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Cano-García MC, Abad Rodríguez-Hesles C, Yuste-Mascarós V, Arrabal Polo MÁ. Initial results of pulsed thulium fiber laser (Dornier®) for the treatment of renal and ureteral stones with ureteroscopy. Actas Urol Esp 2024; 48:484-485. [PMID: 38575069 DOI: 10.1016/j.acuroe.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 04/06/2024]
Affiliation(s)
- M C Cano-García
- Instituto Investigación Biosanitaria de Granada, Granada, Spain; Servicio de Urología, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - V Yuste-Mascarós
- Servicio de Urología, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - M Á Arrabal Polo
- Instituto Investigación Biosanitaria de Granada, Granada, Spain; Servicio de Urología, Hospital Universitario Clínico San Cecilio, Granada, Spain.
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Becker B, Hook S, Gross AJ, Rosenbaum C, Filmar S, Herrmann J, Netsch C. [Thulium or holmium laser or both: where will the journey take us?]. Aktuelle Urol 2024; 55:236-242. [PMID: 38604230 DOI: 10.1055/a-2286-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.
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Affiliation(s)
- Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Sophia Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Simon Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
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Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [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: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
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Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
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Kwok JL, Ventimiglia E, De Coninck V, Panthier F, Barghouthy Y, Danilovic A, Shrestha A, Smyth N, Schmid FA, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed Thulium:YAG laser - What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study. World J Urol 2023; 41:3723-3730. [PMID: 37831156 PMCID: PMC10693514 DOI: 10.1007/s00345-023-04640-4] [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: 07/20/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The novel pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser was recently introduced. Current studies present promising p-Tm:YAG ablation efficiency, although all are based on non-human stone models or with unknown stone composition. The present study aimed to evaluate p-Tm:YAG ablation efficiency for stone dust from human urinary stones of known compositions. METHODS Calcium oxalate monohydrate (COM) and uric acid (UA) stones were subjected to lithotripsy in vitro using a p-Tm:YAG laser generator (Thulio®, Dornier MedTech GmbH, Germany). 200 J was applied at 0.1 J × 100 Hz, 0.4 J × 25 Hz or 2.0 J × 5 Hz (average 10W). Ablated stone dust mass was calculated from weight difference between pre-lithotripsy stone and post-lithotripsy fragments > 250 µm. Estimated ablated volume was calculated using prior known stone densities (COM: 2.04 mg/mm3, UA: 1.55 mg/mm3). RESULTS Mean ablation mass efficiency was 0.04, 0.06, 0.07 mg/J (COM) and 0.04, 0.05, 0.06 mg/J (UA) for each laser setting, respectively. This translated to 0.021, 0.029, 0.034 mm3/J (COM) and 0.026, 0.030, 0.039 mm3/J (UA). Mean energy consumption was 26, 18, 17 J/mg (COM) and 32, 23, 17 J/mg (UA). This translated to 53, 37, 34 J/mm3 (COM) and 50, 36, 26 J/mm3 (UA). There were no statistically significant differences for laser settings or stone types (all p > 0.05). CONCLUSION To our knowledge, this is the first study showing ablation efficiency of the p-Tm:YAG laser for stone dust from human urinary stones of known compositions. The p-Tm:YAG seems to ablate COM and UA equally well, with no statistically significant differences between differing laser settings.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Yazeed Barghouthy
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Alexandre Danilovic
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Universidade de São Paulo Hospital das Clínicas-HCUSP, São Paulo, Brazil
- Department of Urology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Anil Shrestha
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Niamh Smyth
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- University Hospital Monklands, Monkscourt Avenue, Airdrie, ML60JS, UK
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
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Chicaud M, Corrales M, Kutchukian S, Solano C, Candela L, Doizi S, Traxer O, Panthier F. Thulium:YAG laser: a good compromise between holmium:YAG and thulium fiber laser for endoscopic lithotripsy? A narrative review. World J Urol 2023; 41:3437-3447. [PMID: 37932561 DOI: 10.1007/s00345-023-04679-3] [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: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To provide a technological description of the new pulsed solid-state Thulium:YAG laser (Tm:YAG). In addition, current available literature on Tm:YAG lithotripsy is also reviewed. MATERIALS AND METHODS Medline, Scopus, Embase, and Web of Science databases were used to search for Tm:YAG operating mode articles. RESULTS Tm:YAG technology works with a laser cavity with thulium-doped YAG crystal, pumped by laser diodes. Laser beam operates at 2013 nm, with an adjustable peak power (≥ 1000 W) and the minimal fiber laser diameter is of 200 µm. It has an intermediate water absorption coefficient and peak power-pulse duration. Various pulse modulations are proposed, aiming to minimize stone retropulsion. Multiple comparative in vitro studies suggest that Tm:YAG's ability to fragment stones is similar to the one of the Ho:YAG laser; on the contrary, its ability to dust all stone types is similar to the one of the TFL, with a low retropulsion. A single in vivo study assessed Tm:YAG lithotripsy feasibility. CONCLUSIONS The new pulsed solid-state thulium:YAG laser could represent a safe and effective compromise between Ho:YAG laser and TFL for endoscopic lithotripsy, either in retrograde intra-renal surgeries or in percutaneous nephrolithotomy.
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Affiliation(s)
- Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Service d'Urologie, CHU Limoges, 87000, Limoges, France
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Stessy Kutchukian
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000, Poitiers, France
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of endourology, Uroclin SAS, Medellin, Colombia
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vital-Salute San Raffaele University, Milan, Italy
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
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Ventimiglia E, Robesti D, Bevilacqua L, Tondelli E, Oliva I, Orecchia L, Juliebø-Jones P, Pietropaolo A, De Coninck V, Esperto F, Tailly T, Ferretti S, Gauhar V, Somani B, Villa L, Keller EX, Salonia A, Traxer O, Kartalas Goumas I. What to expect from the novel pulsed thulium:YAG laser? A systematic review of endourological applications. World J Urol 2023; 41:3301-3308. [PMID: 37682286 DOI: 10.1007/s00345-023-04580-z] [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: 07/10/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Several preclinical studies about a novel pulsed-thulium:yttrium-aluminum-garnet (p-Tm:YAG) device have been published, demonstrating its possible clinical relevance. METHODS We systematically reviewed the reality and expectations for this new p-Tm:YAG technology. A PubMed, Scopus and Embase search were performed. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized. RESULTS Tm:YAG is a solid state diode-pumped laser that emits at a wavelength of 2013 nm, in the infrared spectrum. Despite being close to the Ho:YAG emission wavelength (2120 nm), Tm:YAG is much closer to the water absorption peak and has higher absorption coefficient in liquid water. At present, there very few evaluations of the commercially available p-Tm:YAG devices. There is a lack of information on how the technical aspects, functionality and pulse mechanism can be maximized for clinical utility. Available preclinical studies suggest that p-Tm:YAG laser may potentially increase the ablated stone weight as compared to Ho:YAG under specific condition and similar laser parameters, showing lower retropulsion as well. Regarding laser safety, a preclinical study observed similar absolute temperature and cumulative equivalent minutes at 43° C as compared to Ho:YAG. Finally, laser-associated soft-tissue damage was assessed at histological level, showing similar extent of alterations due to coagulation and necrosis when compared with the other clinically relevant lasers. CONCLUSIONS The p-Tm:YAG appears to be a potential alternative to the Ho:YAG and TFL according to these preliminary laboratory data. Due to its novelty, further studies are needed to broaden our understanding of its functioning and clinical applicability.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
| | - Daniele Robesti
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Bevilacqua
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Elena Tondelli
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Isabella Oliva
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Luca Orecchia
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Patrick Juliebø-Jones
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Vincent De Coninck
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University of Rome, Campus Bio-medico, Rome, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefania Ferretti
- Urology Department, Hospital and University of Modena, Modena, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France
| | - Ioannis Kartalas Goumas
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
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Shrestha A, Adhikari B, Panthier F, Baidya S, Gauhar V, Traxer O. Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 2023; 41:3345-3353. [PMID: 37728745 DOI: 10.1007/s00345-023-04606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Flexible ureteroscopy (fURS) is steadily gaining popularity in the management of renal calculi, including those located in the lower pole (LP). Due to difficulty in accessing to the LP of kidney in minority of cases with fURS and reports of lower stone-free rate (SFR), it is still considered as a challenge in selected cases. The purpose of the review was to analyze the various aspects of fURS for LP stones. METHODS An extensive review of the recent literature was done including different factors such as anatomy, preoperative stenting, stone size, flexible scopes, types of lasers, laser fibers, suction, relocation, stone-free rates, and complications. RESULTS The significance of various lower pole anatomical measurements remain a subject of debate and requires standardization. Recent improvements in fURS such as single-use digital scopes with better vision and flexibility, high power laser, thulium fiber laser, smaller laser fiber, and accessories have significantly contributed to make flexible ureteroscopy more effective and safer in the management of LP stone. The utilization of thulium fiber lasers in conjunction with various suction devices is being recognized and can significantly improve SFR. CONCLUSIONS With the significant advancement of various aspects of fURS, this treatment modality has shown remarkable efficacy and gaining widespread acceptance in management of LP kidney stones. These developments have made the fURS of LP stones less challenging.
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Affiliation(s)
- Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
- B&B Hospital, Lalitpur, Nepal.
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Solano C, Corrales M, Panthier F, Candela L, Doizi S, Traxer O. Navigating urolithiasis treatment: assessing the practicality and performance of thulium fiber laser, holmium YAG, and thulium YAG in real-world scenarios. World J Urol 2023; 41:2627-2636. [PMID: 37468656 DOI: 10.1007/s00345-023-04487-9] [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: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The management of urolithiasis has undergone significant advancements with the introduction of pulsed lasers, particularly the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently considered the gold standard in endourology. However, the Ho:YAG laser has certain limitations, such as the inability to support small laser fibers (150 μm) and the requirement of a heavy water cooling system, making it challenging to transfer between operating rooms. These limitations have led to the emergence of new laser technologies, including the thulium fiber laser (TFL) and the thulium:yttrium-aluminum-garnet laser (Tm:YAG), as potential alternatives to the Ho:YAG laser. METHODS In this review, we aimed to evaluate the effectiveness and safety of TFL, Ho:YAG, and Tm:YAG lasers in real-life scenarios by comparing clinical trial data with laboratory findings. A literature review was conducted, and relevant in vitro studies and clinical trials until March 2023 were analyzed. RESULTS The findings indicate that TFL has demonstrated high ablation efficiency for stones of any composition, size, and location, superior the capabilities of Ho:YAG lasers. TFL has shown superior dusting and fragmentation abilities, lower retropulsion, and increased patient safety. The laser parameters, such as ablation efficiency, speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes. CONCLUSION Although the number of studies on TFL is limited, the available evidence suggests that TFL represents a significant advancement in laser technology for lithotripsy. However, further research is needed to fully explore the implications and limitations of TFL and Tm:YAG lasers.
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Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Frederic Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Luigi Candela
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steeve Doizi
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
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9
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Kwok JL, Ventimiglia E, De Coninck V, Corrales M, Sierra A, Panthier F, Pauchard F, Schmid F, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed thulium:YAG laser-ready to dust all urinary stone composition types? Results from a PEARLS analysis. World J Urol 2023; 41:2823-2831. [PMID: 37587366 PMCID: PMC10581948 DOI: 10.1007/s00345-023-04549-y] [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: 06/04/2023] [Accepted: 07/23/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE To evaluate whether stone dust can be obtained from all prevailing stone composition types using the novel pulsed thulium:YAG (p-Tm:YAG), including analysis of stone particle size after lithotripsy. METHODS Human urinary stones of 7 different compositions were subjected to in vitro lithotripsy using a p-Tm:YAG laser with 270 µm silica core fibers (Thulio®, Dornier MedTech GmbH®, Wessling, Germany). A cumulative energy of 1000 J was applied to each stone using one of three laser settings: 0.1 J × 100 Hz, 0.4 J × 25 Hz and 2.0 J × 5 Hz (average power 10 W). After lithotripsy, larger remnant fragments were separated from stone dust using a previously described method depending on the floating ability of dust particles. Fragments and dust samples were then passed through laboratory sieves to evaluate stone particle count according to a semiquantitative analysis relying on a previous definition of stone dust (i.e., stone particles ≤ 250 µm). RESULTS The p-Tm:YAG laser was able to produce stone dust from lithotripsy up to measured smallest mesh size of 63 µm in all seven stone composition types. Notably, all dust samples from all seven stone types and with all three laser settings had high counts of particles in the size range agreeing with the definition stone dust, i.e., ≤ 250 µm. CONCLUSION This is the first study in the literature proving the p-Tm:YAG laser capable of dusting all prevailing human urinary stone compositions, with production of dust particles ≤ 250 µm. These findings are pivotal for the broader future implementation of the p-Tm:YAG in clinical routine.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Urology Department, Hospital Naval Almirante Nef, 2520000, Viña del Mar, Chile
| | - Florian Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- CRISTAL Laboratory, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands.
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10
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Juliebø-Jones P, Keller EX, De Coninck V, Uguzova S, Tzelves L, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond. Front Surg 2023; 10:1274583. [PMID: 37780913 PMCID: PMC10533910 DOI: 10.3389/fsurg.2023.1274583] [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: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Ureteroscopy has become an increasingly popular surgical intervention for conditions such as urinary stone disease. As new technologies and techniques become available, debate regarding their proper use has risen. This includes the role of single use ureteroscopes, optimal laser for stone lithotripsy, basketing versus dusting, the impact of ureteral access sheath, the need for safety guidewire, fluoroscopy free URS, imaging and follow up practices are all areas which have generated a lot of debate. This review serves to evaluate each of these issues and provide a balanced conclusion to guide the clinician in their practice.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
| | - Etienne Xavier Keller
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Sabine Uguzova
- Department of Urology, Royal Preston Hospital, Preston, United Kingdom
| | - Lazaros Tzelves
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- 2nd Department of Urology, Sismanogleion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mathias Sørstrand Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar K. Somani
- Department of Urology, Southampton General Hospital, Southampton, United Kingdom
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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11
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Panthier F, Solano C, Chicaud M, Kutchukian S, Candela L, Doizi S, Corrales M, Traxer O. Initial clinical experience with the pulsed solid-state thulium YAG laser from Dornier during RIRS: first 25 cases. World J Urol 2023; 41:2119-2125. [PMID: 37414942 DOI: 10.1007/s00345-023-04501-0] [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: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber (TFL) lasers are currently the two laser sources recommended for endocorporeal laser lithotripsy (ELL). Recently, the pulsed-thulium:YAG (Tm:YAG) laser was also proposed for ELL, as an answer to both Ho:YAG and TFL limitations. We aimed to evaluate the efficiency, safety, and laser settings of Tm:YAG laser in ELL during retrograde intrarenal surgery (RIRS). METHODS A prospective study of the first 25 patients with ureteral and renal stones who underwent RIRS using the Thulio (pulsed-Tm:YAG, Dornier©, Germany) was performed in a single center. 272 µm laser fibers were used. Stone size, stone density, laser-on time (LOT) and laser settings were recorded. We also assessed the ablation speed (mm3/s), Joules/mm3 and laser power (W) values for each procedure. Postoperative results, such as stone-free rate (SFR) and zero fragments rate (ZFR) were also recorded. RESULTS A total of 25 patients were analyzed (Table 1). The median (IQR) age was 55 (44-72) years old. Median (IQR) stone volume was 2849 (916-9153)mm3. Median (IQR) stone density was 1000 (600-1174)HU. Median (IQR) pulse energy, pulse rate and total power were 0.6 (0.6-0,8)J, 15(15-20)Hz and 12(9-16)W, respectively. All procedures used "Captive Fragmenting" pulse modulation (Table 2). The median (IQR) J/mm3 was 14,8 (6-21). The median (IQR) ablation rate was 0,75 (0,46-2)mm3/s. One postoperative complications occurred (streinstrasse). SFR and ZFR were 95% and 55%, respectively. CONCLUSION The pulsed-Tm:YAG laser is a safe and effective laser source for lithotripsy during RIRS, using low pulse energy and low pulse frequency.
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Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of Endourology, Uroclin SAS, Medellin, Colombia
| | - Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Service d'Urologie, CHU Limoges, 87000, Limoges, France
| | - Stessy Kutchukian
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000, Poitiers, France
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
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12
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Emiliani E, Kanashiro A, Angerri O. Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 2023; 33:302-307. [PMID: 36927702 DOI: 10.1097/mou.0000000000001092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. RECENT FINDINGS New Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points.TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SUMMARY Several new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.
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Affiliation(s)
- Esteban Emiliani
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona, Spain
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13
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Basulto-Martínez M, Proietti S, Pavia MP, Yeow Y, Eisner BH, Giusti G. Understanding the ablation rate of Holmium:YAG and thulium fiber lasers. Perspectives from an in vitro study. Urolithiasis 2023; 51:32. [PMID: 36648558 PMCID: PMC9845154 DOI: 10.1007/s00240-022-01402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/30/2022] [Indexed: 01/18/2023]
Abstract
This study sought to analyze the ablation rates of Holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) under different settings combinations. Lasering was carried out by a computed spiral pattern through a stepper motor bearing a laser fiber. BegoStones were placed inside a water container and lasered therein and the ablation rate was calculated. Different combinations were tested for ~12 Watts (W) for Ho:YAG and TFL lasers. Further 25 W combination for TFL were conducted testing higher frequencies. One-hundred-one experiments were conducted. Under ~12 W, the highest ablation rate for Ho:YAG was obtained with 40 Hz/0.3 J, and Virtual Basket™ (VB) emission mode [114.35 (88.30 - 126.40) mg/min] whereas for TFL, using 40 Hz/0.3 J, and long pulse [143.40 (137.40 - 146) mg/min]. A matched-comparison for 12 Hz/1 J settings showed that TFL outperformed Ho:YAG using medium pulse [63.30 (55.30 - 81.30) vs 132.00 (115.70 - 228.60) mg/min, p=0.016] and long pulse [62.90 (51.60 - 78.90) vs 134.70 (110.60 - 149.30) mg/min, p=0.016]. In the 40 Hz/0.3 J settings, TFL outperformed Ho:YAG (p=0.034). Nonetheless, Ho:YAG with VB's ablation rate increased [114.35 (88.30 - 126.40)], being comparable to that of TFL with medium pulse [127.5 (88.90 - 141.70)] (p=0.400). In TFL 25 W experiments, the ablation rate of 500 Hz / 0.05 J, was higher than those of 1000 Hz / 0.025 J (p=0.049). TFL ablation rate is higher than that of Ho:YAG. Moreover, the Virtual Basket™ emission mode, increased Ho:YAG ablation rates, resulting reaching similar to that of TFL in certain modalities.
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Affiliation(s)
- Mario Basulto-Martínez
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- European Training Center in Endourology, Milan, Italy
- Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- European Training Center in Endourology, Milan, Italy
| | - Maria Pia Pavia
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- European Training Center in Endourology, Milan, Italy
- Department of Urology, "Ospedale Riuniti" University Hospital, Marche Polytechnic University, Ancona, Italy
| | - Yuyi Yeow
- European Training Center in Endourology, Milan, Italy
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
- European Training Center in Endourology, Milan, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele S.r.l., Via Olgettina 60, 20132, Milan, MI, Italy.
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Socarrás MR, del Álamo JF, Sancha FG. Long Live Holmium! EUR UROL SUPPL 2022; 48:28-30. [PMID: 36588773 PMCID: PMC9795518 DOI: 10.1016/j.euros.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Moisés Rodriguez Socarrás
- Corresponding author. Instituto de Cirugía Urológica Avanzada, Clínica Cemtro II, Avenida Vestisquero de la Condesa 48, 28035 Madrid, Spain. Tel. +34 692934078.
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15
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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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16
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The Effects of Scanning Speed and Standoff Distance of the Fiber on Dusting Efficiency during Short Pulse Holmium: YAG Laser Lithotripsy. J Clin Med 2022; 11:jcm11175048. [PMID: 36078979 PMCID: PMC9457447 DOI: 10.3390/jcm11175048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the effects of fiber lateral scanning speed across the stone surface (vfiber) and fiber standoff distance (SD) on dusting efficiency during short pulse holmium (Ho): YAG laser lithotripsy (LL), pre-soaked BegoStone samples were treated in water using 0.2 J/20 Hz at SD of 0.10~0.50 mm with vfiber in the range of 0~10 mm/s. Bubble dynamics, pressure transients, and stone damage were analyzed. To differentiate photothermal ablation vs. cavitation damage, experiments were repeated in air, or in water with the fiber tip at 0.25 mm proximity from the ureteroscope end to mitigate cavitation damage. At SD = 0.10 mm, the maximum dusting efficiency was produced at vfiber = 3.5 mm/s, resulting in long (17.5 mm), shallow (0.15 mm), and narrow (0.4 mm) troughs. In contrast, at SD = 0.50 mm, the maximum efficiency was produced at vfiber = 0.5 mm/s, with much shorter (2.5 mm), yet deeper (0.35 mm) and wider (1.4 mm), troughs. With the ureteroscope end near the fiber tip, stone damage was significantly reduced in water compared to those produced without the ureteroscope. Under clinically relevant vfiber (1~3 mm/s), dusting at SD = 0.5 mm that promotes cavitation damage may leverage the higher frequency of the laser (e.g., 40 to 120 Hz) and, thus, significantly reduces the procedure time, compared to at SD = 0.1 mm that promotes photothermal ablation. Dusting efficiency during short pulse Ho: YAG LL may be substantially improved by utilizing an optimal combination of vfiber, SD, and frequency.
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Ibis MA, Gokce MI, Babayigit M, Yitgin Y, Karagoz MA, Boyuk A, Verep S, Turan S, Tefik T, Kiremit MC, Sonmez MG, Ergul R, Guven S, Sarica K. Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20-30 mm) stones? A critical evaluation. Int Urol Nephrol 2022; 54:2141-2148. [PMID: 35763186 DOI: 10.1007/s11255-022-03255-9] [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: 02/12/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2-3 cm. METHODS A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. RESULTS The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1-2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3-4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. CONCLUSIONS mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2-3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, 06380, Turkey.
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Muammer Babayigit
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasin Yitgin
- Department of Urology, Istinye University School of Medicine, Istanbul, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, University of Health Sciences, Cemil Tascıoglu City Hospital Training and Research Hospital, Prof. Dr, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Private Istanbul Medivita Ethica Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Serdar Turan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | | | - Rifat Ergul
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selcuk Guven
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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18
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Van Besien J, Keller EX, De Coninck V. RE: Retropulsion force in laser lithotripsy-an in vitro study comparing a Holmium device to a novel pulsed solid‑state thulium laser. World J Urol 2022; 40:1269-1270. [PMID: 34269861 DOI: 10.1007/s00345-021-03781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- J Van Besien
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - E X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
| | - V De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands.
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19
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Ratajczak JM, Hladun T, Krenz B, Bromber K, Salagierski M, Marczak M. Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031114. [PMID: 35162137 PMCID: PMC8834554 DOI: 10.3390/ijerph19031114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023]
Abstract
Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.
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Affiliation(s)
- Jakub Marek Ratajczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
- Correspondence:
| | - Taras Hladun
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Bartosz Krenz
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Krzysztof Bromber
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
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20
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Kraft L, Petzold R, Suarez-Ibarrola R, Miernik A. In vitro fragmentation performance of a novel, pulsed Thulium solid-state laser compared to a Thulium fibre laser and standard Ho:YAG laser. Lasers Med Sci 2021; 37:2071-2078. [PMID: 34905141 PMCID: PMC8971152 DOI: 10.1007/s10103-021-03495-8] [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: 04/22/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
The aim of this work was to compare the fragmentation efficiency of a novel, pulsed Thulium solid-state laser (p-Tm:YAG) to that of a chopped Thulium fibre laser (TFL) and a pulsed Holmium solid-state laser (Ho:YAG). During the fragmentation process, we used a silicone mould to fixate the hemispherical stone models under water in a jar filled with room-temperature water. Each laser device registered the total energy applied to the stone model to determine fragmentation efficiency. Our study examined laser settings with single pulse energies ranging from 0.6 to 6 J and pulse frequencies ranging from 5 to 15 Hz. Similar laser settings were applied to explicitly compare the fragmentation efficiency of all three devices. We experimented with additional laser settings to see which of the three devices would perform best. The fragmentation performance of the three laser devices differed statistically significantly (p < 0.05). The average total energy required to fragment the stone model was 345.96 J for Ho:YAG, 372.43 J for p-Tm:YAG and 483.90 J for TFL. To fragment the stone models, both Ho:YAG and p-Tm:YAG needed similar total energy (p = 0.97). TFL’s fragmentation efficiency is significantly lower than that of Ho:YAG and p-Tm:YAG. Furthermore, we found the novel p-Tm:YAG’s fragmentation efficiency to closely resemble that of Ho:YAG. The fragmentation efficiency is thought to be influenced by the pulse duration. TFL’s shortest possible pulse duration was considerably longer than that of Ho:YAG and p-Tm:YAG, resulting in Ho:YAG and p-Tm:YAG exhibiting better fragmenting efficiency.
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Affiliation(s)
- Lea Kraft
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Ralf Petzold
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany.
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21
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Kraft L, Yilmaz M, Petzold R, Gratzke C, Suarez-Ibarrola R, Miernik A. Dusting Efficiency of a Novel Pulsed Thulium:Yttrium Aluminum Garnet Laser vs a Thulium Fiber Laser. J Endourol 2021; 36:259-265. [PMID: 34693738 DOI: 10.1089/end.2021.0441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Holmium:yttrium aluminum garnet laser (Ho:YAG) is still considered the gold standard in laser lithotripsy. There is a large body of literature comparing the capabilities of Ho:YAG and thulium fiber lasers (TFLs). The novel, pulsed thulium:yttrium aluminum garnet laser (p-Tm:YAG) evaluation model has only been compared with Ho:YAG in terms of its dusting performance to date. It was this study's aim to compare the p-Tm:YAG's dusting efficiency with that of a chopped TFL. Materials and Methods: During the laser ablation procedure, while the laser device was emitting light, the laser fiber was spiraled across the surface of a uniform kidney stone model via software. We relied on the stone model's difference in weight before and after the dusting procedure to assess the dusting efficiency and assessed each laser device's dusting efficiency at various preset laser configurations and laser fiber-motion speeds. We compared both laser devices' laser configurations, which were identical in pulse energy and frequency, while keeping in mind that the pulse duration differed significantly. In addition, we tested each laser device's capability. Results: The average ablated weight across all laser configurations was 0.61 g (standard deviation [SD] = 0.44 g) for p-Tm:YAG and 0.76 g (SD = 0.51 g) for TFL. After statistical analysis, we found no significant difference in ablated weight between the laser devices (U = 1715.5, p-value = 0.11). The maximum permissible frequency configuration for TFL was 1600 Hz, which resulted in the worst overall dusting output. Conclusions: We observed that the p-Tm:YAG's dusting efficiency resembled that of TFL in the identical pulse energy and frequency laser configurations. The ablation efficiency did not seem to be affected by the laser devices' differences in pulse duration. Slower laser fiber-motion speeds resulted in more efficient ablation. When using the maximum preset frequency and power configuration, TFL's dusting efficiency appeared to be inefficient.
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Affiliation(s)
- Lea Kraft
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Ralf Petzold
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
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22
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Talso M, Keller EX, Traxer O. Re: In Vitro Dusting Performance of a New Solid State Thulium Laser Compared to Holmium Laser Lithotripsy From Ralf Petzold, Arkadiusz Miernik, Rodrigo Suarez-Ibarrola J Endourol J Endourol 2021 Feb;35(2):221-225. doi: 10.1089/end.2020.0525. Epub 2020 Sep 9. J Endourol 2021; 36:418-419. [PMID: 34102873 DOI: 10.1089/end.2021.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michele Talso
- ASST Fatebenefratelli Sacco, 472674, Urology - Ospedale Luigi Sacco University Hospital, Milano, Italy.,Young Academic Urologist , Urolithiasis & Endourology working party, Amsterdam, Netherlands;
| | - Etienne Xavier Keller
- University Hospital Zurich, Department of Urology, Zurich, Switzerland.,Young Academic Urologist , Urolithiasis & Endourology working party, Amsterdam, Netherlands;
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France.,Hopital Tenon, 55705, Urology, Paris, Île-de-France, France;
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23
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[Innovative laser technologies in the treatment of urolithiasis : A change to more gentle methods with increased patient safety]. Urologe A 2020; 60:19-26. [PMID: 33315134 DOI: 10.1007/s00120-020-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Management of urolithiasis has undergone fundamental changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureterorenoscopic techniques in the 1980s. Since then, these minimally invasive techniques have been continuously optimized and specific laser techniques for stone disintegration have emerged. Besides the established holmium laser, other types of lasers are also emerging. Especially the thulium fiber laser is the subject of promising research due to its variable adjustment options. In terms of patient safety, both holmium and thulium techniques seem to be similar . While serious direct physical lesions are rare, there is increasing evidence of clinically relevant secondary thermal injury due to increased temperatures in the upper urinary tract during treatment. Our research group has recently demonstrated in both in vitro and in vivo (porcine animal model) experiments that monitoring the fluorescence spectra of calculi allows precise target differentiation between stone, tissue, and endoscope components. Consequently, pulse emissions were only emitted when stone material was detected. We believe that target monitoring will minimize the risk of laser-induced urothelial damage and decrease energy release into the upper urinary tract allowing adequate temperature management.
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