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High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi.
J Endourol 2017; 31(3):272-277JE

Abstract

INTRODUCTION

The efficiency of holmium laser lithotripsy for urolithiasis depends upon several factors, including laser pulse energy and frequency and stone composition and retropulsion. This study investigates the complex interplay between these factors and quantifies lithotripsy efficiency using different laser settings in a benchtop kidney and ureter model.

MATERIALS AND METHODS

In vitro caliceal and ex vivo porcine ureteral models were constructed. Calcium oxalate monohydrate stones were fragmented using a 200-μm laser fiber. In the caliceal model, stone fragmentation and vaporization rates at settings of 0.6 J/5 Hz, 0.2 J/15 Hz, and 0.2 J/50 Hz were compared. In the ureteral model, fragmentation time, retropulsion rate, fragmentation rate, and fragmented stone weight were compared at settings of 0.6 J/5 Hz and 0.2 J/15 Hz. Retropulsive forces generated at 0.6 J/5 Hz, 0.2 J/15 Hz, and 0.2 J/50 Hz settings were compared. Analysis was performed using Student's t-test and one-way ANOVA.

RESULTS

In the caliceal model, the 0.6 J/5 Hz setting fragmented and vaporized stones at a higher rate than the 0.2 J/15 Hz setting (0.072 vs. 0.049 mg/s; p < 0.001). However, when the 0.2 J energy setting was combined with the 50 Hz frequency, the fragmentation rate (0.069 mg/s) was similar to the fragmentation rate at 0.6 J/5 Hz (0.072 mg/s; p = 0.677). In the ureteral model, the 0.6 J/5 Hz setting produced higher fragmentation rates (0.089 vs. 0.049 mg/s; p < 0.001), but resulted in significantly lower fragmented stone weight overall (16.815 vs. 25.485 mg; p = 0.009) due to higher retropulsion rates (0.732 vs. 0.213 mm/s; p < 0.001). Retropulsive forces decreased significantly when pulse energy decreased from 0.6 to 0.2 J (0.907 vs. 0.223 N; p < 0.001). Frequency did not affect retropulsive force at 15 and 50 Hz settings (0.223 vs. 0.288 N; p = 0.509).

CONCLUSIONS

Laser lithotripsy of calcium oxalate monohydrate stones in the ureter should be performed using the low-energy, moderate-frequency dusting setting to minimize retropulsion and maximize efficiency. In the renal calix, the low-energy high-frequency setting performed similarly to the high-energy low-frequency setting.

Authors+Show Affiliations

Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.Department of Urology, Loma Linda University Health , Loma Linda, California.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27960541

Citation

Li, Roger, et al. "High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi." Journal of Endourology, vol. 31, no. 3, 2017, pp. 272-277.
Li R, Ruckle D, Keheila M, et al. High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi. J Endourol. 2017;31(3):272-277.
Li, R., Ruckle, D., Keheila, M., Maldonado, J., Lightfoot, M., Alsyouf, M., ... Baldwin, D. D. (2017). High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi. Journal of Endourology, 31(3), pp. 272-277. doi:10.1089/end.2016.0547.
Li R, et al. High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi. J Endourol. 2017;31(3):272-277. PubMed PMID: 27960541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi. AU - Li,Roger, AU - Ruckle,David, AU - Keheila,Mohamed, AU - Maldonado,Jonathan, AU - Lightfoot,Michelle, AU - Alsyouf,Muhannad, AU - Yeo,Alexander, AU - Abourbih,Samuel R, AU - Olgin,Gaudencio, AU - Arenas,Javier L, AU - Baldwin,D Duane, Y1 - 2017/01/16/ PY - 2016/12/15/pubmed PY - 2017/8/31/medline PY - 2016/12/15/entrez KW - laser KW - metabolic stone KW - ureteral stones KW - ureteroscopy KW - urolithiasis SP - 272 EP - 277 JF - Journal of endourology JO - J. Endourol. VL - 31 IS - 3 N2 - INTRODUCTION: The efficiency of holmium laser lithotripsy for urolithiasis depends upon several factors, including laser pulse energy and frequency and stone composition and retropulsion. This study investigates the complex interplay between these factors and quantifies lithotripsy efficiency using different laser settings in a benchtop kidney and ureter model. MATERIALS AND METHODS: In vitro caliceal and ex vivo porcine ureteral models were constructed. Calcium oxalate monohydrate stones were fragmented using a 200-μm laser fiber. In the caliceal model, stone fragmentation and vaporization rates at settings of 0.6 J/5 Hz, 0.2 J/15 Hz, and 0.2 J/50 Hz were compared. In the ureteral model, fragmentation time, retropulsion rate, fragmentation rate, and fragmented stone weight were compared at settings of 0.6 J/5 Hz and 0.2 J/15 Hz. Retropulsive forces generated at 0.6 J/5 Hz, 0.2 J/15 Hz, and 0.2 J/50 Hz settings were compared. Analysis was performed using Student's t-test and one-way ANOVA. RESULTS: In the caliceal model, the 0.6 J/5 Hz setting fragmented and vaporized stones at a higher rate than the 0.2 J/15 Hz setting (0.072 vs. 0.049 mg/s; p < 0.001). However, when the 0.2 J energy setting was combined with the 50 Hz frequency, the fragmentation rate (0.069 mg/s) was similar to the fragmentation rate at 0.6 J/5 Hz (0.072 mg/s; p = 0.677). In the ureteral model, the 0.6 J/5 Hz setting produced higher fragmentation rates (0.089 vs. 0.049 mg/s; p < 0.001), but resulted in significantly lower fragmented stone weight overall (16.815 vs. 25.485 mg; p = 0.009) due to higher retropulsion rates (0.732 vs. 0.213 mm/s; p < 0.001). Retropulsive forces decreased significantly when pulse energy decreased from 0.6 to 0.2 J (0.907 vs. 0.223 N; p < 0.001). Frequency did not affect retropulsive force at 15 and 50 Hz settings (0.223 vs. 0.288 N; p = 0.509). CONCLUSIONS: Laser lithotripsy of calcium oxalate monohydrate stones in the ureter should be performed using the low-energy, moderate-frequency dusting setting to minimize retropulsion and maximize efficiency. In the renal calix, the low-energy high-frequency setting performed similarly to the high-energy low-frequency setting. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/27960541/High_Frequency_Dusting_Versus_Conventional_Holmium_Laser_Lithotripsy_for_Intrarenal_and_Ureteral_Calculi_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2016.0547?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -