Could the High-Power Laser Increase the Efficacy of Stone Lithotripsy During Retrograde Intrarenal Surgery?

Tsaturyan, Arman; Martínez, Begoña Ballesta; Lattarulo, Marco; Adamou, Constantinos; Pagonis, Konstantinos; Peteinaris, Angelis; Liourdi, Despoina; Vrettos, Theofanis; Liatsikos, Evangelos; Kallidonis, Panagiotis

doi:10.1089/end.2021.0870

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…The new high-power lasers have made possible new treatment techniques such as the ‘self -popping’ technique. Tsaturyan et al [3] described the stone ‘self-popping’ technique using pulse power at 60 W and compared this novel technique with the traditional dusting technique in 174 patients. Even though the two techniques did not show significant difference in terms of stone-free rate, using high-power lithotripsy resulted in significantly reduced operative time.…”

Section: Laser Technologiesmentioning

confidence: 99%

The future of laser technology in kidney stones

Kallidonis

Vagionis

2022

Current Opinion in Urology

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Purpose of reviewThe aim of this study was to present the recent and promising innovations of the new laser technologies used for the treatment of renal stones. Recent findingsTaking advantage of pulse modulation, new technologies such as the Moses effect, the Virtual basket and the Vapor tunnel have been introduced. These technologies seem to improve lithotripsy efficacy by reducing retropulsion and increasing the stone ablation rate. High-power laser lithotripsy has arisen in everyday clinical practice in some centres. The combination of equal efficacy and safety levels compared with the low-power laser lithotripsy and significantly reduced operative time could explain this trend. Thulium fibre laser is an innovative type of laser-emitting machine that offers a lot of advantages compared with its predecessors. The different mechanism of creating the laser pulse offers new possibilities in laser lithotripsy and perhaps in the future thulium fibre laser could replace Ho:YAG as the golden standard for laser lithotripsy.

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Section: Laser Technologiesmentioning

confidence: 99%

The future of laser technology in kidney stones

Kallidonis

Vagionis

2022

Current Opinion in Urology

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“…Seventh, with the high flow provided by the dual irrigation system, one can use high-power settings in laser lithotripsy (up to 60 W) without the risk of increasing intrarenal temperatures. We consider a “self-popping” technique [ 13 ] more useful than dusting, because one can evacuate bigger fragments through the antegrade access sheath. Eighth, unless working in completely duplicated collecting systems, the activation of the lithotripter from the percutaneous tract should be avoided at the time of RIRS, due to the risk of damaging the flexible ureterorenoscope (see Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Energy settings varied between 1 and 2 J with the frequency ranging from 30 to 60 Hz, according to a previously described “self-popping” technique [ 13 ]. Nitinol baskets were used in some cases to relocate and present fragments for subsequent removal through the antegrade percutaneous access.…”

Section: Methodsmentioning

confidence: 99%

“…Whenever stones could not be reached with the nephroscope, retrograde lithotripsy was performed with a holmium laser Cyber Ho 150® (Quanta System, Samarate, Italy) or MOSES Pulse 120H (Lumenis Ltd, Yokneam, Israel) devices. In male patients it is important to keep free access to the penis for retrograde access Energy settings varied between 1 and 2 J with the frequency ranging from 30 to 60 Hz, according to a previously described "self-popping" technique [13]. Nitinol baskets were used in some cases to relocate and present fragments for subsequent removal through the antegrade percutaneous access.…”

Section: Surgical Techniquementioning

confidence: 99%

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Nonpapillary prone endoscopic combined intrarenal surgery: effectiveness, safety and tips, and tricks

et al. 2022

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Purpose To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful accomplishment of the procedure respecting the anatomical particularities. Material and methods This study is an analysis of a prospectively collected database including all cases of ECIRS performed between January 2019 and December 2021 in a high-volume tertiary center. All patients underwent the procedure in prone-split leg position. A nonpapillary renal puncture was performed. The used access sheaths were 22Fr or 30Fr. Lithotripsy was performed anterogradely with a dual-energy lithotripter with incorporated suction and retrogradely with holmium Yttrium–Aluminum–Garnet laser. Results A total of 33 patients were included. The initial stone-free rate (SFR) was 84.8% and the final SFR was 90.9%. The median stone size was 35 mm and 60% of patients had staghorn calculi. The prevalence of renal abnormalities was 21.3%, including 3 cases of horseshoe kidney, 2 cases of malrotation and 2 cases with complete duplicated systems. The median operative time was 47 min. The median hospital stay was 3 days and median hemoglobin loss was 1.2 gr/dL. Overall, the complication rate was 9.1%, all being Grade II complications (n = 2 fever and n = 1 transient bleeding). Conclusions Nonpapillary prone ECIRS is an effective and safe procedure. Standardization of the procedure is critical to achieve good outcomes. Patients who benefit the most are probably the ones where additional punctures can be avoided using this technique, namely patients with renal abnormalities, incrusted ureteral stents and staghorn stones.

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“…In combination with the miniaturization of the endoscopic equipment, the transition from low-power (LP) to high-power (HP) lithotripsy constituted a milestone that affected the operative outcomes [ 3 ]. The use of HP lithotripsy has been associated with improved operative time, while the dusting has constituted a widely used technique [ 4 , 5 ]. Currently, Holmium: Yttrium-Aluminum-Garnet (Ho:YAG), which can provide HP settings, is widely utilized in the performance of endoscopic surgeries in urology [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

High-power Holmium:Yag lithotripsy in bladder urolithiasis: Is it safe and effective? A combined clinical and experimental study

Pagonis,

Katsakiori,

Peteinaris

et al. 2024

Arab Journal of Urology

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Objective To evaluate the efficacy and safety of Holmium: Yttrium-Aluminum-Garnet (Ho:YAG) laser in bladder lithotripsy using high-power settings > 100 W. Materials and Methods A combined experimental and clinical study was conducted. The Quanta Cyber: Ho 150 with a 550 μm Quanta optical fiber was utilized in all set-ups. Ablation rates for soft and hard artificial stones were tested in vitro using 100 W and 20 W power settings. In the experiment, a porcine bladder was used. The optical fiber was inserted through a rigid cystoscope, whilst a K-type thermocouple was inserted in the bladder dome. The tested high-power settings were 152 W, 120 W and 105 W. In every trial, the lasing time was over 60 s. In the clinical study, 35 patients underwent transurethral high-power bladder lithotripsy. Laser settings were set between 100 W and 150 W. Results Stone mass (stone weight) was significantly lower after stone ablation independently of the stone type or the laser settings. Significantly higher mass decrease and ablation rate were detected in high-power compared to low-power settings. In the experiment, the highest temperature recorded was 32°C at 152 W. At 120 W and 105 W, the peak temperatures didn’t reach 30°C. In the clinical study, a stone-free rate of 100% and a mean operative time of 43 ± 18 min were reported. All patients stayed in the hospital for one day except for one who presented minor hematuria. Additional complications did not occur. Conclusion Ho:YAG laser lithotripsy > 100 W is an effective, fast and safe modality for the treatment of bladder calculi.

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Could the High-Power Laser Increase the Efficacy of Stone Lithotripsy During Retrograde Intrarenal Surgery?

Cited by 12 publications

References 22 publications

The future of laser technology in kidney stones

The future of laser technology in kidney stones

Nonpapillary prone endoscopic combined intrarenal surgery: effectiveness, safety and tips, and tricks

High-power Holmium:Yag lithotripsy in bladder urolithiasis: Is it safe and effective? A combined clinical and experimental study

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