Effect of Pulse Energy, Frequency and Length on Holmium: Yttrium-Aluminum-Garnet Laser Fragmentation Efficiency in Non-Floating Artificial Urinary Calculi

被引:47
作者
Wezel, Felix [1 ]
Haecker, Axel [1 ]
Gross, Andreas J. [2 ]
Michel, Maurice Stephan [1 ]
Bach, Thorsten [1 ,2 ]
机构
[1] Univ Med Ctr Mannheim, Dept Urol, D-68167 Mannheim, Germany
[2] Asklepios Hosp Barmbek, Dept Urol, Hamburg, Germany
关键词
ND-YAG LASER; IN-VITRO; TRANSIENT CAVITATION; STONE RETROPULSION; ACOUSTIC-EMISSION; URETERAL CALCULI; LITHOTRIPSY; MANAGEMENT; URETERORENOSCOPY; URETEROSCOPY;
D O I
10.1089/end.2010.0115
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
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 mu sec). Each setting was performed with a 273 mm and a 365 mm 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 msec 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 ofHo:YAGlaser lithotripsy in impacted or large stones, whenretropulsion is excluded.
引用
收藏
页码:1135 / 1140
页数:6
相关论文
共 30 条
[1]   Advances in ureterorenoscopy [J].
Beiko, Darren T. ;
Denstedt, John D. .
UROLOGIC CLINICS OF NORTH AMERICA, 2007, 34 (03) :397-+
[2]   A perspective on laser lithotripsy: The fragmentation processes [J].
Chan, KF ;
Pfefer, TJ ;
Teichman, JMH ;
Welch, AJ .
JOURNAL OF ENDOUROLOGY, 2001, 15 (03) :257-273
[3]   Ureteroscopy for the management of stone disease [J].
Eisner, Brian H. ;
Kurtz, Michael P. ;
Dretler, Stephen P. .
NATURE REVIEWS UROLOGY, 2010, 7 (01) :40-45
[4]   Effect of holmium:YAG laser pulse width on lithotripsy retropulsion in vitro [J].
Finley, DS ;
Petersen, J ;
Abdelshehid, C ;
Ahlering, M ;
Chou, D ;
Borin, J ;
Eichel, L ;
McDougall, E ;
Clayman, RV .
JOURNAL OF ENDOUROLOGY, 2005, 19 (08) :1041-1044
[5]   The effect of frequency doubled double pulse Nd:YAG laser fiber proximity to the target stone on transient cavitation and acoustic emission [J].
Fuh, Eric ;
Haleblian, George E. ;
Norris, Regina D. ;
Albala, David M. ;
Simmons, Neal ;
Zhong, Pei ;
Preminger, Glenn M. .
JOURNAL OF UROLOGY, 2007, 177 (04) :1542-1545
[6]   Complications of 2735 retrograde semirigid ureteroscopy procedures: A single-center experience [J].
Geavlete, P ;
Georgescu, D ;
Nita, G ;
Mirciulescu, V ;
Cauni, V .
JOURNAL OF ENDOUROLOGY, 2006, 20 (03) :179-185
[7]   Principles and applications of laser lithotripsy: Experience with the holmium laser lithotrite [J].
Grasso, M ;
Chalik, Y .
JOURNAL OF CLINICAL LASER MEDICINE & SURGERY, 1998, 16 (01) :3-7
[8]   Is the holmium:YAG laser the best intracorporeal lithotripter for the ureter?: A 3-year retrospective study [J].
Gupta, Pawan Kumar .
JOURNAL OF ENDOUROLOGY, 2007, 21 (03) :305-309
[9]   Tensile strength of type IV dental stones dried in a microwave oven [J].
Hersek, N ;
Canay, E ;
Akça, K ;
Çiftçi, Y .
JOURNAL OF PROSTHETIC DENTISTRY, 2002, 87 (05) :499-502
[10]   Dependence of calculus retropulsion on pulse duration during Ho: YAG laser lithotripsy [J].
Kang, Hyan Wook ;
Lee, Ho ;
Teichman, Joel M. H. ;
Oh, Junghwan ;
Kim, Jihoon ;
Welch, Ashley J. .
LASERS IN SURGERY AND MEDICINE, 2006, 38 (08) :762-772