Ann Arbor, Michigan, United States, 48109-1382;
| | | | - Timothy L Hall
- University of Michigan, Biomedical Engineering, 2200 Bonisteel Blvd, Ann Arbor, Michigan, United States, 48109;
| | - William W Roberts
- University of Michigan, Urology, 3879 Taubman Center, 1500 East Medical Center Dr,, Ann Arbor, Michigan, United States, 48109-5330.,University of Michigan, Biomedical Engineering, Ann Arbor, Michigan, United States;
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40
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Hein S, Petzold R, Suarez-Ibarrola R, Schoenthaler M, Gratzke C, Miernik A. Thermal effects of thulium: YAG laser treatment of the prostate-an in vitro study. World J Urol 2021; 40:161-167. [PMID: 34476596 PMCID: PMC8813676 DOI: 10.1007/s00345-021-03805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/04/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To objectively determine whether there is potential thermal tissue damage during Tm:YAG laser-based LUTS treatment. METHODS Our experimental model was comprised of a prostatic resection trainer placed in a 37 °C water bath. In a hollowed-out central area simulating the urethral lumen, we placed a RigiFib 800 fibre, irrigation inflow regulated with a digital pump, and a type K thermocouple. A second thermocouple was inserted 0.5/1 cm adjacently and protected with an aluminum barrier to prevent it from urethral fluid. We investigated continuous and intermittent 120 W and 80 W laser application with various irrigation rates in eight measurement sessions lasting up to 14 min. Thermal measurements were recorded continuously and in real-time using MatLab. All experiments were repeated five times to balance out variations. RESULTS Continuous laser application at 120 W and 125 ml/min caused a urethral ∆T of ~ 15 K and a parenchymal temperature increase of up to 7 K. With 50 ml/min irrigation, a urethral and parenchymal ∆T of 30 K and 15 K were reached, respectively. Subsequently and in absence of laser application, prostatic parenchyma needed over 16 min to reach baseline body temperature. At 80 W lower temperature increases were reached compared to similar irrigation but higher power. CONCLUSIONS We showed that potentially harming temperatures can be reached, especially during high laser power and low irrigation. The heat generation can also be conveyed to the prostate parenchyma and deeper structures, potentially affecting the neurovascular bundles. Further clinical studies with intracorporal temperature measurement are necessary to further investigate this potentially harming surgical adverse effect.
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Affiliation(s)
- Simon Hein
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Ralf Petzold
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Division of Urotechnology, Medical Centre, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
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41
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Doizi S, Germain T, Panthier F, Comperat E, Traxer O, Berthe L. Comparison of Holmium:YAG and Thulium Fiber lasers on soft tissue : an ex vivo study. J Endourol 2021; 36:251-258. [PMID: 34409842 DOI: 10.1089/end.2021.0263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the fiber-tissue interaction through ablation, coagulation, and carbonization characteristics of the Ho:YAG laser and Super Pulsed Thulium Fiber Laser (TFL) in a non-perfused porcine kidney model. To assess the degradation of laser fibers during soft tissue treatment. METHODS A 50W TFL generator was compared to a 120W Ho:YAG laser. The laser settings that can be set identically between the two lasers (pulse energy and frequency), and clinically relevant for prostate laser enucleation, were identified and used for tissue incisions on fresh non-frozen porcine kidneys. For each parameter were also tested the short, medium and long pulse durations for the Ho:YAG generator, and the different peak powers 150W, 250W and 500W for the TFL. Laser incisions were performed with 550μm stripped laser fiber fixed on a robotic arm at a distance of 0.1mm with the tissue surface and at a constant speed of 10mm/s. Histological analysis was then performed, evaluating: incision shape, incision depth and width, axial coagulation depth, presence of carbonization. Degradation of the laser fiber was defined as reduction of laser fiber tip length after laser activation. RESULTS Incision depths and areas of coagulation were greater with the Ho:YAG laser compared to the TFL. While no carbonization zone was found with the Ho:YAG laser, this was constant with the TFL. While a fiber tip degradation was constantly observed with Ho:YAG laser, except in the case of a long pulse duration and low pulse energy (0.2J), this was not the case with TFL. CONCLUSION TFL appears to be an efficient alternative to Ho:YAG laser for soft tissue surgery. The histological analysis found greater tissue penetration with the Ho:YAG laser and different coagulation properties between the two lasers. These results need to be investigated in vivo to assess the clinical impact of these differences and find the optimal settings for laser prostate enucleation.
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Affiliation(s)
- Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France.,PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, F-75013 Paris, France, Paris, France;
| | - Thibault Germain
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France;
| | - Frédéric Panthier
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France.,Department of Urology, hôpital européen Georges-Pompidou, Paris-Descartes University, 20, rue Leblanc, 75015 Paris, France., Paris, France;
| | - Eva Comperat
- Sorbonne Université, Service d'Anatomopathologie, AP-HP, Hôpital Tenon, F-75020 Paris, France, Paris, France;
| | - Olivier Traxer
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France;
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, F-75013 Paris, France, Paris, France;
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42
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Rezakahn Khajeh N, Hall TL, Ghani KR, Roberts WW. Pelvicalyceal Volume and Fluid Temperature Elevation During Laser Lithotripsy. J Endourol 2021; 36:22-28. [PMID: 34254838 DOI: 10.1089/end.2021.0383] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND While high-power laser systems facilitate successful ureteroscopic treatment of larger and more complex stones, they can substantially elevate collecting system fluid temperatures with potential thermal injury of adjacent tissue. The volume of fluid in which laser activation occurs is an important factor when assessing temperature elevation. The aim of this study was to measure fluid temperature elevation and calculate thermal dose from laser activation in fluid-filled glass bulbs simulating varying calyx/pelvis volumes. MATERIALS AND METHODS Glass bulbs of volumes 0.5, 2.8, 4.0, 7.0, 21.0, and 60.8 ml were submerged in a 16 L tank of 37˚C deionized water. A 230-µm laser fiber extending 5mm from the tip of a ureteroscope was positioned in the center of each glass bulb. Irrigation with 0, 8, 15, and 40 ml/min of room temperature DI water was applied. Once steady state temperature was achieved, a Ho:YAG laser was activated for 60 seconds at 40W (0.5J x 80Hz, SP). Temperature was measured from a thermocouple affixed to the external tip of the ureteroscope. Thermal dose was calculated using the Dewey and Sapareto t43 methodology. RESULTS The extent of temperature elevation and thermal dose from laser activation were inversely related to the volume of fluid in each model and the irrigation rate. The time to threshold of thermal injury was only 3 seconds for the smallest model (0.5ml) without irrigation but was not reached in the largest model (60.8ml) regardless of irrigation rate. Irrigation delivered at 40 ml/min maintained safe temperatures below the threshold of tissue injury in all models with 1 minute of continuous laser activation. CONCLUSIONS The volume of fluid in which laser activation occurs is an important factor in determining the extent of temperature elevation. Smaller volumes receive greater thermal dose and reach threshold of tissue injury more rapidly than larger volumes.
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Affiliation(s)
- Nikta Rezakahn Khajeh
- University of Michigan, 1259, Urology, 4432 Med Sci I, 1301 Catherine St., Ann Arbor, Michigan, United States, 48109-1382;
| | - Timothy L Hall
- University of Michigan, Biomedical Engineering, 2200 Bonisteel Blvd, Ann Arbor, Michigan, United States, 48109;
| | - Khurshid R Ghani
- University of Michigan, Urology, 3448 Riverbend Drive, Ann Arbor, Michigan, United States, 48105.,University of Michigan, 1259, Ann Arbor, Michigan, United States, 48109-1382;
| | - William W Roberts
- University of Michigan, Urology, 3879 Taubman Center, 1500 East Medical Center Dr,, Ann Arbor, Michigan, United States, 48109-5330.,University of Michigan, Biomedical Engineering, Ann Arbor, Michigan, United States;
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43
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Ventimiglia E, Pauchard F, Quadrini F, Sindhubodee S, Kamkoum H, Jiménez Godínez A, Doizi S, Traxer O. High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series. J Endourol 2021; 35:1146-1152. [PMID: 33677987 DOI: 10.1089/end.2020.0090] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: There is no clear evidence that high-power (HP) laser generators perform better than low-power (LP) ones in terms of lithotripsy outcomes. We aimed to perform a systematic review of literature to compare the efficacy outcomes of both HP and LP during ureteroscopic lithotripsy. Materials and Methods: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting perioperative outcomes of HP and LP lithotripsy. Using the methodology recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we identified 22 nonrandomized noncomparative retrospective studies published between 2015 and 2019 that were eligible for inclusion in this systematic review. Because of the lack of comparative studies, we decided to perform two separate meta-analytic syntheses for LP and HP studies, then we compared them using a Wald-type test. Results: Overall, the selected studies included 6403 patients. Study design, exposure assessment, selection criteria, and outcome of interest were heterogeneous. LP studies were more common (n = 17, 77%), whereas HP studies were more common in the latest inclusion period. Faster lithotripsy (32.9 minutes vs 63.9 minutes, p < 0.01) was observed in HP studies. However, stone volume resulted twofold higher (2604 mm3 vs 1217 mm3, p = 0.048) in LP studies. Pooled stone-free rate was similar in both LP and HP studies, 81% and 82%, respectively, p > 0.05. No difference in complication rate was observed between the two groups, p = 0.12. Conclusions: HP laser lithotripsy appears to require shorter operative time, with similar stone-free and complication rates as compared with LP traditional lithotripsy. However, when taking into account stone burden, this advantage seems to be lost, or at least not to be comparable with what observed in laboratory studies. Because of the lack of high-level comparative evidence, further clinical studies are needed to elucidate the benefits of using HP laser generators during ureteroscopic stone treatment.
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Affiliation(s)
- Eugenio Ventimiglia
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Felipe Pauchard
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Department of Urology, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Francesca Quadrini
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Sermsin Sindhubodee
- Division of Urology, Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
| | - Hatem Kamkoum
- Urology Department, Hazm Mebaireek General Hospital (HMGH), Doha, Qatar
| | | | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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44
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Lopes AC, Dall'Aqua V, Carrera RV, Molina WR, Glina S. Intra-renal pressure and temperature during ureteroscopy: Does it matter? Int Braz J Urol 2021; 47:436-442. [PMID: 33284547 PMCID: PMC7857755 DOI: 10.1590/s1677-5538.ibju.2020.0428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Antonio Corrêa Lopes
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Vinícius Dall'Aqua
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Raphael V Carrera
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Wilson R Molina
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Sidney Glina
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
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45
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Aldoukhi AH, Hall TL, Ghani KR, Roberts WW. Response to Wollin re: "Strike Rate: Analysis of Laser Fiber to Stone Distance During Different Modes of Laser Lithotripsy". J Endourol 2021; 35:361. [PMID: 33595359 DOI: 10.1089/end.2021.29105.aha] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ali H Aldoukhi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L Hall
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khurshid R Ghani
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William W Roberts
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
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46
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Aldoukhi AH, Dau JJ, Majdalany SE, Hall TL, Ghani KR, Hollingsworth JM, Ambani SN, Dauw CA, Roberts WW. Patterns of Laser Activation During Ureteroscopic Lithotripsy: Effects on Caliceal Fluid Temperature and Thermal Dose. J Endourol 2021; 35:1217-1222. [PMID: 33397188 DOI: 10.1089/end.2020.1067] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Characterizing patterns of laser activation is important for assessing thermal dose during laser lithotripsy. The objective of this study was twofold: first, to quantify the range of operator duty cycle (ODC) and pedal activation time during clinical laser lithotripsy procedures, and second, to determine thermal dose in an in vitro caliceal model when 1200 J of energy was applied with different patterns of 50% ODC for 60 seconds. Methods: Data from laser logs of ureteroscopy cases performed over a 3-month period were used to calculate ODC (lasing time/lithotripsy time). Temporal and rolling 1-minute average power tracings were generated for each case. In vitro experiments were conducted using a 21 mm diameter glass bulb in a 37°C water bath, simulating a renal calix. A LithoVue ureteroscope with attached thermocouple was inserted and 8 mL/min irrigation was delivered with a 242 μm laser fiber within the working channel. In total, 1200 J of laser energy was applied in five different patterns at 20 W average power for 60 seconds. Thermal dose was calculated using the Sapareto and Dewey t43 method. Results: A total of 63 clinical cases were included in the analysis. Mean ODC was 32% overall and 63% during the 1-minute of greatest energy delivery. Mean time of pedal activation was 3.6 seconds. In vitro studies revealed longer pedal activation times produced higher peak temperature and thermal dose. Thermal injury threshold was reached in 9 seconds when 40 W was applied at 50% ODC with laser activation patterns of 30 seconds on/off and 15 seconds on/off. Conclusion: ODC was quantified from clinical laser lithotripsy cases: 32% overall and 63% during 1-minute of peak power. Time of pedal activation is an important factor contributing to fluid heating and thermal dose. Awareness of these concepts is necessary to reduce risk of thermal injury during laser lithotripsy procedures.
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Affiliation(s)
- Ali H Aldoukhi
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Julie J Dau
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Sami E Majdalany
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sapan N Ambani
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Casey A Dauw
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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47
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Khusid JA, Khargi R, Seiden B, Sadiq AS, Atallah WM, Gupta M. Thulium fiber laser utilization in urological surgery: A narrative review. Investig Clin Urol 2021; 62:136-147. [PMID: 33660440 PMCID: PMC7940849 DOI: 10.4111/icu.20200467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
The thulium fiber laser (TFL) is a novel technology under active investigation as an conceivable alternative to the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently the gold standard for an array of urologic procedures. The purpose of this review is to discuss the existing literature on the functionality and effectiveness of TFL in urological practice. We conducted a search of the PubMed, Medline, Web of Science Core Collection, SCOPUS, Embase (OVID), and Cochrane Databases for all full articles and systematic reviews on the TFL. We found a total of 35 relevant pieces of literature. The early research findings pertaining to the TFL exhibit numerous potential advantages over the Ho:YAG laser. In vitro and ex vivo studies have highlighted the TFL's ability to utilize smaller laser fibers, obtain faster stone ablation rates, and achieve less retropulsion when tested against the Ho:YAG laser in lithotripsy. Currently, there is limited in vivo research that investigates the utilization of the TFL. The in vivo results that are available, however, look promising both for laser lithotripsy and soft tissue ablation. Indeed, the existing literature suggests that the TFL has great potential and may possess numerous technological advantages over the Ho:YAG laser, especially in laser lithotripsy. Although these early studies are promising, randomized control trials are needed to assess the full applicability of the TFL in urology.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Raymond Khargi
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Benjamin Seiden
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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48
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Dau JJ, Hall TL, Maxwell AD, Ghani KR, Roberts WW. Effect of Chilled Irrigation on Caliceal Fluid Temperature and Time to Thermal Injury Threshold During Laser Lithotripsy: In Vitro Model. J Endourol 2020; 35:700-705. [PMID: 33176475 DOI: 10.1089/end.2020.0896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: High-power lasers (100-120 W) have widely expanded the available settings for laser lithotripsy and facilitated tailoring of treatment for individual cases. Previous in vitro and in vivo studies have demonstrated that a toxic thermal dose to tissue can result from treatment within a renal calix. The objective of this in vitro study was to compare thermal dose and time with tissue injury threshold when using chilled (CH) irrigation and room temperature (RT) irrigation. Materials and Methods: A glass tube attached to a 19 mm diameter bulb simulating a renal calix was placed in a 37°C water bath. A 242 μm laser fiber was passed through a ureteroscope with its tip in the center of the glass bulb. A wire thermocouple was placed 3 mm proximal to the ureteroscope tip to measure caliceal fluid temperature. RT at 19°C or CH at 1°C irrigation was delivered at 0, 8, 12, 15, or 40 mL/minute. The laser was activated at 0.5 J × 80 Hz (40 W) for 60 seconds. Thermal dose was calculated using the Sapareto and Dewey t43 methodology with thermal dose = 120 equivalent minutes considered the threshold for thermal tissue injury. Results: At each irrigation rate, CH irrigation produced a lower starting temperature, a lower plateau temperature, and less thermal dose compared with RT irrigation. The threshold of thermal injury was reached after 13 seconds of laser activation without irrigation. With 12 mL/minute irrigation, the threshold was reached in 46 seconds with RT irrigation but was not reached with CH irrigation. Conclusion: As higher power laser lithotripsy techniques become further refined, methods to mitigate and control thermal dose are necessary to enhance efficiency. CH irrigation slows temperature rise, decreases plateau temperature, and lowers thermal dose during high-power laser lithotripsy.
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Affiliation(s)
- Julie J Dau
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Khurshid R Ghani
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology and University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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49
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Chung JH, Baek M, Park SS, Han DH. The Feasibility of Pop-Dusting Using High-Power Laser (2 J × 50 Hz) in Retrograde Intrarenal Surgery for Renal Stones: Retrospective Single-Center Experience. J Endourol 2020; 35:279-284. [PMID: 33081518 DOI: 10.1089/end.2020.0585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: Recently, retrograde intrarenal surgery (RIRS) using laser lithotripsy has become popular. However, the optimal laser energy setting for pop-dusting has not been established. In this study, we report our experiences of RIRS using the high-power (up to 100 W) pop-dusting (HPPD) technique. Methods: This study retrospectively assessed 82 cases with RIRS using HPPD. Patients who underwent abdominal CT or mercaptoacetyltriglycine (MAG3) diuretic renal scan at 3 months postoperatively were included in this study. Patient and stone characteristics and perioperative and postoperative outcomes were evaluated. Results: The average number of renal stones was 3.67 ± 4.11, and the average length of the largest stones was 13.30 ± 6.41 mm. The mean Hounsfield units was 959.99 ± 384.73. The operation time was 58.10 ± 26.67 minutes. The mean HPPD time was 11.93 ± 9.48 minutes, with settings of 1.97 ± 0.25 J and 48.78 ± 3.29 Hz. The stone-free rate was 89%. The mean hospital stay was 1.68 ± 1.29 days. Pelvicaliceal and ureter injuries were observed in 9.8% and 32.9% of the study population, respectively. However, there was no transfusion, subcapsular hematoma, persistent urinary leakage, ureteral or infundibular stricture, or renal functional deterioration. There was transient postoperative fever in 12.2% of the study population. Conclusions: HPPD could be performed safely during RIRS for renal stones without significant complications such as collecting system injury or bleeding. High-power laser mode (up to 100 W) can be a safe and effective choice for pop-dusting during RIRS, especially for large and hard stones.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Soo Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Panthier F, Doizi S, Gorny C, Berthe L, Traxer O. Impact of Laser Fiber Diameter and Irrigation Fluids on Induced Bubble Stream Dynamics with Thulium Fiber Laser: An In Vitro Study. J Endourol 2020; 35:1883-1890. [PMID: 33050715 DOI: 10.1089/end.2020.0766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives: The Thulium Fiber Laser (TFL) is studied as an alternative to the holmium:yttrium-aluminium-garnet (Ho:YAG) laser for lithotripsy, with the advantage of an induced bubble stream (IBS). This in vitro study compared the TFL's IBS with 150- and 272 μm-core-diameter laser fiber (CDF) and in four irrigant fluids. Methods: A TFL of 50 W (IPG Photonics©) and 150 and 272 μm-CDF (Boston Scientific©) were used, comparing nine energies (in the range from 0.025 to 4 J). An experimental setup consisted of a vertically disposed fiber in a cuvette filled with saline, iodinated contrast agent (IOA), human urine, or deionized water (DW) at ambient temperature. High-speed imaging of three consecutive IBS was performed to determine the influence of energy on their maximum length (ML; μm), width (MW; μm), and duration (MD; μs). Fibers were cleaved with ceramic scissors between each experience. Results: The IBS had higher ML and MW and MD with 150CDF than 272CDF. Maximum pulse rate for 150CDF and 272CDF was 2182 and 2000 Hz, respectively. Every maximum power was higher than the technological limit of TFL (>50 W). At equal energy density, 150CDF was associated with lower dimensions and durations. The IBS had higher maximum dimensions in IOA compared with saline solution (SS). Compared with DW and urine, IBS in IOA were longer beyond 500 mJ. Over 25 mJ, IBS were thinner in DW, urine, and SS. The IBS in DW, urine, and SS had similar maximum dimensions. The IBS's duration was higher in IOA compared with DW, urine, and SS, meaning a lower theoretical maximum pulse rate and power in IOA. Conclusion: Lasering with 150CDF fits with lower pulse energies-higher pulse rates settings than 272CDF, such as fine dusting mode. In IOA, Induced Bubbles Streams present higher dimensions and durations than in other studied fluids, related to its higher viscosity. Safety distance and pulse rate should be increased and decreased, respectively.
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Affiliation(s)
- Frédéric Panthier
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Européen George Pompidou, Paris, France
| | - Steeve Doizi
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
| | - Cyril Gorny
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
| | - Olivier Traxer
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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