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Thulium fiber laser: ready to dust all urinary stone composition types?
摘要： Purpose To evaluate whether stone dust can be obtained from all prevailing stone composition types using the thulium fiber laser (TFL) for lithotripsy. Where applicable, stone dust was further characterized by morpho-constitutional analysis. Methods Human urinary stones were submitted to in vitro lithotripsy using a FiberLase U2 TFL generator with 150 μm silica core fibers (IPG Photonics?, IPG Medical?, Marlborough, MA, USA). Laser settings were 0.05 J, 320 Hz and 200 μs. A total of 2400 J were delivered to each stone composition type. All evaluated stones had a > 90% degree of purity (calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite and cystine). Spontaneously floating stone particles were considered as stone dust and collected for analysis by scanning electron microscopy and Fourier transform infrared spectroscopy. Results Stone dust could be retrieved from all evaluated urinary stones after TFL lithotripsy. Most stone dust samples revealed changes in crystalline organization, except for calcium oxalate monohydrate and carbapatite, which conserved their initial characteristics. Mean maximal width of stone dust particles did not exceed 254 μm. Conclusions The TFL is capable to produce stone dust from all prevailing stone types. Morpho-constitutional changes found in stone dust suggest a photothermal interaction of laser energy with the stone matrix during TFL lithotripsy.
关键词： Urolithiasis,Stone dust,Fourier transform infrared spectroscopy,Lithotripsy,Scanning electron microscopy,Thulium fiber laser
更新于2025-09-23 15:21:01
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Hounsfield units-a significant predictor of lasering time and energy in the management of upper urinary tract stones using Holmium: Yttriuma??Aluminum Garnet lasers
摘要： Purpose To study the impact of stone density as assessed by Hounsfield units (HU) on total laser energy (TLE) used and total laser time (TLT) spent in complete fragmentation of upper urinary tract stones. In addition, we also studied the impact of stone composition on the laser energy and time required for fragmentation. Methods Thirty consecutive patients fulfilling inclusion and exclusion criteria were included in the study. Patients with renal or proximal ureteral stones with a size of 5–20?mm were included. Stone fragmentation was performed using Ho:YAG 100?W laser and TLT and TLE were correlated with the HU and stone composition. Results The mean stone diameter was 10.83 ± 3.5?mm and the mean HU was 893 ± 315. The mean TLE and TLT were 8.86 ± 3.12?kJ and 18.46 ± 6.9?min, respectively. We observed a strong positive correlation between HU and TLE (r = 0.84, p value < 0.001) and between HU and TLT (r = 0.58, p value = 0.001). However, the stone composition did not influence the lasering energy (p value = 0.36) and lasering time (p value = 0.30). Stone diameter also had significant positive correlation with TLE (r = 0.41; p = 0.02) and TLT (r = 0.54; p? 0.002). When controlling for stone size the correlation of HU with TLE (r = 0.83; p < 0.001) and TLT (r = 0.52; p = 0.004) remained significant. Conclusions HU and stone diameter are significant predictors of TLE and TLT when using Ho:YAG laser for stone fragmentation. However, stone composition and stone location failed to show any significant effect on either of these parameters.
关键词： Urolithiasis,Energy,fURS,RIRS,Laser,Holmium YAG
更新于2025-09-23 15:19:57
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Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser
摘要： The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
关键词： urolithiasis,flexible ureteroscopy,infection,Renal rupture,diabetes mellitus
更新于2025-09-19 17:13:59
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Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence
摘要： In Holmium laser lithotripsy, usually, the surgeon is guided by a visible beam superimposing the infrared (IR) treatment radiation. It has been shown that a green aiming beam excites stone autofluorescence. This fluorescence signal can be used for calculi detection to check the correct fiber position before triggering the IR laser, thus preventing damage to soft tissue and application devices. However, also the directly reflected green light from the fiber tip gives valuable information on fiber position and its surface condition. Materials and Methods: An external fiber‐fiber‐coupling‐box (fiber core diameter 365 μm) for pulsed holmium laser radiation (2.1 μm) was set up containing a green diode laser module (520 nm, average power on the sample <0.5 mW) and optics and detectors for measuring the reflected light of this aiming beam as well as the fluorescence excited with it. Measurements were done via a lock‐in technique with more than 20 human calculi samples and porcine calix in vitro. After the implementation of automatic data storage signals during ongoing in vitro lithotripsy procedures were recorded with the fiber positioned on tissue, stone, or in/on medical equipment (working channel of an endoscope, stone retrieval basket). Results: Stone fluorescence signals measured were a factor of 7 to >100 higher than those of tissue. Stone fluorescence was detectable in “non‐contact mode” with a linear signal decrease over a distance up to ~1 mm in front of the fiber tip (core diameter 365 μm) and with severely damaged fibers (max. decrease: 75% with pinched off fiber). Reflection signals of the fiber tip surface in air and water surrounding decreased significantly when the fiber was damaged; measured ratios of intact to damaged fiber found in the air were (5–17):1 and in water (1.6–3.7):1. Surfaces in front of the fiber aggravated the evaluation of fiber condition due to reflections but enabled to detect, for example, the working channel of a flexible endoscope in combination with the (missing) fluorescence signal. Conclusions: Autofluorescence induced by a green aiming beam can be exploited for stone detection in laser lithotripsy. A reflection measurement can give further information on fiber condition and position. Implementing this kind of safety features for an automatic block of IR laser emission in case of weak or missing fluorescence and un‐normal reflections can assist the surgeon by avoiding tissue perforation, and damage to medical devices such as endoscopes.
关键词： Holmium laser,feedback control,urolithiasis,fluorescence,laser lithotripsy,urinary calculi
更新于2025-09-19 17:13:59
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Effect of ureteral calculus in outpatients receiving semirigid ureteroscope laser lithotripsy
摘要： The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.
关键词： laser,ureteroscopy,urolithiasis,outcome,injury,risk
更新于2025-09-19 17:13:59
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Management von Urethralsteinen beim Hund mittels pneumatischer und laserenergetischer Lithotripsie
摘要： Objective Description of clinical experience with two different lithotripsy modalities for treatment of urethral stones in dogs. Material and methods Retrospective analysis (October 2016 – November 2017) of medical records from dogs with urinary stones that underwent transurethral pneumatic or laser lithotripsy. Results In 28 male and 5 female dogs, either pneumatic lithotripsy (39 %) or laser lithotripsy (61 %) was performed. In the urethra, stone free rates of 100 % in females and over 85 % in males could be achieved using either fragmentation modality. In 3 of 28 (11 %) male dogs, after fragmentation of urethral stones, urethral patency was impaired because of endoscopically suspected polypoid urethritis requiring urethrostomy. In 8 out of 28 (29 %) male dogs and in 1 of 5 (20 %) female dogs, an additional lithocystotomy was necessary to achieve stone-free status in the lower urinary tract. Conclusion and clinical relevance Transurethral pneumatic or laser lithotripsy of urinary stones is a successful procedure in dogs. Major pathological conditions of the urethral mucosa may require further surgical or interventional methods for the restoration of a functional urethra.
关键词： pneumatic lithotripsy,laser lithotripsy,Urethra,urolithiasis
更新于2025-09-16 10:30:52