Transient cavitation and shockwave generation produced by pulsed-dye and holmium:YAG laser lithotripters were studied using high-speed photography and acoustic emission measurements. In addition, stone phantoms were used to compare the fragmentation efficiency of various laser and electrohydraulic lithotripters. The pulsed-dye laser, with a wavelength (504 nm) strongly absorbed by most stone materials but not by water, and a short pulse duration of approximately 1 microsec, induces plasma formation on the surface of the target calculi. Subsequently, the rapid expansion of the plasma forms a cavitation bubble, which expands spherically to a maximum size and then collapses violently, leading to strong shockwave generation and microjet impingement, which comprises the primary mechanism for stone fragmentation with short-pulse lasers. In contrast, the holmium laser, with a wavelength (2100 nm) most strongly absorbed by water as well as by all stone materials and a long pulse duration of 250 to 350 microsec, produces an elongated, pear-shaped cavitation bubble at the tip of the optical fiber that forms a vapor channel to conduct the ensuing laser energy to the target stone (Moss effect). The expansion and subsequent collapse of the elongated bubble is asymmetric, resulting in weak shockwave generation and microjet impingement. Thus, stone fragmentation in holmium laser lithotripsy is caused primarily by thermal ablation (drilling effect).

Using high-speed photography and acoustic emission measurements, we studied the dynamics of a transient cavitation bubble near a stone surface and the concomitant shockwaves generated during electrohydraulic lithotripsy (EHL). At each spark discharge, a vapor plasma and subsequently a cavitation bubble oscillating around the tip of an EHL probe are produced. Simultaneously, three distinctive shockwave pulses are generated. The first shockwave is produced by the rapid expansion of the vapor plasma, while the second and third waves are produced by rebounds of the cavitation bubble. Depending on the proximity of the probe to the stone surface, the collapse of the cavitation bubble may be symmetric, resulting in a strong shockwave emission; or asymmetric, leading to the formation of a liquid jet. For the Nortech AUTOLITH lithotripter with a 1.9F probe that was used in this study, maximum shockwave emission is produced when the probe is about 1 mm from the stone surface, whereas the maximum jet velocity is produced when the probe tip is at distance equivalent to the maximum bubble radius of about 3 mm. These findings are consistent with clinical experience, which suggests that for optimal treatment results, the EHL probe should be placed close to the stone surface.