Will Stone Density Stop Being a Key Factor in Endourology? The Impact of Stone Density on Laser Time Using Lumenis Laser p120w and Standard 20 W Laser: A Comparative Study

Mekayten, Matan; Lorber, Amitay; Katafigiotis, Ioannis; Sfoungaristos, Stavros; Leotsakos, Ioannis; Heifetz, Eliyahu M; Yutkin, Vladimir; Gofrit, Ofer N.; Duvdevani, Mordechai

doi:10.1089/end.2019.0181

Cited by 37 publications

(27 citation statements)

References 15 publications

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“…Consequently, the evaluation of an endoscopic stone procedure and surgeons may rely on the delivered energy for a stone volume. In this regard, our results are in line with the previous report by Mekayten et al [21], which reported that in average 13 J is needed to ablate 1 mm 3 of a stone of ~ 1000 HU. We also showed that COM stones required more RE than Cys and UA stones.…”

Section: Required Energy To Treat 1 MM 3 Of Stonesupporting

confidence: 93%

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

et al. 2020

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Introduction Holmium:yttrium-aluminium-garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in vitro study evaluated the required energy to ablate 1 mm 3 of various stone types with different laser settings using Ho:YAG. Methods 272 µm core-diameter laser fibers (Boston Scientific © ) were connected to a 30 Watt MH1 Ho:YAG generator (Rocamed®). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1 mm 3 (RE). Results All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6 J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2 J, respectively The mean REs at 1 J PE for COM, Cys and UA were 14.7, 6.4 and 2 J, respectively. At 0.6 J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively. Conclusion This in vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice.

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Section: Required Energy To Treat 1 MM 3 Of Stonesupporting

confidence: 93%

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

et al. 2020

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“…No RCT was found. Except from one comparative observational study, 22 only observational noncomparative studies were selected during the systematic search process. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][23][24][25][26][27][28][29]34 Included studies contributed for a total of 6403 patients.…”

Section: Overall Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…Hypothetically, faster popcorning speed can stochastically cause a higher number of fragments to hit the caliceal walls; this repeated microtraumatism could increase the risk of bleeding, which could further interfere with the quality of vision. It was previously shown that HP is able to reduce laser only time by a half as compared with LP, 22 despite the possibility of having up to five times higher frequency and with an increased total amount of delivered energy. This point highlights again the issue of the efficiency in energy delivery when working at high frequencies.…”

Section: High-vs Low-power Laser Lithotripsymentioning

confidence: 99%

High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series

Ventimiglia

Pauchard

Quadrini

et al. 2021

Journal of Endourology

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Purpose: There is no clear evidence that high-power (HP) laser generators perform better than low-power (LP) ones in terms of lithotripsy outcomes. We aimed to perform a systematic review of literature to compare the efficacy outcomes of both HP and LP during ureteroscopic lithotripsy. Materials and Methods: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting perioperative outcomes of HP and LP lithotripsy. Using the methodology recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we identified 22 nonrandomized noncomparative retrospective studies published between 2015 and 2019 that were eligible for inclusion in this systematic review. Because of the lack of comparative studies, we decided to perform two separate meta-analytic syntheses for LP and HP studies, then we compared them using a Wald-type test. Results: Overall, the selected studies included 6403 patients. Study design, exposure assessment, selection criteria, and outcome of interest were heterogeneous. LP studies were more common (n = 17, 77%), whereas HP studies were more common in the latest inclusion period. Faster lithotripsy (32.9 minutes vs 63.9 minutes, p < 0.01) was observed in HP studies. However, stone volume resulted twofold higher (2604 mm 3 vs 1217 mm 3 , p = 0.048) in LP studies. Pooled stone-free rate was similar in both LP and HP studies, 81% and 82%, respectively, p > 0.05. No difference in complication rate was observed between the two groups, p = 0.12. Conclusions: HP laser lithotripsy appears to require shorter operative time, with similar stone-free and complication rates as compared with LP traditional lithotripsy. However, when taking into account stone burden, this advantage seems to be lost, or at least not to be comparable with what observed in laboratory studies. Because of the lack of high-level comparative evidence, further clinical studies are needed to elucidate the benefits of using HP laser generators during ureteroscopic stone treatment.

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“…A comparative study between high and low power laser lithotripsy showed significantly less operative time but higher joules/mm 3 values for the high power laser [ 10 ]. What happens with this extra delivered energy?…”

Section: Methodsmentioning

confidence: 99%

A Practical Guide for Intra-Renal Temperature and Pressure Management during Rirs: What Is the Evidence Telling Us

Pauchard

Ventimiglia

Corrales

et al. 2022

JCM

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Introduction: One of the main limitations of Ho:YAG lithotripsy is represented by its advancement speed. The need for faster lithotripsy has led to the introduction of high-power laser equipment. This general trend in increasing Ho:YAG lithotripsy power has certain points that deserve to be considered and analyzed. The objective is to carry out a narrative review on intrarenal temperature and pressure during ureteroscopy. Methods: A literature search using PUBMED database from inception to December 2021 was performed. The analysis involved a narrative synthesis. Results: Using more power in the laser correlates with an increase in temperature that can be harmful to the kidney. This potential risk can be overcome by increasing either the irrigation inflow or outflow. Increasing irrigant flow can lead to high intrarenal temperature (IRP). The factors that allow the reduction of intrarenal pressure are a low irrigation flow, the use of a ureteral access sheath of adequate diameter according to the equipment used, and the occupation of the working channel by the laser or basket. Conclusion: To maintain a safe temperature profile, it has been proposed to use chilled irrigation fluid, intermittent laser activation or to increase irrigation flow. This last recommendation can lead to increased IRP, which can be overcome by using a UAS. Another option is to use low power laser configurations in order to avoid temperature increases and not require high irrigation flows.

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Will Stone Density Stop Being a Key Factor in Endourology? The Impact of Stone Density on Laser Time Using Lumenis Laser p120w and Standard 20 W Laser: A Comparative Study

Cited by 37 publications

References 15 publications

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series

A Practical Guide for Intra-Renal Temperature and Pressure Management during Rirs: What Is the Evidence Telling Us

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