PD37-05 BALL TIPPED HOLMIUM:YAG OPTICAL FIBER: PULSE ENERGY SETTINGS INCREASE DEGRADATION DURING CLINICAL USE

Abstract

You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-05 BALL TIPPED HOLMIUM:YAG OPTICAL FIBER: PULSE ENERGY SETTINGS INCREASE DEGRADATION DURING CLINICAL USE Bodo Knudsen, Shubha De, and Manoj Monga Bodo KnudsenBodo Knudsen More articles by this author , Shubha DeShubha De More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We report our initial experience in 98 consecutive flexible ureteroscopy procedures utilizing a ball−tipped fiber (Flexiva TracTip, Boston Scientific) for Ho:YAG laser lithotripsy. METHODS The ball−tipped fiber was utilized in 98 consecutive flexible ureteroscopic procedures. Pulse energy, frequency, and total energy was recorded for each procedure. The condition of the fiber and whether the ball−tip remained intact was recorded. The fiber tip length was measured with a micrometer after the procedure. RESULTS All 98 cases were successfully completed with the ball−tipped fiber. No fiber had to be re−cleaved during the procedure. The ball−tip broke off or burnt back completely in 36/98 and partially in 11/98 procedures. It remained intact in 51/98 (51%) of procedures. For fibers with complete or partial degradation of the ball−tip, the mean energy transmitted was 3.13 kJ versus only 1.58 kJ when the ball−tip remained intact. Stone analysis was available in 39/47 of the procedures where ball−tip degradation occurred and demonstrated either primarily calcium oxalate monohydrate or calcium phosphate brushite composition in 69%. 5/98 fibers had visible charring of the jacket due to complete burn back of the fiber tip. Pulse energy settings correlated strongly with fiber tip degradation. No fibers fractured with deflection. All fibers passed through the flexible ureteroscopes without difficulty and no scope damage reported. CONCLUSIONS Higher pulse energy settings correlated with deterioration of the ball-tip of the fiber. As pulse energy was increased, the correlation between fiber tip degradation strengthened with total energy delivered. At 0.6 J and above fiber tip degradation correlates with energy delivered. Lower pulse energy settings are more likely to keep the ball-tip intact during the procedure and therefore the lowest effective pulse energy should be selected that fragments the stone. Hard stone types (COM, CaP) may increase the rate of ball-tip degradation. The ball-tip protective effect when passing through the ureteroscope channel, should be considered a first-pass only benefit. © 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 Bodo Knudsen More articles by this author Shubha De More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...