Abstract
Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.
Highlights
Frontiers in SurgeryModern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW)
The prevalence of kidney stone disease has increased in the modern era due to the effects of increasing obesity, diabetes, and changes in dietary habits on urinary stone formation [1]
We provide a synopsis of the different factors that should be considered when performing modern day holmium laser lithotripsy
Summary
Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval.
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