The effect of force on laser fiber burnback during lithotripsy

Optical fibers for lithotripsy are designed to deliver the maximum energy precisely to the treatment site without a decrease in performance and without increasing the risks to patients and users. One of the obstacles to constant energy delivery is burnback of the optical fiber tip. So far, researchers identified mechanical, thermal, and optical factors as mechanisms in burnback phenomena. Among mechanical factors, the force applied by urologists against a stone is expected to play a dominant role in burnback. In this study, we introduce a novel technique to measure accurately the stone depth and volume ablation under varying force. Our results show varying burnback lengths on the optical fibers and varying stone depth and volume ablation depending on the optical fiber core size. For instance, the slope of the burnback as a function of the applied force for 273 mu m fibers was more than two times higher than for the 550 mu m fibers. The slope of the total volume of stone ablated as function of force for 550 mu m fibers was almost twice as much as for the 273 mu m fibers. The data suggest urologists can maximize the stone ablation rate and minimize fiber tip burnback by controlling the applied force on the optical fiber during a lithotripsy procedure.