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In Vitro Comparison of Stone Fragmentation When Using Various Settings with Modern Variable Pulse Holmium Lasers.
J Endourol. 2017 10; 31(10):1067-1072.JE

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.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Bell JR
    1 Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
    Penniston KL
    1 Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
    Nakada SY
    1 Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin. 2 Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin. 3 Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.

    MeSH

    HolmiumHumansLasers, Solid-StateLithotripsy, LaserModels, BiologicalPhantoms, ImagingUreteral Calculi

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    28728505

    Citation

    Bell, John Roger, et al. "In Vitro Comparison of Stone Fragmentation when Using Various Settings With Modern Variable Pulse Holmium Lasers." Journal of Endourology, vol. 31, no. 10, 2017, pp. 1067-1072.
    Bell JR, Penniston KL, Nakada SY. In Vitro Comparison of Stone Fragmentation When Using Various Settings with Modern Variable Pulse Holmium Lasers. J Endourol. 2017;31(10):1067-1072.
    Bell, J. R., Penniston, K. L., & Nakada, S. Y. (2017). In Vitro Comparison of Stone Fragmentation When Using Various Settings with Modern Variable Pulse Holmium Lasers. Journal of Endourology, 31(10), 1067-1072. https://doi.org/10.1089/end.2017.0351
    Bell JR, Penniston KL, Nakada SY. In Vitro Comparison of Stone Fragmentation when Using Various Settings With Modern Variable Pulse Holmium Lasers. J Endourol. 2017;31(10):1067-1072. PubMed PMID: 28728505.
    * Article titles in AMA citation format should be in sentence-case
    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&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -