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Ortner G, Somani BK, Güven S, Kitzbichler G, Traxer O, Giusti G, Proietti S, Liatsikos E, Kallidonis P, Krambeck A, Goumas IK, Duvdevani M, Kamphuis GM, Ferretti S, Dragos L, Ghani K, Miernik A, Juliebø-Jones P, Jung H, Tailly T, Pietropaolo A, Hamri SB, Papatsoris A, Sarica K, Scoffone CM, Cracco CM, Keller EX, Durutovic O, Pereira S, Herrmann TRW, Nagele U, Gözen AS, Tokas T. Experts' recommendations in laser use for the treatment of urolithiasis: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2024; 42:33. [PMID: 38217743 DOI: 10.1007/s00345-023-04726-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: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. METHODS After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. CONCLUSIONS Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kitzbichler
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Olivier Traxer
- Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Guido Giusti
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | | - Mordechai Duvdevani
- Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefania Ferretti
- Department of Urology, Hospital, University of Modena, Modena, Italy
| | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Helene Jung
- Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Saeed Bin Hamri
- Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia
| | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kemal Sarica
- Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey
| | | | | | | | - Otas Durutovic
- Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sergio Pereira
- Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal
| | - 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
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
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