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The aim of the study was to evaluate the developed technique of contact lithotripsy using a strongly heated distal tip of a fiber providing controlled fragmentation of urinary stones. Materials and Methods. Postoperative kidney stones were used as research objects. For renal calculi fragmentation we applied a standard 0.97 μm diode laser with a continuous wave laser regime, laser power 15 W. As a strongly absorbing coating (SAC), we used a solution of graphite carbon microparticles in silicone varnish. SAC was localized at the distal end of the light guide of multimode quartz fiber, d=550 μm. The contact zone of the light guide with a stone (heated to 2000°K) was smeared with a CО2 gas stream, which made it possible to optimize the high-temperature oxidation of graphite in the destruction of stones. Laser fragmentation was performed ex vivo in physiological saline and in liquid-free conditions by means of direct calculus contact. Results. Large calculus fragmentation was achieved through the carbonization with mechanical destruction of the surface by high temperature of an optical fiber tip. Calculus fragmentation time depended on stone density, cross-sectional dimension, and was from 10 to 80 s. Maximum cross-sectional dimension of calculi was from 6 to 21 mm, X-ray calculus density being 158–1,587 HU. Calculi with X-ray density of over 1,400 HU were unaffected by fragmentation in liquid, however, fragmentation in the atmospheric air proceeded successfully. Conclusion. The use of SAC of the laser fiber tip enables to develop new calculus fragmentation mechanism and provide the break of a stone along the marked line. The technique excludes small stone fragmentation, therefore enables to prevent intra-operative microbial dissemination of renal tissue from biofilms of potentially infected calculi. New opportunities enable to use various laser types as a lithotripter, and significantly simplify and cheapen the technology of their manufacture.

Contact Laser Lithotripsy Using Strongly Heated Distal Tip of Optic Fiber