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The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy.
J Endourol 2019JE

Abstract

Introduction: Temperatures over 43°C-the threshold for cellular injury-may be achieved during ureteroscopic holmium laser lithotripsy. The time to reach and subsequently clear high temperatures at variable laser power settings and irrigation pressures has not been studied.

Methods:

A flexible or semirigid ureteroscope was placed within an 11/13 F ureteral access sheath inserted into a 250-mL saline bag simulating a normal-caliber ureter, renal pelvis reservoir, and antegrade irrigation flow. A thermocouple was placed adjacent to a 365 μm fiber fired for 45 seconds at 0.6 J/6 Hz, 0.8 J/8 Hz, 1 J/10 Hz, 1 J/20 Hz, and 0.2 J/80 Hz. Irrigation pressures of 200, 100, and 0 mm Hg were tested. Mean temperature changes were recorded with 6°C increase as a threshold for injury (as body temperature is 6°C below 43°C).

Results:

Semirigid scope: At 200 mm Hg no temperature changes >6°C were observed. At 100 mm Hg, changes >6°C occurred with 1 J/20 Hz within 1 second of activation and returned to ≤6°C within 1 second of cessation. At 0 mm Hg, changes >6°C occurred with all settings; within 1 second at power ≥10 W. Temperatures returned to ≤6°C within 5-10 seconds. Flexible scope: At 200 mm Hg, changes >6°C occurred at 1 J/10 Hz (15 seconds), 0.2 J/80 Hz (3 seconds), and 1 J/20 Hz (2 seconds). Temperatures returned within 6°C of baseline within 2 seconds. At 100 mm Hg, changes >6°C occurred in all but 0.6 J/6 Hz. Temperatures returned to ≤6°C in 5-10 seconds. At 0 mm Hg, all settings produced changes >6°C within 3 seconds, except 0.6 J/6 Hz (35 seconds). Temperatures returned to ≤6°C in under 10 seconds.

Conclusions:

High temperatures were achieved in our in vitro model in as little as 1 second at common irrigation pressures and laser settings, particularly with a flexible ureteroscope and power ≥10 W. However, with laser cessation, temperatures quickly returned to a safe level at each irrigation pressure.

Authors+Show Affiliations

1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.2 Veterans Affairs Boston Healthcare System, Boston, Massachusetts.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.1 Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31016991

Citation

Winship, Brenton, et al. "The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy." Journal of Endourology, 2019.
Winship B, Wollin D, Carlos E, et al. The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy. J Endourol. 2019.
Winship, B., Wollin, D., Carlos, E., Peters, C., Li, J., Terry, R., ... Lipkin, M. E. (2019). The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy. Journal of Endourology, doi:10.1089/end.2019.0084.
Winship B, et al. The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy. J Endourol. 2019 May 27; PubMed PMID: 31016991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Rise and Fall of High Temperatures During Ureteroscopic Holmium Laser Lithotripsy. AU - Winship,Brenton, AU - Wollin,Daniel, AU - Carlos,Evan, AU - Peters,Chloe, AU - Li,Jingqiu, AU - Terry,Russell, AU - Boydston,Kohldon, AU - Preminger,Glenn M, AU - Lipkin,Michael E, Y1 - 2019/05/27/ PY - 2019/4/25/pubmed PY - 2019/4/25/medline PY - 2019/4/25/entrez KW - laser KW - thermal injury KW - ureteral stone KW - ureteroscopy instrumentation JF - Journal of endourology JO - J. Endourol. N2 - Introduction: Temperatures over 43°C-the threshold for cellular injury-may be achieved during ureteroscopic holmium laser lithotripsy. The time to reach and subsequently clear high temperatures at variable laser power settings and irrigation pressures has not been studied. Methods: A flexible or semirigid ureteroscope was placed within an 11/13 F ureteral access sheath inserted into a 250-mL saline bag simulating a normal-caliber ureter, renal pelvis reservoir, and antegrade irrigation flow. A thermocouple was placed adjacent to a 365 μm fiber fired for 45 seconds at 0.6 J/6 Hz, 0.8 J/8 Hz, 1 J/10 Hz, 1 J/20 Hz, and 0.2 J/80 Hz. Irrigation pressures of 200, 100, and 0 mm Hg were tested. Mean temperature changes were recorded with 6°C increase as a threshold for injury (as body temperature is 6°C below 43°C). Results: Semirigid scope: At 200 mm Hg no temperature changes >6°C were observed. At 100 mm Hg, changes >6°C occurred with 1 J/20 Hz within 1 second of activation and returned to ≤6°C within 1 second of cessation. At 0 mm Hg, changes >6°C occurred with all settings; within 1 second at power ≥10 W. Temperatures returned to ≤6°C within 5-10 seconds. Flexible scope: At 200 mm Hg, changes >6°C occurred at 1 J/10 Hz (15 seconds), 0.2 J/80 Hz (3 seconds), and 1 J/20 Hz (2 seconds). Temperatures returned within 6°C of baseline within 2 seconds. At 100 mm Hg, changes >6°C occurred in all but 0.6 J/6 Hz. Temperatures returned to ≤6°C in 5-10 seconds. At 0 mm Hg, all settings produced changes >6°C within 3 seconds, except 0.6 J/6 Hz (35 seconds). Temperatures returned to ≤6°C in under 10 seconds. Conclusions: High temperatures were achieved in our in vitro model in as little as 1 second at common irrigation pressures and laser settings, particularly with a flexible ureteroscope and power ≥10 W. However, with laser cessation, temperatures quickly returned to a safe level at each irrigation pressure. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/31016991/The_Rise_and_Fall_of_High_Temperatures_During_Ureteroscopic_Holmium_Laser_Lithotripsy_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2019.0084?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -