What is the exact definition of stone dust? An in vitro evaluation

Keller, Etienne Xavier; Coninck, Vincent De; Doizi, Steeve; Daudon, Michel; Traxer, Olivier

doi:10.1007/s00345-020-03178-z

Cited by 44 publications

(28 citation statements)

References 37 publications

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“…To date, there is no consensus regarding the exact definition of dust; nonetheless, a size limit of ≤250 μm seems to properly adhere to an adequate definition of stone dust capable of being aspirated through the working channel [ 62 ]. Laboratory studies have suggested that the TFL produces smaller fragments than the Ho: YAG laser does in dusting mode, regardless of the stone type or laser settings [ 50 , 63 ].…”

Section: Resultsmentioning

confidence: 99%

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Traxer

Corrales

2021

JCM

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Thirty-three years ago, pulsed lasers marked the beginning of a new era in endoscopic lithotripsy, and the one that was highlighted because of its potential was the Holmium: YAG laser, which became and still is the gold standard in endourology. Recently, a new laser technology has been accepted for clinical use in lithotripsy: the thulium fiber laser (TFL), showing appealing characteristics not seen before in several preclinical studies. A review of the literature was performed and all relevant in vitro studies and clinical trials until April 2021 were selected. The search came back with 27 clinical experiences (7 full-text clinical trials and 20 peer-reviewed abstracts) and 33 laboratory studies (18 full-text articles and 15 peer-reviewed abstracts). The clinical experiences confirmed the clinical safety of using the wide parameter range of the TFL. This technology demonstrated the performance at a higher ablation speed, the higher ablation efficiency, and the better dust quality of the TFL, as well as reduced stone retropulsion, thus helping to maintain an optimal visibility. No thermal or radiation damage was found. Given the current evidence, we may be facing the future gold standard laser in endoscopic lithotripsy.

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Section: Resultsmentioning

confidence: 99%

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Traxer

Corrales

2021

JCM

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“…This was followed by noncontact lithotripsy (popcorning), until fine dust, small enough to pass spontaneously, was formed. [ 12 ] Thus, popcorning is common in both modes, at the end, to obtain fine dust. No stone retrieval was done after fragmentation mode.…”

Section: Methodsmentioning

confidence: 99%

“…[ 7 ] The ablation rates are two-fold higher than Ho YAG laser from the reports of in vitro studies[ 8 9 10 ] and ablation volume is 2.2, 2.0, and 1.6 times higher than short pulse, long pulse, and Moses modes of Ho YAG laser. [ 11 ] The preclinical studies propose that TFL enables achieve faster and finer “Dust,”[ 12 ] as very low pulse energy and very high frequency is possible. [ 6 ] Claimed to have so many advantages, this study assessed the application of TFL in a clinical scenario.…”

Section: Introductionmentioning

confidence: 99%

The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery

Vaddi¹,

Ramakrishna²,

Ganeshan³

et al. 2022

Indian Journal of Urology

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Introduction: Our aim is to evaluate the clinical efficiency and safety of 60W Thulium fiber laser (TFL) during retrograde intrarenal surgery (RIRS). The performance of the TFL across different ranges of stone volumes and stone densities is assessed. Materials and Methods: Between October 2019 and August 2020, a prospective study was done on 135 patients with < 20 mm renal stones, who underwent RIRS using TFL. Stone parameters, total laser time, total energy delivered (kJ), and fiber burn-back were recorded. Laser efficacy (J/mm3) and ablation speed (mm3/s) were calculated. Results: Data of 126 of 135 patients included in the study were analyzed. The mean patient age was 45.04 ± 12.30 years. Mean stone size was 15.19 ± 4.52 mm, and mean stone volume was 1061.85 ± 806.81 mm3. Mean laser time was 19.78 ± 12.32 min. At higher stone volume (>1000 mm3), J/mm3 decreased significantly from 16.18 ± 5.90 to 10.92 ± 3.21 (P < 0.001) and the ablation speed increased significantly (0.77 ± 0.28–1.04 ± 0.28 mm3/s [P < 0.001]). Stone density did not have a significant influence on the laser efficacy [B = -0.31 (-2.45 to 1.82, p=0.771)] or on the ablation speed [B = -0.06 (-0.17 to 0.05, p=0.278)]. Overall SFR was 93.6%. The complication rate was 16.6% (21/126). Out of the 21, 12 patients had hematuria and 9 had fever, which were of Clavien grades 1–2. Conclusion: Superpulse TFL is efficient and safe. The work efficiency increases for larger volume stones. The work efficiency remains the same across different stone densities. No complication more than Clavien grade 2 was encountered.

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“…"Dust" has been recently defined as fragments floating under irrigation [29]. Whereas Keller et al demonstrated in vitro that fragments smaller than 250 µm, except for struvite (125 µm), met this definition; the SFR level is still under discussion [30,31]. Consequently, we left the SFR assessment to the surgeon's preference.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

et al. 2021

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Introduction Kidney Stone Calculator (KSC) is a free, three-dimensional (3D) planning software for flexible ureteroscopy(fURS) with Holmium:YAG(Ho:YAG) endocorporeal lithotripsy (EL). KSC provides the stone volume (SV) and expected duration of lithotripsy (ExDL) estimations based on non-enhanced-CT scan (NECT) DICOM series. We aimed to provide a preclinical and clinical evaluation of KSC. Patients and methods A preclinical evaluation measured the SV by three operators (resident, endourology expert and research engineer) among 17 NECT cases. Between January and March 2020, a multicentric, prospective, observational double-blind clinical evaluation was conducted in patients presenting with renal stones treated with Ho:YAG-EL during fURS and preoperative NECT. Demographic and surgical data were collected. The primary endpoint was a significant median difference between ExDL and EffectiveDL (EfDL). Second, efficiency (J/mm 3 ) and efficacy (mm 3 /min) ratios were calculated. Results The preclinical evaluation showed no significant difference in the SV measurements among operators ( p > 0.05). Pearson and Kendall coefficients of 0.99 and 0.98, respectively, were found. Twenty-six patients were included in the clinical evaluation, with a median age of 55 years. In 66% of cases, there was a single stone located in the lower pole, with a density > 1000 Hounsfield Unit observed in 42% and 85% of cases. A 14% [Q1–Q3 (5.4–24.8); p = 0.36] median difference between ExDL and EfDL was noted, which was greater in the case of lower pole stones with no possible relocation ( p = 0.008). Median values of 17.6 J/mm 3 and 0.4 (0.32–0.56) mm 3 /s EL were also noted. Conclusions Kidney Stone Calculator is a reproducible and accurate software that allows for an estimation of the stone burden and provides an ExDL for URSf. Defining the influencing factors of EL will improve its ExDL. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03671-z.

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What is the exact definition of stone dust? An in vitro evaluation

Cited by 44 publications

References 37 publications

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

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