V11-12 HOLMIUM LASER SETTINGS DURING LITHOTRIPSY OF DIFFERENT TYPES OF KIDNEY STONES

Abstract

You have accessJournal of UrologyUrolithiasis1 Apr 2017V11-12 HOLMIUM LASER SETTINGS DURING LITHOTRIPSY OF DIFFERENT TYPES OF KIDNEY STONES Oriol Angerri, Juan Manuel López, Pavel Gavrilov, Francisco Sánchez-Martín, Félix Millán, and Humberto Villavicencio Oriol AngerriOriol Angerri More articles by this author , Juan Manuel LópezJuan Manuel López More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Francisco Sánchez-MartínFrancisco Sánchez-Martín More articles by this author , Félix MillánFélix Millán More articles by this author , and Humberto VillavicencioHumberto Villavicencio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3001AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently, holmium laser is the most versatile energy source for the treatment of intrarenal stones by intracorporeal lithotripsy since it may be used with both flexible and rigid endoscopes, permitting access to all parts of the kidney. High-power laser enables the destruction of all kinds of stones, but the settings most suitable for the treatment of individual types remain to be defined. METHODS In the operation theatre we used a pelvic trainer into which we introduced six different types of urinary stones from our stone library: uric acid, cystine, struvite, brushite, calcium oxalate monohydrate, and calcium oxalate dihydrate. Ex vivo lithotripsy was performed by means of continuous serum irrigation with the Lumenis VersaPulse 120 W high-power laser, with a 550-micron fibre. Power, frequency, and potency parameters, as well as the short-pulse/long-pulse variable, were varied among the six different types of stones. RESULTS In all cases lithotripsy was commenced using low power and frequency: 0.2 J and 10 Hz. Power and frequency were raised up to a maximum of 3 J and 40 Hz, according to the type of stone, and until maximum potencies close to 120 W were obtained. The difference in hardness of the investigated types of stones required differing power settings according to whether fragmentation into large pieces or pulverisation was desired. The different power settings used for the various types of stones are described, and the fragmentation ability and speed of the holmium laser are appraised. CONCLUSIONS High-power laser is useful for destruction of any type of urinary stone. The harder the stone, the greater is the potency needed; however, the frequency is not so important. Low power is able to yield good results on soft stones, and excellent pulverisation can be obtained by increasing the pulse frequency. The long pulse is very useful for lowering the stone retropulsion and increasing pulverisation, particularly in the case of softer stones. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1285 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Oriol Angerri More articles by this author Juan Manuel López More articles by this author Pavel Gavrilov More articles by this author Francisco Sánchez-Martín More articles by this author Félix Millán More articles by this author Humberto Villavicencio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...