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World Journal of Urology

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01-12-2024 | Laser | Original Article

Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro

Authors: Zonghai He, Yang Xun, Shaogang Wang

Published in: World Journal of Urology | Issue 1/2024

Abstract

Purpose

To evaluate the cooling effect and other advantages of a novel circulation system for ureteroscopic holmium laser lithotripsy (URSL) in a standardized in vitro model.

Materials and methods

The novel circulation system was assembled by connecting a 4Fr ureteral catheter and a filter. Trails were divided into a new URSL group and a conventional URSL group. First, different power settings (18–30 W) of the holmium laser and irrigation flow rates (20–50 mL/min) were used to evaluate the thermal effect on the lithotripsy site of all groups. Then, renal pelvic temperature and pressure were assessed during URSL at a power of 1.5 J/20 Hz and irrigation flow rates of (20–50 mL/min). Finally, the whole process of lithotripsy was performed at 1.5 J/20 Hz (operator duty cycle ODC: 50%) with an irrigation flow rate of 30 mL/min. The time required for lithotripsy, visual field clarity, and stone migration were observed.

Results

Temperature of the lithotripsy point was significantly lower in the new URSL group than in the conventional group (P < 0.05) with irrigation rates (20, 30 mL/min). The renal pelvic pressure of the new group was significantly lower than that of the conventional group in which intrarenal hypertension developed at an irrigation rate of 50 ml/min. The new group had better visual clarity and lesser stone upward migration when lithotripsy was performed at 1.5 J/20 Hz and 30 ml/min.

Conclusion

The novel circulation system is more effective in reducing the thermal effects of URSL, pelvic pressure, stone upward migration, and improving the visual clarity of the operative field.

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Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC (2015) Contemporary surgical trends in the management of upper tract calculi. J Urol 193(3):880–884. https://doi.org/10.1016/j.juro.2014.09.006CrossRefPubMed

Kronenberg P, Traxer O (2015) Update on lasers in urology 2014: current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 33(4):463–469. https://doi.org/10.1007/s00345-014-1395-1CrossRefPubMed

Skolarikos A, Jung H, Neisius A, Petřík A, Somani B, Tailly T, Gambaro G (2023) EAU Guidelines on Urolithiasis. The European Association of Urology (EAU), 2023. Available at: EAU-Guidelines-on-Urolithiasis-2023.pdf (d56bochluxqnz.cloudfront.net)

Leijte JA, Oddens JR, Lock TM (2008) Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success. J Endourol 22(2):257–260. https://doi.org/10.1089/end.2007.0299CrossRefPubMed

Pierre S, Preminger GM (2007) Holmium laser for stone management. World J Urol 25(3):235–239. https://doi.org/10.1007/s00345-007-0162-yCrossRefPubMed

Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ et al (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol 13(3):181–190. https://doi.org/10.1089/end.1999.13.181CrossRefPubMed

Zhong P, Tong HL, Cocks FH, Pearle MS, Preminger GM (1998) Transient cavitation and acoustic emission produced by different laser lithotripters. J Endourol 12(4):371–378. https://doi.org/10.1089/end.1998.12.371CrossRefPubMed

May PC, Hsi RS, Tran H, Stoller ML, Chew BH, Chi T et al (2018) The morbidity of ureteral strictures in patients with prior ureteroscopic stone surgery: multi-institutional outcomes. J Endourol 32(4):309–314. https://doi.org/10.1089/end.2017.0657CrossRefPubMed

Aldoukhi AH, Ghani KR, Hall TL, Roberts WW (2017) Thermal response to high-power holmium laser lithotripsy. J Endourol 31(12):1308–1312. https://doi.org/10.1089/end.2017.0679CrossRefPubMed

10.

Buttice S, Sener TE, Proietti S, Dragos L, Tefik T, Doizi S et al (2016) Temperature changes inside the kidney: What happens during holmium:yttrium-aluminium-garnet laser usage? J Endourol 30(5):574–579. https://doi.org/10.1089/end.2015.0747CrossRefPubMed

11.

Aldoukhi AH, Black KM, Hall TL, Ghani KR, Maxwell AD, MacConaghy B et al (2020) Defining thermally safe laser lithotripsy power and irrigation parameters: in vitro model. J Endourol 34(1):76–81. https://doi.org/10.1089/end.2019.0499CrossRefPubMed

12.

Dau JJ, Hall TL, Maxwell AD, Ghani KR, Roberts WW (2021) Effect of chilled irrigation on caliceal fluid temperature and time to thermal injury threshold during laser lithotripsy: in vitro model. J Endourol 35(5):700–705. https://doi.org/10.1089/end.2020.0896CrossRefPubMed

13.

Doizi S, Letendre J, Cloutier J, Ploumidis A, Traxer O (2021) Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study. World J Urol 39(2):555–561. https://doi.org/10.1007/s00345-020-03216-wCrossRefPubMed

14.

Noureldin YA, Farsari E, Ntasiotis P, Adamou C, Vagionis A, Vrettos T et al (2021) Effects of irrigation parameters and access sheath size on the intra-renal temperature during flexible ureteroscopy with a high-power laser. World J Urol 39(4):1257–1262. https://doi.org/10.1007/s00345-020-03287-9CrossRefPubMed

15.

Ahmed M, Pedro RN, Kieley S, Akornor JW, Durfee WK, Monga M (2009) Systematic evaluation of ureteral occlusion devices: insertion, deployment, stone migration, and extraction. Urology 73(5):976–980. https://doi.org/10.1016/j.urology.2008.12.048CrossRefPubMed

16.

Hein S, Petzold R, Schoenthaler M, Wetterauer U, Miernik A (2018) Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model. World J Urol 36(9):1469–1475. https://doi.org/10.1007/s00345-018-2303-xCrossRefPubMed

17.

Louters MM, Dau JJ, Hall TL, Ghani KR, Roberts WW (2022) Laser operator duty cycle effect on temperature and thermal dose: in-vitro study. World J Urol 40(6):1575–1580. https://doi.org/10.1007/s00345-022-03967-8CrossRefPubMed

18.

Aldoukhi AH, Dau JJ, Majdalany SE, Hall TL, Ghani KR, Hollingsworth JM et al (2021) Patterns of laser activation during ureteroscopic lithotripsy: effects on caliceal fluid temperature and thermal dose. J Endourol 35(8):1217–1222. https://doi.org/10.1089/end.2020.1067CrossRefPubMedPubMedCentral

19.

van Rhoon GC, Samaras T, Yarmolenko PS, Dewhirst MW, Neufeld E, Kuster N (2013) CEM43 degrees C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels? Eur Radiol 23(8):2215–2227. https://doi.org/10.1007/s00330-013-2825-yCrossRefPubMedPubMedCentral

20.

Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG et al (2015) A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol 193(1):165–169. https://doi.org/10.1016/j.juro.2014.07.002CrossRefPubMed

21.

Dong H, Peng Y, Li L, Gao X (2018) Prevention strategies for ureteral stricture following ureteroscopic lithotripsy. Asian J Urol 5(2):94–100. https://doi.org/10.1016/j.ajur.2017.09.002CrossRefPubMed

22.

Winship B, Wollin D, Carlos E, Peters C, Li J, Terry R et al (2019) The rise and fall of high temperatures during ureteroscopic holmium laser lithotripsy. J Endourol 33(10):794–799. https://doi.org/10.1089/end.2019.0084CrossRefPubMed

23.

Aldoukhi AH, Hall TL, Ghani KR, Maxwell AD, MacConaghy B, Roberts WW (2018) Caliceal fluid temperature during high-power holmium laser lithotripsy in an in vivo porcine model. J Endourol 32(8):724–729. https://doi.org/10.1089/end.2018.0395CrossRefPubMedPubMedCentral

24.

Hein S, Petzold R, Suarez-Ibarrola R, Muller PF, Schoenthaler M, Miernik A (2020) Thermal effects of Ho:YAG laser lithotripsy during retrograde intrarenal surgery and percutaneous nephrolithotomy in an ex vivo porcine kidney model. World J Urol 38(3):753–760. https://doi.org/10.1007/s00345-019-02808-5CrossRefPubMed

25.

Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME (2018) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol 32(1):59–63. https://doi.org/10.1089/end.2017.0658CrossRefPubMed

26.

Kallidonis P, Amanatides L, Panagopoulos V, Kyriazis I, Vrettos T, Fligou F et al (2016) Does the heat generation by the thulium: yttrium aluminum garnet laser in the irrigation fluid allow its use on the upper urinary tract? An experimental study. J Endourol 30(4):422–427. https://doi.org/10.1089/end.2015.0252CrossRefPubMed

27.

Noureldin YA, Kallidonis P, Ntasiotis P, Adamou C, Zazas E, Liatsikos EN (2019) The effect of irrigation power and ureteral access sheath diameter on the maximal intra-pelvic pressure during ureteroscopy: in vivo experimental study in a live anesthetized pig. J Endourol 33(9):725–729. https://doi.org/10.1089/end.2019.0317

28.

Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A et al (2016) Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. Springerplus 5(1):1707. https://doi.org/10.1186/s40064-016-3383-yCrossRefPubMedPubMedCentral

29.

Sener TE, Cloutier J, Villa L, Marson F, Buttice S, Doizi S et al (2016) Can we provide low intrarenal pressures with good irrigation flow by decreasing the size of ureteral access sheaths? J Endourol 30(1):49–55. https://doi.org/10.1089/end.2015.0387CrossRefPubMed

Title: Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro
Authors: Zonghai He
Yang Xun
Shaogang Wang
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keyword: Laser
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04705-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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