A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

Zhu, Xiaozhong; Hu, Xuedong; Li, Haiping; Wu, Songjiang; Jiang, Haihong

doi:10.1016/j.ajur.2022.05.011

Cited by 1 publication

(1 citation statement)

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“…Previous research has highlighted the risk of ureteral stricture post-ureteroscopic lithotripsy [15], attributing it to laser-induced thermal effects on the ureteral mucosa [2,16]. Although the threshold for thermal damage in the urothelium remains unclear, existing literature suggests tissue injury typically begins at 43°C [17], with complete necrosis observed at 54°C [14].…”

Section: Discussionmentioning

confidence: 99%

Exploring Thermal Dynamics of Thulium Super-Pulsed Lasers in Lithotripsy Procedures

Hu,

hilowle,

Shen

et al. 2024

Preprint

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Purpose Optimizing lithotripsy protocols for clinical practice by studying the thermal effects of laser technologies across different parameters and perfusion rates. Methods This study highlights Thulium Super-Pulsed Lasers from Lakh Medical Equipment (Beijing) Co., Ltd. Both operate at 1940nm peak wavelength and 500W power output. An in vitro model used detached pig kidney ureters in a constant-temperature water bath 37°C. A disposable ureteroscope with domestically produced pulsed thulium fiber laser stimulated the ex vivo simulated ureteral model. Laser parameters included 15ml/min, 25ml/min, and 35ml/min perfusion rates with physiological saline at 25℃±1℃. Artificial stones were inserted using ureteroscopy. Results At 15 ml/min infusion rate and 6W stone fragmentation power, ureter temperature rises positively with excitation time, reaching 37.4°C within 30 seconds. Increasing to 12W, the thulium laser surpassed 43.4°C within 30 seconds. At 18W, consistent temperature elevation regardless of mode, reaching 43°C in 5 seconds at >400Hz. For 6W, 12W, and 18W, excitation time remains under 30 seconds, ensuring ureter stays <43°C. Except for specific parameters, ureteral temperature exceeds the safety threshold at 24W and 30W. At 35 ml/min infusion rate and 30W, intrapelvic temperature remains safe within 30 seconds except for one mode. Conclusion This investigation demonstrates that Thulium laser therapy can safely raise ureter temperature within controlled limits, aiding urological disease treatment. Urologists gain a scientific footing for laser parameter selection. Thulium laser's power, energy, frequency, and pulse width dictate temperature changes, demanding careful consideration for effective treatment planning.

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