Update on lasers in urology 2014: current assessment on holmium:yttrium–aluminum–garnet (Ho:YAG) laser lithotripter settings and laser fibers

Kronenberg, Peter; Traxer, Olivier

doi:10.1007/s00345-014-1395-1

Cited by 161 publications

(88 citation statements)

References 44 publications

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“…Furthermore, newer techniques such as intracorpor eal laser lithotripsy using highwattage holmium lasers to 'dust' stones are emerging, which might obviate the need for fragment retrieval in some patients. 64,65 Finally, the routine deployment of a UAS is not without its risks. 66 Until level 1 evidence for the safety and effectiveness of this procedure emerges, the indications for use of a UAS and retrieval will likely remain very much influenced by both patientrelated and stonerelated factors.…”

Section: Active Retrieval Of Fragmentsmentioning

confidence: 99%

What is the stone-free rate following flexible ureteroscopy for kidney stones?

2015

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Flexible ureteroscopy (URS) is increasingly being used as the first-line treatment for patients with renal stones. Despite this increase in use, substantial variations exist in the reported stone-free rates (SFR) following flexible URS. These variations are a result of inconsistencies in the definition of 'stone-free', which reflect variations in the type of imaging used to assess the presence of stones postoperatively and the timing of the assessment. Other possible factors such as the importance of residual fragments following stone surgery, and the size and position of the stones might also account for variations in stone-free rates. In order to obtain an accurate estimate of the SFR, especially within subgroups defined by stone characteristics and exact technique, we compare reported SFRs from studies that use imaging other than CT for follow-up and those that use only CT. We also review the evidence on the importance of active retrieval of fragments during flexible URS and whether this technique improves the outcomes of patients with kidney stones.

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Section: Active Retrieval Of Fragmentsmentioning

confidence: 99%

What is the stone-free rate following flexible ureteroscopy for kidney stones?

2015

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“…More recently, newer laser lithotripsy techniques such as dusting utilizing highwatt holmium systems have been popularized. 15 Dusting uses a high-frequency, low-pulse energy setting, such as 30-50 Hz · 0.2-0.5 J, which seeks to fragment stones to fine powder and small fragments, and thus reduce the need to retrieve fragments. We were surprised to find out that twothirds of respondents indicated using this technique.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Practice Patterns of Flexible Ureteroscopy for Treating Renal Stones: Results of a Worldwide Survey

Dauw

Simeon

Alruwaily

et al. 2015

Journal of Endourology

119

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“…We found that using 60 W from the start for all stones produced large fragments if the stone was fragile. Numerous large fragments may significantly increase the operative time, require an additional step for removal or the use of a specific laser technique, such as the 'popcorn effect', to reduce the stone burden [13]. Therefore, we recommend starting with 40-W power to produce small fragments and to increase the power to 60 W if the speed of disintegration is not satisfactory in cases of hard stones.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high‐power holmium laser versus ultrasonic lithotripsy

et al. 2016

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ObjectiveTo compare high-power holmium laser lithotripsy (HP-HLL) and ultrasonic lithotripsy (US-L) for disintegration of staghorn stones during percutaneous nephrolithotomy (PCNL). Patients and MethodsA non-inferiority randomised controlled trial was conducted between August 2011 and September 2014. Inclusion criteria were patients' aged >18 years who had complete staghorn stones (branching to the three major calyces), without contraindications to PCNL. Eligible patients were randomised between two groups: HP-HLL and US-. A standard PCNL in the prone position was performed for all patients. The only difference between the treatment groups was the method of stone disintegration. In the first group (HP-HLL), a laser power of 40-60 W (2 J, 20-30 Hz) was used to pulverise the staghorn stone into very small fragments, which could pass through the Amplatz sheath with the irrigation fluid. US-L, with suction of the fragments, was used in the second group. The primary outcome (stone-free rate) was evaluated with non-contrast computed tomography after 3 months. Secondary outcomes of complications, blood transfusion, operative time, and haemoglobin deficit were compared. The outcome assessor was 'blinded' to the treatment arm. ResultsThe study included 70 patients (35 in each group). The baseline characteristics (age, sex, body mass index, side, stone volume, and density) and operative technique (number, size of tracts, and need for second PCNL session) were comparable for both groups. Operative time was significantly shorter in US-L group, at a mean (SD) of 130 (34) vs 148.7 (35) min (P = 0.028). The haemoglobin deficit was significantly more with in the US-L group, at a mean (SD) of 1.7 (0.9) vs 1.3 (0.6) g/dL (P = 0.037). The differences in blood transfusion (17% for US-L vs 11% for HP-HLL) and the complication rates (34% for US-L vs 23% for HP-HLL) were not significant (P = 0.495 and P = 0.290, respectively). The stone-free rates at 3 months were comparable (60% for US-L and 66% for HPL-L; P = 0.621). ConclusionsCompared with US-L for intracorporeal lithotripsy of staghorn stones during PCNL, HP-HLL showed comparable safety and efficacy with a lower haemoglobin deficit but longer operative time.

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Update on lasers in urology 2014: current assessment on holmium:yttrium–aluminum–garnet (Ho:YAG) laser lithotripter settings and laser fibers

Abstract: Many technical factors influence the performance of holmium laser lithotripsy. Knowing and understanding these controllable parameters allows the urologist to perform a laser lithotripsy procedure safely, efficiently, and with few complications.

Cited by 161 publications

References 44 publications

What is the stone-free rate following flexible ureteroscopy for kidney stones?

What is the stone-free rate following flexible ureteroscopy for kidney stones?

Contemporary Practice Patterns of Flexible Ureteroscopy for Treating Renal Stones: Results of a Worldwide Survey

Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high‐power holmium laser versus ultrasonic lithotripsy

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