Abstract
To evaluate the thermal effect of high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy in flexible/semirigid ureteroscopy (fURS/sURS) and percutaneous nephrolithotomy (PNL) in a standardized ex vivo porcine kidney model with real-time temperature assessment. The experimental setup consisted of three models designed to evaluate the thermal effects of Ho:YAG laser lithotripsy in fURS, sURS and PNL, respectively. In all setups, a postmortem porcine kidney was placed in a 37°C water bath. Three thermocouples were inserted into the renal parenchyma while a flexible thermocouple was placed 3-4mm proximal to the laser fiber to measure temperature variations in the collecting system. The thermal impact was evaluated in relation to laser power between 5 and 100W and various irrigation rates (37°C, 0-100ml/min). In all three experimental setups, sufficient irrigation was required to prevent potentially damaging temperatures into the renal pelvis and parenchyma. Even 5W in fURS can lead to a potentially harming temperature rise if insufficient irrigation is applied. Particularly, high-power settings ≥ 30W carry an elevated risk for critical temperature rises. The results allow the definition of a specific irrigation threshold for any power setting to prevent critical temperatures in the present study design. Ho:YAG laser lithotripsy bears the risk of thermal damages to the urinary tract even at low-power settings if inadequate irrigation is applied. Sufficient irrigation is mandatory to perform safe Ho:YAG laser lithotripsy. Based on the results, we developed a formula calculating the approximate ΔT for irrigation rates ≥ 30ml/min: ΔT = 15K×(power [W]/irrigation [ml/min]).
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