Laser‐induced lithotripsy: a review, insight into laboratory work, and lessons learned

Abstract

This manuscript summarizes the laser‐induced method for the destruction of kidney stones. Special emphasis is placed on laser‐induced lithotripsy, and a historical overview is given from the early beginnings in 1968 to the current developments. New laser parameter settings have to be tested in order to characterize novel laser devices for best clinical results and to meet demanding medical needs. At present, the stones are usually dusted, which makes it possible to flush these tiny fragments out of the urinary system without having to remove larger fragments additionally. Two in vitro setups were used to quantitatively evaluate the dust content and stone movement (propulsion) in a defined laboratory environment. The autofluorescence of stones can be used either to verify a stone‐free environment or to introduce safety measures such as differentiation between stone and tissue. In addition to describing these state‐of‐the‐art methods, a historical overview is given from the early beginnings in 1968 to the current developments.

Perspective Chapter: Clinical Indications for the Use of Laser in Urolithiasis

“…However, this has been the most widely used option for intracorporeal management of urinary calculi due to its effectiveness regardless of the stone composition and its high lithiasic clearance capacity, therefore is a growing interest in the development of new laser energies [5][6][7][8].…”

In Search of Optimal Laser Settings for Lithotripsy by Numerical Response Surfaces of Ablation and Retropulsion

“…This vapor bubble usually has a minimal mechanical effect on hard tissues but rather parts the water (the "Moses effect" [34]) for direct delivery of the remaining part of the laser light onto the stone [35]. The term "Moses effect" technology is also used by breaking one laser pulse into two, where the first pulse generates a bubble between the fiber tip and the stone to let the second pulse through this bubble to the surface of the stone [36]. The shock-wave image can be captured by a high-speed camera with ~1 μs frame interval [37]; it is a disturbance wave that is faster than the sound wave, which can quickly damp down to sound wave speed [38].…”