Optimal settings for the Holmium:YAG laser in endo-urology

Introduction. - The pulsed Holmium:YAG laser is the main laser source in endo-urology. The optimization of the laser parameters is certainly the most important independent-operator factor for the success of an endo-urological procedure. Laser parameters. - Three parameters determine the biological effectiveness of a laser: the pulse frequency, the pulse duration and the energy per pulse. Four main laser profiles are defined for the endo-urology of the upper urinary tract: the dusting and fragmentation for the treatment of stones, the section for ureteral strictures and coagulation/ablation for tumors of the urinary tract. For renal stones, the dusting has the advantage of avoiding the formation of residual fragments, but fragmentation is more suited for very hard stones. Diameter of the fiber. - The use of a small diameter fiber (200-270 microns) is recommended as it is as effective as a larger fiber, allows a better irrigation and a better maneuverability. (C) 2016 Elsevier Masson SAS. All rights reserved.