PD37-04 BALL-TIP HOLMIUM LASER FIBER: IN VITRO STONE COMMINUTION AND FIBER TIP DEGRADATION

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You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-04 BALL-TIP HOLMIUM LASER FIBER: IN VITRO STONE COMMINUTION AND FIBER TIP DEGRADATION Richard Shin, Jaclyn Lautz, Fernando Cabrera, Zachariah Goldsmith, Nicholas Kuntz, Ramy Youssef, Andreas Neisius, Charles Scales, Michael Ferrandino, Pei Zhong, Walter Simmons, Glenn Preminger, and Michael Lipkin Richard ShinRichard Shin More articles by this author , Jaclyn LautzJaclyn Lautz More articles by this author , Fernando CabreraFernando Cabrera More articles by this author , Zachariah GoldsmithZachariah Goldsmith More articles by this author , Nicholas KuntzNicholas Kuntz More articles by this author , Ramy YoussefRamy Youssef More articles by this author , Andreas NeisiusAndreas Neisius More articles by this author , Charles ScalesCharles Scales More articles by this author , Michael FerrandinoMichael Ferrandino More articles by this author , Pei ZhongPei Zhong More articles by this author , Walter SimmonsWalter Simmons More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Michael LipkinMichael Lipkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2022AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Advancing a standard laser fiber through a fully deflected ureteroscope can result in significant damage to the delicate working channel, resulting in significant repair costs. A new ball-tip holmium laser fiber (Flexiva TracTip - Boston Scientific) was designed to atraumatically pass through a deflected ureteroscope. We evaluated the stone comminution capabilities and tip degradation of this fiber in an in vitro model. METHODS A 200 μm ball-tip (BT) fiber and standard fiber (SF) (Flexiva - Boston Scientific) were compared by delivering energy to a Begostone over a constant surface area controlled by a stage controller and 3 dimensional positioning system. Laser settings were 0.2J/50Hz, 0.6J/6Hz, 0.8J/8Hz, and 1J/10Hz. Fiber tip degradation was measured at 1 kJ and 4 kJ of delivered energy. Fiber-stone contact was adjusted every 1 kJ to account for any loss in length. Comminution efficiency was determined by measuring stone weight loss following lithotripsy at each energy setting. ANOVA or Kruskal Wallace test was used for multiple groups, and post hoc tests with Bonferroni correction were then applied (t-test, Wilcoxon). RESULTS A total of 5 virgin fibers were used to test each condition. Tip degradation by 1 kJ with all energy settings and 4 kJ at 0.2J/50Hz was minimal for both fibers without significant differences. By 4 kJ, tip degradation was less overall for the BT and maximal for the SF at 1J/10Hz (Table). Comminution was found to increase with pulse energy for both BT and SF fibers up to the 0.8J/8Hz setting (p < 0.003). No significant differences were found between 0.8J/8Hz and 1J/10Hz or between BT and SF fibers at any energy setting (Figure). CONCLUSIONS The ball-tip fiber exhibits similar comminution efficiency to a standard holmium laser fiber with minimal tip degradation at clinically relevant laser settings in our in vitro model. The new tip design may provide an advantage in access maneuverability without loss of performance. Further in vivo studies are warranted to validate these objective findings. Standard fiber (SF) and ball-tip (BT) fiber tip degradation at 1 kJ and 4 kJ (Median with IQR) Setting Energy SF tip degradation (mm) BT tip degradation (mm) P value 0.2J/50Hz 1 kJ 0 (-0.1 - 0.03) -0.02 (-0.05 - 0.02) 1 4 kJ 0 (-0.12 - 0.06) 0.07 (0.01 - 0.1) 0.207 0.6J/6Hz 1 kJ 0 (-0.08 - 0.05) 0 (-0.05 - 0.1) 0.747 4 kJ 0.16 (0.1 - 0.2) 0.15 (0.02 - 0.56) 0.599 0.8J/8Hz 1 kJ 0.05 (0 - 0.08) 0.1 (0 - 0.1) 0.576 4 kJ 0.25 (0.23 - 0.28) 0.1 (0.03 - 0.23) 0.112 1J/10Hz 1 kJ 0 (-0.05 - 0) 0.05 (0.02 - 0.1) 0.084 4 kJ 0.3 (0.2 - 1.35) 0.08 (0 - 0.2) 0.036 © 2014FiguresReferencesRelatedDetailsCited byKronenberg P and Traxer O (2018) Lithotripsy Performance of Specially Designed Laser Fiber TipsJournal of Urology, VOL. 195, NO. 5, (1606-1612), Online publication date: 1-May-2016. Volume 191Issue 4SApril 2014Page: e947 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Richard Shin More articles by this author Jaclyn Lautz More articles by this author Fernando Cabrera More articles by this author Zachariah Goldsmith More articles by this author Nicholas Kuntz More articles by this author Ramy Youssef More articles by this author Andreas Neisius More articles by this author Charles Scales More articles by this author Michael Ferrandino More articles by this author Pei Zhong More articles by this author Walter Simmons More articles by this author Glenn Preminger More articles by this author Michael Lipkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...