Abstract
INTRODUCTION AND OBJECTIVE
There are limited data regarding optimal laser and energy settings during stone fragmentation. We assessed effects on fragmentation using a variety of energy and frequency settings with two laser systems.
METHODS
Artificial stones were created using BegoStone. A clear polyvinylchloride (PVC) tube with an inner diameter of 13 mm was closed at one end with a removable plug to create the in vitro ureteral and caliceal environments. The Lumenis Pulse 120H and the Cook Rhapsody H-30 holmium lasers were studied in the caliceal and ureteral models. A single urologist fragmented each stone to <2 mm. The caliceal studies assessed the time to fragmentation (n = 56). The ureteral studies measured the retropulsion distance of each stone phantom after 5 minutes of laser treatment time using different pulse width settings (n = 15).
RESULTS
Complete treatment of the stone with the 120H required 10.9 minutes at ≥1 J vs 26.9 minutes at <1 J (p < 0.001). The H-30 showed similar results with treatment times of 11.2 minutes at ≥1 J vs 22.8 minutes at <1 J (p < 0.001). There was no significant difference in treatment time when comparing the two lasers using settings of 0.8 J × 8 Hz and 1.5 J × 10 Hz (25.5 minutes vs 24.8 minutes, p = 0.861; and 13.2 minutes vs 9.5 minutes, p = 0.061; respectively). Retropulsion distances using the 120H were 13.9 cm using long pulse, 25.2 cm using medium pulse, and 56.6 cm using short pulse. Retropulsion distances using the H-30 laser were 7 cm using long pulse and 14.5 cm using short pulse, which differed from the 120H (p < 0.001).
CONCLUSIONS
Laser fragmentation was faster with both lasers when energy settings of ≥1 J were used. Treatment times using the 120H and the H-30 lasers were equivalent. Retropulsion distances were less with both lasers when longer pulse widths were used. The H-30 resulted in less stone retropulsion compared with the 120H.
TY - JOUR
T1 - In Vitro Comparison of Stone Fragmentation When Using Various Settings with Modern Variable Pulse Holmium Lasers.
AU - Bell,John Roger,
AU - Penniston,Kristina L,
AU - Nakada,Stephen Y,
Y1 - 2017/08/23/
PY - 2017/7/22/pubmed
PY - 2018/5/17/medline
PY - 2017/7/22/entrez
KW - holmium laser dusting
KW - instrumentation
KW - pulse width
KW - ureteroscopy
KW - urolithiasis
SP - 1067
EP - 1072
JF - Journal of endourology
JO - J. Endourol.
VL - 31
IS - 10
N2 - INTRODUCTION AND OBJECTIVE: There are limited data regarding optimal laser and energy settings during stone fragmentation. We assessed effects on fragmentation using a variety of energy and frequency settings with two laser systems. METHODS: Artificial stones were created using BegoStone. A clear polyvinylchloride (PVC) tube with an inner diameter of 13 mm was closed at one end with a removable plug to create the in vitro ureteral and caliceal environments. The Lumenis Pulse 120H and the Cook Rhapsody H-30 holmium lasers were studied in the caliceal and ureteral models. A single urologist fragmented each stone to <2 mm. The caliceal studies assessed the time to fragmentation (n = 56). The ureteral studies measured the retropulsion distance of each stone phantom after 5 minutes of laser treatment time using different pulse width settings (n = 15). RESULTS: Complete treatment of the stone with the 120H required 10.9 minutes at ≥1 J vs 26.9 minutes at <1 J (p < 0.001). The H-30 showed similar results with treatment times of 11.2 minutes at ≥1 J vs 22.8 minutes at <1 J (p < 0.001). There was no significant difference in treatment time when comparing the two lasers using settings of 0.8 J × 8 Hz and 1.5 J × 10 Hz (25.5 minutes vs 24.8 minutes, p = 0.861; and 13.2 minutes vs 9.5 minutes, p = 0.061; respectively). Retropulsion distances using the 120H were 13.9 cm using long pulse, 25.2 cm using medium pulse, and 56.6 cm using short pulse. Retropulsion distances using the H-30 laser were 7 cm using long pulse and 14.5 cm using short pulse, which differed from the 120H (p < 0.001). CONCLUSIONS: Laser fragmentation was faster with both lasers when energy settings of ≥1 J were used. Treatment times using the 120H and the H-30 lasers were equivalent. Retropulsion distances were less with both lasers when longer pulse widths were used. The H-30 resulted in less stone retropulsion compared with the 120H.
SN - 1557-900X
UR - https://www.unboundmedicine.com/medline/citation/28728505/In_Vitro_Comparison_of_Stone_Fragmentation_When_Using_Various_Settings_with_Modern_Variable_Pulse_Holmium_Lasers_
L2 - https://www.liebertpub.com/doi/full/10.1089/end.2017.0351?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
DB - PRIME
DP - Unbound Medicine
ER -
