Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction.

Abstract

Data are lacking on distribution of size of fragments created with the laser lithotripsy, stone density, and composition. Dust (< 1mm) and small fragments (1-3mm) may be too small to be efficiently removed with forceps compared to larger fragments (> 3mm). We aim to report the size distribution of fragments formed during holmium laser lithotripsy. One hundred ten patients with renal calculi < 3cm underwent miniPCNL using ClearPetra sheath (Well Lead Medical Co., China) with controllable irrigation and suction system that minimizes fragment dispersion and maximizes fragment aspiration. Moses holmium laser (Lumenis INC, Israel) was used with predefined laser energy settings for lithotripsy. Proportion of fragment size < 1mm was 46.36 ± 16.68%, 1-3mm was 28.18 ± 10.01%, and > 3mm was 25.19 ± 16.18% for the entire cohort. Complete stone clearance at 48h was achieved in 77.3% cases. The remaining 22.7% patients had complete clearance at 1-month follow-up CT. In all the stone density, volume, and composition groups, majority of fragments created were either < 1mm or 1-3mm. Only 25% fragments were > 3mm that would get aspirated out through the sheath with suction or could be retrieved with forceps. The combination of a high-power holmium laser and suction would help in complete stone clearance with effective aspiration of smaller stone fragments and dust simultaneously during lasing.