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

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.