Lithotripsy Performance of Specially Designed Laser Fiber Tips

Purpose: We evaluated and compared a standard laser lithotripsy fiber to laser fibers claimed to have lithotripsy performance enhancing features. Materials and Methods: A special AccuMax (TM) 200 polished tip fiber and an AccuTrac (TM) ball-shaped tip fiber, each with an approximately 240 mm core, were compared to a standard 272 mm core fiber (Rocamed (TM)). The polished and ball-shaped tip fibers were used and reused without preparation. The standard fiber was stripped and cleaved according to manufacturer instructions after each experiment. An automated laser fragmentation testing system was used to perform multiple 30-second laser lithotripsy experiments. To mimic most typical lithotripsy conditions soft and hard stone materials were used with high frequency, low pulse energy (20 Hz and 0.5 J) or with low frequency, high pulse energy (5 Hz and 2.0 J) lithotripter settings. Ablation volumes and laser fiber tip photographs before and after lithotripsy were compared. Results: The standard and ball-shaped tip fibers did not differ in ablation volume (p = 0.72) but they ablated 174% and 188% more stone, respectively, than the polished tip fiber (p < 0.0001). The ball-shaped tip showed remarkable fiber tip degradation after short-term use at low frequency, high pulse energy settings. When high pulse energy settings were applied first even for short-term use, the ablation volume achieved by the polished and ball-shaped tip fibers at high frequency, low pulse energy settings decreased more than 20%. Conclusions: The standard laser fiber was as good as and sometimes better than the specially designed fibers. Rapid degradation of the specially designed laser fiber tips strongly limits their general usefulness but ball-shaped tip fibers may be useful in specific situations.