You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-05 SUPERPULSE THULIUM, HOLMIUM, AND HOLMIUM MOSES LASER LITHOTRIPSY: AN EX-VIVO LABORATORY EVALUATION ON THE EFFECTIVENESS OF “DUSTING” COUPLED WITH URETEROSCOPIC FRAGMENT ASPIRATION Pengbo Jiang, Akhil Peta, Raphael Arada, Maged Ayad, Andrew Afyouni, Luke Limfuenco, Andrew Brevik, Nicholas Nguyen, Zhamshid Okhunov, Roshan Patel, Jaime Landman, and Ralph Clayman Pengbo JiangPengbo Jiang More articles by this author , Akhil PetaAkhil Peta More articles by this author , Raphael AradaRaphael Arada More articles by this author , Maged AyadMaged Ayad More articles by this author , Andrew AfyouniAndrew Afyouni More articles by this author , Luke LimfuencoLuke Limfuenco More articles by this author , Andrew BrevikAndrew Brevik More articles by this author , Nicholas NguyenNicholas Nguyen More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Roshan PatelRoshan Patel More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph ClaymanRalph Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Conventional renal stone dusting is challenging, as both the holmium laser (Ho:YAG) and holmium with MOSES technology (MOSES) fail to reliably reduce calculi to fragments <100 microns (i.e. dust). The Superpulse thulium fiber laser (sTFL) is an emerging technology that may allow for more effective “dusting” of uroliths. We evaluated each of the three laser options using “dusting” settings and then evaluated the effectiveness of fragment aspiration via a dual lumen ureteroscope. METHODS: Seventy-two ex-vivo porcine kidney-ureter models were divided into 12 groups: laser type (Ho:YAG, MOSES, sTFL), ureteroscope (URS) with a single or dual lumen, and use of a 14Fr ureteral access sheath (UAS) or no sheath. Calcium oxalate stones were pre-weighed and implanted into each kidney via a pyelotomy. Stones were treated at 16 watts using dusting settings of 0.4Jx40Hz (Ho:YAG and MOSES), and 0.2Jx80Hz (sTFL) for a maximum period of 20 minutes. No stone basketing was performed; however, aspiration via the dual lumen ureteroscope was performed. The kidneys were bi-valved and residual fragments were collected, dried, weighed, and then sieved to determine what proportion of the remnants were larger than dust (i.e. >100 microns). RESULTS: Initial stone mass (mg), procedure time (sec), and laser energy expenditure (kJ) were similar amongst groups. The greatest stone clearance was seen with sTFL+dual URS+UAS (94%) compared to conventional technique (Ho:YAG+single+no UAS) at 65% (p<0.01). The use of sTFL resulted in significantly greater stone clearance than either Ho:YAG or Ho:YAG-MOSES. Aspiration via the dual lumen URS significantly improved stone clearance for sTFL (p=0.01) but not for Ho:YAG or Ho:YAG-MOSES. The use of a 14F UAS significantly improved stone clearance regardless of the type of laser or URS used (p<0.01). CONCLUSIONS: sTFL when combined with a 14F UAS, a dual lumen ureteroscope, and endoscopic suction resulted in a 94% stone clearance rate. Source of Funding: UCI Endourology Lab Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1120-e1120 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pengbo Jiang More articles by this author Akhil Peta More articles by this author Raphael Arada More articles by this author Maged Ayad More articles by this author Andrew Afyouni More articles by this author Luke Limfuenco More articles by this author Andrew Brevik More articles by this author Nicholas Nguyen More articles by this author Zhamshid Okhunov More articles by this author Roshan Patel More articles by this author Jaime Landman More articles by this author Ralph Clayman More articles by this author Expand All Advertisement Loading ...