A Users Guide to Holmium Laser Lithotripsy Settings in the Modern Era

Abstract

Endoscopic stone surgery has gone through rapid technological advances in the last decade with the development of next-generation holmium lasers. These systems allow the user to adjust multiple parameters that can optimize fragmentation efficiency during ureteroscopy (URS). Parameters include an increased range in pulse energy (PE), frequency (Fr), and manipulation of the pulse duration (PD). More recently, introduction of pulse modulation with the Moses TechnologyTM provides pulse modulation with energy delivered over two pulses. In light of these developments, it may be difficult for the urologist to understand how to best utilize laser settings in the modern era. We provide an overview of how PE, Fr, and PD affect three different aspects of laser lithotripsy performance: (A) Fragmentation, (B) Stone retropulsion, and (C) Laser fiber-tip degradation (Table 1). Table 1 Relationship between pulse energy, frequency, pulse duration, and pulse modulation on laser lithotripsy performance parameters.