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In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser.
Urology. 2017 Sep; 107:37-42.U

Abstract

OBJECTIVE

To compare the performance of variable- and fixed-pulse lasers on stone phantoms in vitro.

MATERIALS AND METHODS

Seven-millimeter stone phantoms were made to simulate calcium oxalate monohydrate stones using BegoStone plus. The in vitro setting was created with a clear polyvinyl chloride tube. For each trial, a stone phantom was placed at the open end of the tubing. The Cook Rhapsody H-30 variable-pulse laser was tested on both long- and short-pulse settings and was compared to the Dornier H-20 fixed-pulse laser; 5 trials were conducted for each trial arm. Fragmentation was accomplished with the use of a flexible ureteroscope and a 273-micron holmium laser fiber using settings of 1 J × 12 Hz. The treatment time (in minute) for complete fragmentation was recorded as was the total retropulsion distance (in centimeter) during treatment. Laser fibers were standardized for all repetitions.

RESULTS

The treatment time was significantly shorter with the H-30 vs the H-20 laser (14.3 ± 2.5 vs 33.1 ± 8.9 minutes, P = .008). There was no difference between the treatment times using the long vs short pulse widths of the H-30 laser (14.4 ± 3.4 vs 14.3 ± 1.7 minutes, P = .93). Retropulsion differed by laser type and pulse width, H-30 long pulse (15.8 ± 5.7 cm), H-30 short pulse (54.8 ± 7.1 cm), and H-20 (33.2 ± 12.5 cm) (P <.05).

CONCLUSION

The H-30 laser fragmented stone phantoms in half the time of the H-20 laser regardless of the pulse width. Retropulsion effects differed between the lasers, with the H-30 causing the least retropulsion. Longer pulse widths result in less stone retropulsion.

Authors+Show Affiliations

Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: bellj@urology.wisc.edu.Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28647563

Citation

Bell, John Roger, et al. "In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser." Urology, vol. 107, 2017, pp. 37-42.
Bell JR, Penniston KL, Nakada SY. In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser. Urology. 2017;107:37-42.
Bell, J. R., Penniston, K. L., & Nakada, S. Y. (2017). In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser. Urology, 107, 37-42. https://doi.org/10.1016/j.urology.2017.06.018
Bell JR, Penniston KL, Nakada SY. In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser. Urology. 2017;107:37-42. PubMed PMID: 28647563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser. AU - Bell,John Roger, AU - Penniston,Kristina L, AU - Nakada,Stephen Y, Y1 - 2017/06/21/ PY - 2017/04/25/received PY - 2017/06/06/revised PY - 2017/06/12/accepted PY - 2017/6/26/pubmed PY - 2018/11/28/medline PY - 2017/6/26/entrez SP - 37 EP - 42 JF - Urology JO - Urology VL - 107 N2 - OBJECTIVE: To compare the performance of variable- and fixed-pulse lasers on stone phantoms in vitro. MATERIALS AND METHODS: Seven-millimeter stone phantoms were made to simulate calcium oxalate monohydrate stones using BegoStone plus. The in vitro setting was created with a clear polyvinyl chloride tube. For each trial, a stone phantom was placed at the open end of the tubing. The Cook Rhapsody H-30 variable-pulse laser was tested on both long- and short-pulse settings and was compared to the Dornier H-20 fixed-pulse laser; 5 trials were conducted for each trial arm. Fragmentation was accomplished with the use of a flexible ureteroscope and a 273-micron holmium laser fiber using settings of 1 J × 12 Hz. The treatment time (in minute) for complete fragmentation was recorded as was the total retropulsion distance (in centimeter) during treatment. Laser fibers were standardized for all repetitions. RESULTS: The treatment time was significantly shorter with the H-30 vs the H-20 laser (14.3 ± 2.5 vs 33.1 ± 8.9 minutes, P = .008). There was no difference between the treatment times using the long vs short pulse widths of the H-30 laser (14.4 ± 3.4 vs 14.3 ± 1.7 minutes, P = .93). Retropulsion differed by laser type and pulse width, H-30 long pulse (15.8 ± 5.7 cm), H-30 short pulse (54.8 ± 7.1 cm), and H-20 (33.2 ± 12.5 cm) (P <.05). CONCLUSION: The H-30 laser fragmented stone phantoms in half the time of the H-20 laser regardless of the pulse width. Retropulsion effects differed between the lasers, with the H-30 causing the least retropulsion. Longer pulse widths result in less stone retropulsion. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/28647563/In_Vitro_Comparison_of_Holmium_Lasers:_Evidence_for_Shorter_Fragmentation_Time_and_Decreased_Retropulsion_Using_a_Modern_Variable_pulse_Laser_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(17)30638-6 DB - PRIME DP - Unbound Medicine ER -