Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi.

Abstract:

BACKGROUND AND PURPOSE:Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy is the standard lithotrite in ureteroscopy. We investigated the influence of pulse frequency, energy and length on the fragmentation efficiency of Ho:YAG laser lithotripsy in non-floating artificial stones in vitro. MATERIALS AND METHODS:Stone fragmentation efficiency of three different Ho:YAG laser devices were evaluated in vitro at different pulse energy (1.0 and 2.0 J) and frequency settings (5 and 10 Hz), resulting in a standardized output power of 10W, respectively. Where possible, pulse length was modified (350 vs 700 microsec). Each setting was performed with a 273 microm and a 365 microm fiber. Lithotripsy was conducted using non-repulsive stones consisting of soft stone (plaster of Paris) and hard stone composition (Fujirock type 4). RESULTS:Our results showed an increased stone disintegration efficiency at higher pulse energy (2.0 J/5 Hz vs 1.0 J/10 Hz) independently of two fiber diameters and stone types applied in this study (P < 0.05 in 18 of 20 groups). Similarly, reduction of the pulse length from 700 to 350 microsec resulted in a higher stone disintegration (P < 0.05 in 13 of 16 groups). This effect was most prominent when applied to soft stones. Higher fiber diameter was not constantly associated with an increase in stone disintegration. CONCLUSION:We demonstrate that an increase of pulse energy and a reduction of pulse length at a standardized output power of 10W can improve Ho:YAG laser fragmentation efficiency in vitro in nonfloating stones. These results may potentially affect clinical practice of Ho:YAG laser lithotripsy in impacted or large stones, when retropulsion is excluded.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Wezel F,Häcker A,Gross AJ,Michel MS,Bach T

doi

10.1089/end.2010.0115

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

1135-40

issue

7

eissn

0892-7790

issn

1557-900X

journal_volume

24

pub_type

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