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27.05.2020 | Original Article

How do we assess the efficacy of Ho:YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm³ and laser activity concepts

verfasst von: Eugenio Ventimiglia, Felipe Pauchard, Antonio Rebello Horta Gorgen, Frédéric Panthier, Steeve Doizi, Olivier Traxer

Erschienen in: World Journal of Urology | Ausgabe 3/2021

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Abstract

Objectives

To estimate the total energy needed to ablate 1mm³ of stone volume (Joules/mm³) during flexible ureteroscopic lithotripsy using a low-power Ho:YAG laser device, as a proxy of lithotripsy efficacy.

Patients and methods

We selected 30 patients submitted to flexible ureteroscopy for renal stones whose volume was bigger than 500 mm³. A 35 W Ho:YAG laser (Dornier Medilas H Solvo 35, Germany) was used for every procedure with a 272 µm laser fiber. We recorded laser parameters, the total energy delivered by the laser fiber, the time from the first laser pulse until the last one (lithotripsy time), and the active laser time as provided by the machine. We then estimated J/mm³ values and determinants, along with ablation speed (mm³/s), and laser activity (ratio between laser active time and lithotripsy time).

Results

Median (IQR) stone volume and stone density were respectively 1599 (630–3502) mm³ and 1040 (753–1275) Hounsfield units (HU). In terms of laser parameters, median (IQR) energy and frequency were 0.6 (0.4–0.8) J and 15 (15–18) Hz. Median (IQR) total delivered energy and lithotripsy time were 37,050 (13,375–57,680) J and 68 (36–88) min, respectively. Median (IQR) J/mm³ and ablation speed were, respectively, 19 (14–24) J/mm³ and 0.7 (0.4–0.9) mm³/s. The laser was active during 84% (70–95%) of the total lithotripsy time. HU density > 1000 was associated with reduced efficacy.

Conclusions

It is possible to perform laser lithotripsy using a low-power laser device with a virtually continuous laser activity. The estimation of the pre-operative parameters as well as the J/mm³ values are fundamental for a proper pre-operatory planning.

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Titel: How do we assess the efficacy of Ho:YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm3 and laser activity concepts
verfasst von: Eugenio Ventimiglia
Felipe Pauchard
Antonio Rebello Horta Gorgen
Frédéric Panthier
Steeve Doizi
Olivier Traxer
Publikationsdatum: 27.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 3/2021
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03241-9

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How do we assess the efficacy of Ho:YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm³ and laser activity concepts