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Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi.
J Endourol. 2010 Jul; 24(7):1135-40.JE

Abstract

BACKGROUND AND PURPOSE

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy is the standard lithotrite in ureteroscopy. We investigated the influence of pulse frequency, energy and length on the fragmentation efficiency of Ho:YAG laser lithotripsy in non-floating artificial stones in vitro.

MATERIALS AND METHODS

Stone fragmentation efficiency of three different Ho:YAG laser devices were evaluated in vitro at different pulse energy (1.0 and 2.0 J) and frequency settings (5 and 10 Hz), resulting in a standardized output power of 10W, respectively. Where possible, pulse length was modified (350 vs 700 microsec). Each setting was performed with a 273 microm and a 365 microm fiber. Lithotripsy was conducted using non-repulsive stones consisting of soft stone (plaster of Paris) and hard stone composition (Fujirock type 4).

RESULTS

Our results showed an increased stone disintegration efficiency at higher pulse energy (2.0 J/5 Hz vs 1.0 J/10 Hz) independently of two fiber diameters and stone types applied in this study (P < 0.05 in 18 of 20 groups). Similarly, reduction of the pulse length from 700 to 350 microsec resulted in a higher stone disintegration (P < 0.05 in 13 of 16 groups). This effect was most prominent when applied to soft stones. Higher fiber diameter was not constantly associated with an increase in stone disintegration.

CONCLUSION

We demonstrate that an increase of pulse energy and a reduction of pulse length at a standardized output power of 10W can improve Ho:YAG laser fragmentation efficiency in vitro in nonfloating stones. These results may potentially affect clinical practice of Ho:YAG laser lithotripsy in impacted or large stones, when retropulsion is excluded.

Authors+Show Affiliations

Department of Urology, University Medical Center Mannheim, Mannheim, Germany. felix.wezel@medma.uni-heidelberg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20575700

Citation

Wezel, Felix, et al. "Effect of Pulse Energy, Frequency and Length On Holmium:yttrium-aluminum-garnet Laser Fragmentation Efficiency in Non-floating Artificial Urinary Calculi." Journal of Endourology, vol. 24, no. 7, 2010, pp. 1135-40.
Wezel F, Häcker A, Gross AJ, et al. Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi. J Endourol. 2010;24(7):1135-40.
Wezel, F., Häcker, A., Gross, A. J., Michel, M. S., & Bach, T. (2010). Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi. Journal of Endourology, 24(7), 1135-40. https://doi.org/10.1089/end.2010.0115
Wezel F, et al. Effect of Pulse Energy, Frequency and Length On Holmium:yttrium-aluminum-garnet Laser Fragmentation Efficiency in Non-floating Artificial Urinary Calculi. J Endourol. 2010;24(7):1135-40. PubMed PMID: 20575700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi. AU - Wezel,Felix, AU - Häcker,Axel, AU - Gross,Andreas J, AU - Michel,Maurice Stephan, AU - Bach,Thorsten, PY - 2010/6/26/entrez PY - 2010/6/26/pubmed PY - 2010/11/16/medline SP - 1135 EP - 40 JF - Journal of endourology JO - J. Endourol. VL - 24 IS - 7 N2 - BACKGROUND AND PURPOSE: Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy is the standard lithotrite in ureteroscopy. We investigated the influence of pulse frequency, energy and length on the fragmentation efficiency of Ho:YAG laser lithotripsy in non-floating artificial stones in vitro. MATERIALS AND METHODS: Stone fragmentation efficiency of three different Ho:YAG laser devices were evaluated in vitro at different pulse energy (1.0 and 2.0 J) and frequency settings (5 and 10 Hz), resulting in a standardized output power of 10W, respectively. Where possible, pulse length was modified (350 vs 700 microsec). Each setting was performed with a 273 microm and a 365 microm fiber. Lithotripsy was conducted using non-repulsive stones consisting of soft stone (plaster of Paris) and hard stone composition (Fujirock type 4). RESULTS: Our results showed an increased stone disintegration efficiency at higher pulse energy (2.0 J/5 Hz vs 1.0 J/10 Hz) independently of two fiber diameters and stone types applied in this study (P < 0.05 in 18 of 20 groups). Similarly, reduction of the pulse length from 700 to 350 microsec resulted in a higher stone disintegration (P < 0.05 in 13 of 16 groups). This effect was most prominent when applied to soft stones. Higher fiber diameter was not constantly associated with an increase in stone disintegration. CONCLUSION: We demonstrate that an increase of pulse energy and a reduction of pulse length at a standardized output power of 10W can improve Ho:YAG laser fragmentation efficiency in vitro in nonfloating stones. These results may potentially affect clinical practice of Ho:YAG laser lithotripsy in impacted or large stones, when retropulsion is excluded. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/20575700/Effect_of_pulse_energy_frequency_and_length_on_holmium:yttrium_aluminum_garnet_laser_fragmentation_efficiency_in_non_floating_artificial_urinary_calculi_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2010.0115?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -