The optimal Holmium laser settings for disintegration of cystine and calcium oxalate monohydrate stones: In vitro study

Abstract

Objective Disintegrating cystine and calcium oxalate monohydrate stones present a formidable challenge owing to their hardness and distinct composition. This study aimed to establish optimal laser settings for these hard stones lithotripsy. Patients and Methods Cystine and calcium oxalate monohydrate stones were extracted from two patients. Two experiments were conducted in vitro by utilizing a 272 μm laser fiber with variable settings to disintegrate the cystine and calcium oxalate monohydrate stones. In the first experiment, energy was adjustable while frequency was constant, whereas the second experiment involved constant energy with adjustable frequency on each type of stone and each experiment was repeated three times to ensure robustness and reliability. Results Our findings indicated that for cystine stones, use of higher total power with high energy and low frequency proved to be effective. Conversely, for calcium oxalate monohydrate stones, settings involving higher total power with low energy and high frequency demonstrated superior efficacy and safety. Conclusion Holmium (Ho: YAG) laser settings with higher total power, high energy, and low frequency effectively disintegrate cystine stones despite increased heat, which was measured by a thermometer with a thermocouple. For calcium oxalate monohydrate stones, higher total power, high frequency, and low energy settings are recommended and safe.

Comparison of high and low pulse energy dusting protocols using holmium: YAG laser in flexible ureteroscopy for treatment of renal stones

“…Dusting of hard stones with the known setting of dusting (low energy, high frequency) is usually difficult and time consuming. Our technique of changing the dusting setting into high energy, with the same dusting technique of no touch and continuous moving of laser fiber is a promising technique to efficiently dust hard stones in a shorter operative time [ 9 , 13 , 14 ].…”