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Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG)

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A Letter to the Editor to this article was published on 22 October 2021

Abstract

Purpose

The holmium-YAG (Ho:YAG) Laser system is the current gold standard for laser lithotripsy (LL). Super Pulse Thulium Fiber Laser (SPTF) has emerged as an effective alternative. We compared the temperature profile of both the 120 W Ho:YAG and the 60 W SPTF systems during ureteral lithotripsy.

Methods

Antegrade ureteroscopy with LL was performed in ex-vivo porcine kidneys with 3 mm Begostones. Intra-ureteral temperature was measured using one probe proximal and one distal to the site of lithotripsy. LL was performed using a 200 μm core fiber at dusting (SPTF—0.1 J, 200 Hz, SP; Ho:YAG—0.3 J, 70 Hz, LP) and fragmenting (0.8 J, 8 Hz, SP for both) settings for 5 s. Fifteen repetitions were recorded for each laser at each setting. Tissue samples of the ureter were collected for histological analysis.

Results

There was a rise in temperature at the site of lithotripsy using both systems at every setting evaluated. The median temperatures were greater for the SPTF on the fragmenting setting (33.3 °C vs 30.0 °C, p = 0.004). On the dusting setting, the median temperature was not statistically greater for Ho:YAG (40.6 °C vs 35.8 °C, p = 0.064), (Graphic 1). Histological analysis did not show any signs of injury or necrosis in any of the tested settings.

Conclusion

Higher power settings used for dusting have a higher temperature rise in the ureter during lasering. Median ureteral intra-luminal temperature rise during LL was equivalent during dusting and higher in the SPTF during fragmentation, but neither reached the threshold for thermal injury based on the duration of exposure.

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Fig. 1
Graphic 1

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Abbreviations

SPTF:

Super Pulse Thulium Fiber Laser

NADH:

Nicotinamide adenine dinucleotide

LL:

Laser Lithotripsy

Ho:YAG:

Holmium YAG Laser

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Funding

Olympus—OSTA.

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Authors and Affiliations

  1. Department of Urology, University of Kansas Medical Center, Kansas City, USA

    Wilson R. Molina & Raphael V. Carrera

  2. Department of Urologic Sciences, Vancouver General Hospital, University of British Columbia, Vancouver, Canada

    Ben H. Chew

  3. Department of Urology, The Ohio State University, Columbus, USA

    Bodo E. Knudsen

Authors
  1. Wilson R. Molina
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  2. Raphael V. Carrera
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  3. Ben H. Chew
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  4. Bodo E. Knudsen
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Contributions

WRM: protocol/project development, data analysis, manuscript writing/editing; RVC: manuscript writing/editing; BHC: data analysis, manuscript writing/editing; BEK: data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Wilson R. Molina.

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Conflict of interest

W Molina, BH Chew and BE Knudsen are medical consultants for Olympus. RV Carrera has no conflicts of interest to declare.

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The authors did not perform any procedures on living humans or animals. Only fresh ex-vivo porcine kidneys were utilized in this study.

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Molina, W.R., Carrera, R.V., Chew, B.H. et al. Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG). World J Urol 39, 3951–3956 (2021). https://doi.org/10.1007/s00345-021-03619-3

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