Optimal Power Settings for Holmium:YAG Lithotripsy

被引:140
|
作者
Sea, Jason
Jonat, Lee M.
Chew, Ben H.
Qiu, Jinze
Wang, Bingqing
Hoopman, John
Milner, Thomas
Teichman, Joel M. H.
机构
[1] Univ British Columbia, Dept Urol Sci, Vancouver, BC V5Z 1M9, Canada
[2] Univ Texas Austin, Dept Elect Engn, Biomed Opt Program, Austin, TX 78712 USA
[3] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
来源
JOURNAL OF UROLOGY | 2012年 / 187卷 / 03期
关键词
urinary calculi; lithotripsy; lasers; solid-state; efficiency; calcium oxalate; LASER LITHOTRIPSY; YAG LITHOTRIPSY; STONE RETROPULSION; EFFICIENCY VARIES; PULSE DURATION; IN-VITRO; FRAGMENTATION; DEPENDENCE; FREQUENCY; CALCULI;
D O I
10.1016/j.juro.2011.10.147
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We determined the optimal Ho:YAG lithotripsy power settings to achieve maximal fragmentation, minimal fragment size and minimal retropulsion. Materials and Methods: Stone phantoms were irradiated in water with a Ho: YAG laser using a 365 inn optical-fiber. Six distinct power settings were tested, including 0.2 to 2.0 J and 10 to 40 Hz. For all cohorts 500 J total radiant energy were delivered. A seventh cohort (0.2 J 40 Hz) was tested post hoc to a total energy of 1,250 J. Two experimental conditions were tested, including with and without phantom stabilization. Total fragmentation, fragment size and retropulsion were characterized. In mechanism experiments using human calculi we measured crater volume by optical coherence tomography and pressure transients by needle hydrophone across similar power settings. Results: Without stabilization increased pulse energy settings produced increased total fragmentation and increased retropulsion (each p <0.0001). Fragment size was smallest for the 0.2 J cohorts (p <0.02). With stabilization increased pulse energy settings produced increased total fragmentation and increased retropulsion but also increased fragment size (each p <0.0001). Craters remained symmetrical and volume increased as pulse energy increased. Pressure transients remained modest at less than 30 bars even at 2.0 J pulse energy. Conclusions: Holmium:YAG lithotripsy varies as pulse energy settings vary. At low pulse energy (0.2 J) less fragmentation and retropulsion occur and small fragments are produced. At high pulse energy (2.0 J) more fragmentation and retropulsion occur with larger fragments. Anti-retropulsion devices produce more efficient lithotripsy, particularly at high pulse energy. Optimal lithotripsy laser dosimetry depends on the desired outcome.
引用
收藏
页码:914 / 919
页数:6
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