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Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience
Author(s) -
Enikeev Dmitry,
Grigoryan Vagarshak,
Fokin Igor,
Morozov Andrey,
Taratkin Mark,
Klimov Roman,
Kozlov Vasiliy,
Gabdullina Svetlana,
Glybochko Petr
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14443
Subject(s) - medicine , interquartile range , lithotripsy , ureteroscopy , thulium , laser lithotripsy , ablation , surgery , nuclear medicine , urology , laser , ureter , optics , physics
Objectives To estimate the efficacy and safety of SuperPulsed thulium‐fiber laser ureteral lithotripsy and to identify optimal laser settings. Methods Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium‐fiber laser (NTO IRE‐Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser‐on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three‐point Likert scale. Complications were assessed using the Clavien–Dindo classification system. Results A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94–357) mm 3 . The median (interquartile range) total energy was 1 (0.4–2) kJ, and laser‐on time 1.2 (0.5–2.7) min. The median (interquartile range) stone ablation speed was 140 (80–279) mm 3 /min, energy for ablation of 1 mm 3 was 5.6 (3–9.9) J/mm 3 and energy consumption was 0.9 (0.6–1) J/min. A correlation was found between retropulsion and the energy used ( r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6–2774.1; P = 0.028). No predictors for worse visibility were identified. Conclusion The SuperPulsed thulium‐fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting.