Ureteroscopy and laser lithotripsy: technologic advancements

Abstract

Ureteroscopic lithotripsy has evolved since the first reported cases employing rigid rod-lens endoscopes and stiff ultrasonic lithotrites. Fiber optics facilitated rigid endoscope miniaturization and the development of a steerable, deflectable flexible ureteroscopes. Over 30 years of technical innovations culminating in digital imagers and powerful, precise laser lithotrites, complimented by progressive endoscopic techniques have produced efficient endoscopic therapies with minimal morbidity and commonly performed in an outpatient setting.

Flexible ureteroscopy: Technological advancements, current indications and outcomes in the treatment of urolithiasis

“…Unfortunately, digital flexible ureteroscopes had a larger diameter than the conventional fiberoptic flexible counterparts and their use was associated with increased need for placement of a ureteral access sheath (UAS) [7] , which is associated with higher risk of ureteral injuries [8] . However, further development led to the introduction of smaller caliber digital flexible ureteroscopes comparable to the previous conventional endoscopes [9] .…”

Numerical Response Surfaces of Volume of Ablation and Retropulsion Amplitude by Settings of Ho:YAG Laser Lithotripter

“…We wanted to note that the range of testing conditions in this study are 0.2–3 J, 333–1000 μ s, and 1–10 pulses (10 Hz); the calculus phantom is gypsum white cement, the phantom is fixed in a holder, and only 356 μ m core diameter fiber is used for testing. There is another well-known issue in laser lithotripter: fiber tip burn back [ 44 , 53 , 54 ], which is also a key factor for procedure time, patient safety, and care economics. Further study should explore laser settings beyond the current range, and fiber burn back should be taken into account when searching for the optimum laser setting for urolithiasis.…”

Digital ureteroscopes: technology update

“…Early digital ureteroscopes had image distortion due to acoustic wave production during laser lithotripsy, but this was reduced by the implementation of shock absorbers at image sensor. 16 In the authors’ experience, image distortion can still occur with modern digital ureteroscopes due to the photoacoustic effect of the holmium:YAG laser when activated near the tip of the ureteroscope.…”

“…This ovoid shape is believed to provide improved drainage during ureteroscopy. 16 Karl Storz also offers imaging technology aimed at improving visualization. The Storz Professional Image Enhancement System (SPIES) includes several modalities: Spectra A, Spectra B, Clara, and Chroma.…”