PD26-06 IS LESS MORE WHEN USING THE NOVEL THULIUM LASER: WHAT FIBER SIZE AND LASER SETTINGS RESULT IN THE MOST EFFICIENT IN SITU LOWER POLE LITHOTRIPSY?

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III (PD26)1 Sep 2021PD26-06 IS LESS MORE WHEN USING THE NOVEL THULIUM LASER: WHAT FIBER SIZE AND LASER SETTINGS RESULT IN THE MOST EFFICIENT IN SITU LOWER POLE LITHOTRIPSY? Akin S. Amasyali, Joshua D. Belle, Natalie Chen, Mohammed Keheila, Jenna Lee, Nathaniel Srikureja, Elizabeth Baldwin, and D. Duane Baldwin Akin S. AmasyaliAkin S. Amasyali More articles by this author , Joshua D. BelleJoshua D. Belle More articles by this author , Natalie ChenNatalie Chen More articles by this author , Mohammed KeheilaMohammed Keheila More articles by this author , Jenna LeeJenna Lee More articles by this author , Nathaniel SrikurejaNathaniel Srikureja More articles by this author , Elizabeth BaldwinElizabeth Baldwin More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002019.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The novel thulium fiber laser (TFL) has advantages compared to the Holmium laser (HL) including smaller fiber size (150 μm) and higher frequency settings (up to 2000 Hz). These characteristics may be of particular benefit when performing in situ treatment of calcium oxalate monohydrate (COM) lower pole kidney stones. The purpose of this study was to determine the optimal fiber size and laser settings for in situ treatment of COM lower pole stones. METHODS: In a benchtop model, a 3D printed kidney and ureter were attached to a 2x2 mm metal mesh and submerged in a saline bath. Forty 1cm BegoStones (COM consistency) were placed in the lower pole and fragmented in situ by the same surgeon using a flexible ureteroscope. The stone was considered fully treated when residual fragments were small enough to fit through the 2mm mesh grid. Laser settings used were: 1Jx20Hz (20W), 0.4Jx50 Hz (20W), 0.2Jx100Hz (20W), and 0.1Jx200Hz (20W) for both the 150 and 200μm fiber sizes. Data collected included lasing time, procedure time, total pulse energy, and fiber stripping. ANOVA and independent T-tests were used to compare outcomes between treatment arms with p<0.05 considered significant. RESULTS: Pre-procedure stone weights were similar between trials (0.99 gm, p=0.944). Lasing time, overall procedure time, and total pulse energy were significantly different across all 8 trials (p<0.05 for all; Fig 1). Overall, use of the 150μm fiber resulted in less total lasing time, procedure time, and pulse energy compared to the 200μm fiber (p<0.05 for all). Lasing with 0.2J and 100Hz and the 150μm fiber had the shortest procedure time (18.5 min) compared to all other laser setting and fiber combinations (p<0.05). There was no difference in the number of fiber strippings between groups (p>0.05). CONCLUSIONS: In this benchtop lower pole model of in situ treatment of COM stones, the 150μm laser fiber resulted in shorter lasing time, procedure time, and lower total pulse energy compared to the 200μm fiber overall. When comparing different laser energies and frequencies, the fastest procedure time was seen when using 100Hz and 0.2J. Understanding these data can help improve efficiency of treatment for dense lower pole COM stones in situ. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e439-e439 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akin S. Amasyali More articles by this author Joshua D. Belle More articles by this author Natalie Chen More articles by this author Mohammed Keheila More articles by this author Jenna Lee More articles by this author Nathaniel Srikureja More articles by this author Elizabeth Baldwin More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Loading ...