Thulium Fiber Laser Research Articles

Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study

Objective The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model. Methods Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 μm and 200 μm) and Ho:YAG (270 μm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W. Results Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 μm fiber at 2.4 W resulted in a 2.6 °C rise from baseline (p = 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 °C (p = 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 μm was 39.6 °C compared to 44.9 °C using 200 μm, p < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers. Conclusion In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.

Enhanced Uptake and Retention of 0.03% Bimatoprost, 0.5% 5-Fluorouracil, and 5% Minoxidil After 1,550-nm or 1,927-nm Nonablative Laser Pretreatment.

Laser pretreatment with cosmeceutical topicals is growing in popularity. However, lasers may also enhance the uptake of medical topicals that treat dermatologic conditions, such as vitiligo, alopecia, and cancerous and precancerous lesions. Permeation of these topicals must be quantified to optimize treatment protocols. To analyze transdermal uptake of 3 topicals after nonablative fractional 1,550-nm erbium-doped glass or 1,927-nm thulium fiber laser pretreatment. Human donor tissue was pretreated with a nonablative fractional 1,550-nm erbium-doped glass or 1,927-nm thulium fiber laser followed by application of 0.03% bimatoprost, 0.5% 5-fluorouracil, or 5% minoxidil. Permeation and retention were measured over 24 hours (bimatoprost and 5-fluorouracil) or 90 minutes (minoxidil), and uptake was calculated. Pretreatment with 1,927-nm thulium laser (500 MTZ/cm2; 5 mJ; 5 W) enhanced uptake and retention of bimatoprost versus untreated control at 24 hours post-treatment. Pretreatment with 1,550-nm erbium-doped glass laser (2,000 MTZ/cm2; 10 mJ; 30 W) enhanced permeation, uptake, and retention of 5-fluorouracil at 24 hours post-treatment and enhanced permeation and uptake of minoxidil at 90 minutes post-treatment. Nonablative laser pretreatment may enhance topical treatment of dermatologic conditions. Device settings must be optimized to maximize topical permeation while minimizing laser-associated thermal side effects.

Safety and Effectiveness of Low-Density 1927-nm Fractional Thulium Fiber Laser for Hyperpigmented Scar Treatment in Fitzpatrick Skin Types II-V.

Safety and Effectiveness of Low-Density 1927-nm Fractional Thulium Fiber Laser for Hyperpigmented Scar Treatment in Fitzpatrick Skin Types II-V.

Laser-Induced Ocular Lesions with Thulium Fiber Laser in Endourology: An Ex Vivo Study.

Introduction and Objectives: The thulium fiber (Tm-F) laser is currently studied as an alternative to the holmium: yttrium-aluminum-garnet (Ho:YAG) laser, the gold standard for endocorporeal laser lithotripsy. We aimed to evaluate the ex vivo effects of an accidental Tm-F laser exposure on bovine eyes and to test the protective action of different eyeglasses in preventing eye lesions in case of an accident. Methods: A 50-W TFL generator (IPG Photonics®, Russia) with a wavelength of 1940 nm and 200-μm core diameter fibers (CDFs) were used. The laser fiber tip was pointed perpendicularly at different distances (0, 1, 3, 5, 8, and 10 cm, respectively) to the pupil center of the bovine eye. The Tm-F laser was activated for 1 or 3 seconds at three different settings (0.5 J-20 Hz, 1 J-10 Hz, and 2 J-10 Hz, respectively). The experiment was repeated using laser safety glasses and eyeglasses. After lasering, eye samples were immersed in a 0.5% fluorescein serum (Faure-Ciba-Geigy®, Switzerland), then rinsed with saline. White and blue light examination looked for localized epithelial burns (LEBs), extended epithelial burns (EEBs), superficial corneal ulcerations (SCUs), and deep corneal ulcerations (DCUs). Results: A total of 68 bovine eyes were used. Despite the laser settings, both DCU (contact) and SCU (1 cm) developed without eye protection for 1 and 3 seconds of lasering. At the 3-cm fiber-eye distance, only burning lesions were observed. Over 5 cm, no lesion was found. At contact or 1-cm fiber-eye distance, pulse energy did not change the lesion grade, but at 3 cm, high pulse energy led to higher grade corneal lesions (0.5 J-10 Hz:LEB; 1 J-10 Hz:EEB). Despite the fiber-eye distance, no corneal lesions were reported in the laser safety glass or eyeglass group for 1 second of laser exposure. Conclusions: Our study highlights the risk of eye damage caused by Tm-F. Without proper eye protection, the Tm-F laser can cause corneal lesions up to 5 cm in distance with 1 second of exposure despite laser settings. Only dedicated protective eyeglasses are effective for long exposures.

Comparative analysis of MOSESTM technology versus novel thulium fiber laser (TFL) for transurethral enucleation of the prostate: A single-institutional study.

Novel laser technologies have been developed for the minimally invasive surgical management of benign prostatic hyperplasia (BPH). The objective of this study was to assess the safety and efficacy of MOSESTM technology versus the thulium fiber laser (TFL) in patients with BPH undergoing transurethral enucleation of the prostate. We conducted a retrospective review of prospectively collected data of eighty-two patients who underwent transurethral enucleation of the prostate using MOSESTM or TFL technologies from August 2020 to September 2021. Preoperative and intraoperative parameters, in addition to postoperative outcomes, were collected and analyzed. Twenty patients underwent transurethral enucleation of the prostate with TFL, while 62 had MOSESTM HoLEP. No statistically significant difference in preoperative characteristics was observed between the groups. Patients in the TFL group had longer median enucleation, hemostasis, and morcellation times (p < 0.001) than those in the MOSESTM cohort. The longer morcellation time of TFL is mostly related to less visibility. The postoperative outcomes IPSS, QoL, Qmax, and post void residual (PVR), were comparable between the groups at 1, 3 and 6 months. The incidence of urge urinary incontinence (p = 0.79), stress urinary incontinence (p = 0.97), and hospital readmission rates (p = 0.1) were comparable between the two groups. A satisfactory safety and efficacy profile with comparable postoperative outcomes was demonstrated for both techniques; though, MOSESTM technology was superior to TFL in terms of shorter overall operative time.

The future of laser technology in kidney stones.

The aim of this study was to present the recent and promising innovations of the new laser technologies used for the treatment of renal stones. Taking advantage of pulse modulation, new technologies such as the Moses effect, the Virtual basket and the Vapor tunnel have been introduced. These technologies seem to improve lithotripsy efficacy by reducing retropulsion and increasing the stone ablation rate.High-power laser lithotripsy has arisen in everyday clinical practice in some centres. The combination of equal efficacy and safety levels compared with the low-power laser lithotripsy and significantly reduced operative time could explain this trend.Thulium fibre laser is an innovative type of laser-emitting machine that offers a lot of advantages compared with its predecessors. The different mechanism of creating the laser pulse offers new possibilities in laser lithotripsy and perhaps in the future thulium fibre laser could replace Ho:YAG as the golden standard for laser lithotripsy. Laser lithotripsy is heavily based on technological equipment. The continuous improvement of available lasers increases the endoscopic lithotripsy levels of efficacy and safety.

Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings.

PurposeProlonged ureteroscopy (URS) is associated with complications including ureteral perforation, stricture, and urosepsis. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. This retrospective study was designed to determine if Thulium fiber laser (TFL) lithotripsy decreases operative time and costs compared to standard Holmium:YAG (Ho:YAG) lithotripsy without pulse modulation.MethodsA retrospective review of URS with laser lithotripsy was conducted for 152 cases performed from August 2020 to January 2021. Variables including cumulative stone size, location, chemical composition, prior ureteral stenting, and ureteral access sheath use were recorded for each case. A cost benefit analysis was performed to show projected cost savings due to potentially decreased operative times.ResultsCompared to Ho:YAG, use of TFL resulted in an average decrease of 12.9 min per case (p = .021, 95% CI [2.03–23.85]). In subgroup analysis of cases with cumulative stone diameter less than 15 mm, the difference was 14.0 min (p = .007, CI [3.95–23.95]). For cases less than 10 mm, the mean difference was 17.3 min in favor of TFL (p = .002, 95% CI [6.89–27.62]). This ~ 13 min reduction in operative time resulted in saving $440/case in direct operating room costs giving our institution a range of $294,000 to $381,900 savings per year.ConclusionsTFL has a significantly shorter operative time and decreased cost when compared to the standard Ho:YAG for equivalent kidney stone and patient characteristics. Longer term follow up is needed to see if recurrence rates are affected.

Comparing Pediatric Ureteroscopy Outcomes with SuperPulsed Thulium Fiber Laser and Low-Power Holmium:YAG Laser.

The thulium fiber laser is a promising new lithoptripsy technology never before studied in the pediatric population. Our center adopted the first platform in North America, the SuperPulsed thulium fiber laser (SPTF). We aimed to compare outcomes in pediatric ureteroscopy using the SPTF to those using the gold standard, low-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This is a retrospective, consecutive cohort study of unilateral ureteroscopy with laser lithotripsy performed in pediatric patients from 2016 to 2021 as an early adopter of the SPTF. Thirty-day complications and stone-free status, defined as the absence of a stone fragment on followup imaging within 90 days, were analyzed using logistic regression. Operative times were compared using linear regression. Propensity scores for use of SPTF were used in regression analyses to account for potential cohort imbalance. A total of 125 cases were performed in 109 pediatric patients: 93 with Ho:YAG and 32 with SPTF. No significant difference was noted in age (p=0.2), gender (p=0.6), stone burden (p >0.9) or stone location (p=0.1). The overall stone-free rate was 62%; 70% with SPTF and 59% with Ho:YAG. The odds of having a residual stone fragment were significantly lower with SPTF than with Ho:YAG (OR=0.39, 95% CI: 0.19-0.77, p=0.01). There was no significant difference in operative time (p=0.8). Seven (25%) complications were noted with SPTF and 19 (22%) with Ho:YAG (p=0.6). The SPTF laser was associated with a higher stone-free rate than the low-power Ho:YAG laser without compromising operative time and safety.

Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP.

To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12weeks and 6months were collected. Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms.Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.

Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose?

To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.

Lithotripsy devices for percutaneous nephrolithotomy (PNL) - new developments.

Percutaneous nephrolithotomy (PNL) is the mainstay of surgery for renal calculi>2 cm or complex multiple calculi and is a technique that has been around since 1976. We review recent literature surrounding novel lithotripsy devices and technology used in PNL. At present, the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is widely accepted as the gold standard laser lithotripsy for PNL. SwissLithoClast Trilogy offers a range of probes with a trifecta of electromagnetic, ultrasonic energy with surgeon-controlled suction. The Olympus Shockpulse-SE is a similar lithotripter that relies on continuous ultrasonic energy with pulsed ballistic energy to break stones. Thulium Fiber Laser (TFL) offers an alternative laser energy source to the Holmium laser, which has been shown to be very effective at producing small stone fragments and dust. The Moses technology is another addition in a long list of improvements to the Ho:YAG laser, forming vaporization bubble through which more effective energy can be applied to stones. Trilogy, Shockpulse, TFL and Moses pulse modulation technology for the Holmium laser all provide improvements compared with older lithotripsy devices. In particular, they convey a safer, efficient and more effective way to manage and clear stones.

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Aug 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Pediatric Ureteroscopy Laser Outcomes The application of new medical technology in children commonly lags innovation in adult patients. Jaeger et al (page 426) at Boston Children’s Hospital in Boston, Massachusetts describe their early-adopter experience using a superpulse thulium fiber laser (SPTF) to treat upper tract stones in children.1 The group started using SPTF in September 2020. In a retrospective analysis, the authors compared stone-free rates in patients less than 21 years of age treated with either SPTF (23) or low-power Ho:YAG (holmium:yttrium-aluminum-garnet) laser (69). Stone-free rate, measured by primarily renal ultrasound within 90 days of the procedure, was higher in patients treated with SPTF (70% vs 59%). Because of concern about SPTF generating higher temperatures, the authors were careful to use continuous irrigation and low power settings. The SPTF was not associated with higher postoperative complications or an increase in operative time. The authors’ careful analysis addresses some of the limitations of the retrospective nature of this study. Nevertheless, their success with SPTF without increase in complication rate or operative time is very promising. Salvage Surgery Rates for Pediatric Testicular Torsion Hospital rating systems have weaknesses, but are there any strengths? Mandated reporting of hospital metrics can be a motivator to focus attention on specific aspects of care quality. In 2015, the US News & World Report introduced the quality metric of “time from ED/clinic to operating room” for testicular torsion in their Best Children’s Hospital Rankings. Using the Pediatric Health Information System database, which includes 52 children’s hospitals across the United States, Chun et al (page 441) from Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania compared testicular salvage rate before and after this metric was introduced.2 The authors found that the salvage rate improved. Of course, temporal association does not prove causation. However, it is suggestive that salvage rates did not change at hospitals that were receiving full score when the metric was introduced but did increase at hospitals not initially receiving the full score. From 2015 to 2019, the number of hospitals that received a full score for this question increased from 62% to 98%. Hospital rating systems are here to stay. Although it will take work, there is the potential for the pediatric urology community to replace flawed measures with meaningful ones that can nudge care quality. Dietary Risk Factors for Pediatric Kidney Stones Dietary counseling for children with stone disease is primarily based on adult data. Wang et al (page 434) from Boston Children’s Hospital in Boston, Massachusetts present one of the only studies to investigate the relationship between dietary nutrient intake and urolithiasis occurrence in children.3 At Boston Children’s, the primary care clinic was administering the Harvard Service Food Frequency Questionnaire at well child visits while the pediatric stone clinic was administering the Youth Adolescent Food Frequency Questionnaire to first-time stone formers within 6 months of diagnosis. The Harvard School of Public Health Nutrition Department has an analysis mechanism to translate data from both these validated surveys to standardized daily nutrition intake. The authors elegantly used this information to perform a case-control study in 57 stone patients and 228 controls. Unsurprisingly, they found that stone formers had higher sodium intake and lower potassium intake. Unexpectedly, they also found an association with increased calcium intake and increased beta-carotene intake. Although carrots are the most well-known dietary source of beta-carotene, high oxalate foods like spinach and kale also have beta-carotene; however, there did not appear to be an association with dietary oxalate intake. Unfortunately, the dietary surveys did not include data on water intake or specific diets (eg ketogenic diet). However, this novel exploratory study generates intriguing questions for future pediatric stone research.

V03-09 THULIUM FIBER LASER: A UNIVERSAL DEVICE IN UROLOGY. FROM BENCH TO BEDSIDE

You have accessJournal of UrologyCME1 May 2022V03-09 THULIUM FIBER LASER: A UNIVERSAL DEVICE IN UROLOGY. FROM BENCH TO BEDSIDE Dmitry Enikeev, Mark Taratkin, Camilla Azilgareeva, Anastasia Shpikina, Leonid Rapoport, Roman Sukhanov, and Petr Glybochko Dmitry EnikeevDmitry Enikeev More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Camilla AzilgareevaCamilla Azilgareeva More articles by this author , Anastasia ShpikinaAnastasia Shpikina More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , Roman SukhanovRoman Sukhanov More articles by this author , and Petr GlybochkoPetr Glybochko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A new thulium fiber laser (TFL) has been recently developed as a novel surgical tool with multiple applications in urology. The latest modification of the device incorporates two modes for surgery – quasi-continuous (QCW, for soft tissue surgery) and SuperPulsed (SP, for lithotripsy). Evaluation of the utility of the novel device began with in-vitro comparison of TFL with conventional Ho:YAG. After clinical approval, device efficacy was assessed for soft tissues (BPH, NMIBC) and stones. METHODS: This prospective clinical trial started following local IRB approval. For TFL enucleation of the prostate (ThuFLEP), TFL (NTO IRE-Polus, Russia) in QCW mode with 600-μm laser fiber and 26 Ch resectoscope (Karl Storz, Germany) with continuous irrigation (0.9% saline) was used. TFL en bloc resection of bladder tumor (TFL-ERBT) was performed using the following settings: QCW; 1.0 J; 10 W. Lithotripsy was performed with TFL using 200-, 400- and 600-μm fibers in SP mode. Stone-free rate (SFR) was assessed with low-dose computed tomography 3 months after. RESULTS: ThuFLEP was performed in 1392 patients, TFL-ERBT in 118 cases, and TFL lithotripsy (PCNL, RIRS, URS, bladder) was performed in 321 patients. In the ThuFLEP group median prostate volume was 80 (IQR 60; 105) cc. Qmax and IPSS before surgery were 9.6±2.6 and 22.9±1.8, respectively. Mean surgery duration was 70.5±31.0 min, whereas the mass of resected tissue was 69.8±34.7 g. Mean catheterization time was 1.7±0.8 days; mean hospital stay was 3.7±1.0 days. PVR, Qmax, IPSS and QOL all significantly improved at 3 months after surgery (p <0.001). TFL-ERBT was performed in 118 patients with detrusor rate of 91.6%. RFS at 6 months was 91.5%. Of 321 patients with urinary calculi treated with TFL, 153 had kidney stones (median stone volume – 279.6 (IQR, 139.4–615.8) mm3, mean density – 1020±382 HU), 149 had ureter stones (median stone volume - 179 (IQR, 94–357) mm3, mean density – 985±360 HU) and 19 had bladder stones (mean size 22.2 mm, mean density – 1050 HU). Stone-free rate was 92%. CONCLUSIONS: TFL shows high efficiency and acceptable safety profile in the treatment of urinary stones, NMIBC and BPH. The combination of SuperPulsed and quasi-continuous modes within a single device allowed for developing a universal tool for urologic surgery. However, further studies are necessary to assess the comparative efficacy of this surgical modality with standard options offered by guidelines. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e204 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Enikeev More articles by this author Mark Taratkin More articles by this author Camilla Azilgareeva More articles by this author Anastasia Shpikina More articles by this author Leonid Rapoport More articles by this author Roman Sukhanov More articles by this author Petr Glybochko More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP05-19 IS THE THULIUM FIBER LASER COST EFFECTIVE COMPARED TO THE HOLMIUM LASER WHEN TREATING RENAL STONES?

You have accessJournal of UrologyCME1 May 2022MP05-19 IS THE THULIUM FIBER LASER COST EFFECTIVE COMPARED TO THE HOLMIUM LASER WHEN TREATING RENAL STONES? Akin S. Amasyali, Nikoli Brown, Cayde Ritchie, Jason Groegler, Joshua D. Belle, Daniel Baldwin, Mohammad Hajiha, and D. Duane Baldwin Akin S. AmasyaliAkin S. Amasyali More articles by this author , Nikoli BrownNikoli Brown More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Jason GroeglerJason Groegler More articles by this author , Joshua D. BelleJoshua D. Belle More articles by this author , Daniel BaldwinDaniel Baldwin More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002522.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New laser technologies including the 60W Thulium fiber laser (TFL) and 100W holmium laser with long pulse duration and stabilization mode (LPDSM) have been developed. Although these new technologies may fragment stones faster, they require greater capital expenditure. The purpose of this study was to compare the cost effectiveness of these new laser technologies and the conventional 30W holmium laser (HL) using a 1 cm upper pole kidney stone in a benchtop model. METHODS: Ten identical 1 cm BegoStones (CaOx monohydrate consistency) were placed into the upper pole calyx of a 3D printed kidney and treated by the same surgeon using a flexible ureteroscope. The kidney was attached to a 2x2 mm metal mesh and stones were fragmented until all pieces passed through the mesh. All stones were fragmented at 10W using a 272 μm fiber. The lasers tested included: A Soltive Premium 60W TFL, the Empower 100W HL with LPDSM and the Dornier 30W with no pulse modulation. The cost of the laser box, fibers, and the mean cost of OR time in California ($37/min) were used to compare cost effectiveness using an ANOVA test. RESULTS: Stone weights were similar between groups (p=0.422). Lasing time (13.6 vs. 19.8 vs. 24.0 min, p=0.000) and overall operating time (14.2 vs. 24.5 min vs. 44.3 min, p=0.000) were significantly lower in the TFL compared to the 100W HL with LPDSM and the 30W HL, respectively (Fig.1). The TFL and 100W HL with LPDSM required no fiber stripping, while the 30W HL required one fiber stripping. Compared to the 30W HL, the TFL and 100W HL with LPDSM resulted in cost savings of $1087.40 and $731.90 per case, respectively. When modeling cost, factoring in the original purchase price, the TFL and 100W HL with LPDSM became cost effective over the 30W HL after treating 83 and 81 stones, respectively. The Thulium laser was more cost effective compared to the 100W HL with LPDSM after 85 cases. CONCLUSIONS: In this model the 60W Thulium laser was 67.8% faster than the 30W HL and 41.8% faster than the 100W Empower with long pulse duration and stone stabilization. The Thulium fiber laser will become cost effective after 83 and 85 cases over the 30W HL and 100W HL, respectively. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e75 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akin S. Amasyali More articles by this author Nikoli Brown More articles by this author Cayde Ritchie More articles by this author Jason Groegler More articles by this author Joshua D. Belle More articles by this author Daniel Baldwin More articles by this author Mohammad Hajiha More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD48-02 IS THE THULIUM FIBER LASER SUPERIOR TO THE LOW-POWER HO:YAG LASER FOR URETEROSCOPY IN CHILDREN?

You have accessJournal of UrologyCME1 May 2022PD48-02 IS THE THULIUM FIBER LASER SUPERIOR TO THE LOW-POWER HO:YAG LASER FOR URETEROSCOPY IN CHILDREN? Christopher Jaeger, Caleb Nelson, Bartley Cilento, Tanya Logvinenko, and Michael Kurtz Christopher JaegerChristopher Jaeger More articles by this author , Caleb NelsonCaleb Nelson More articles by this author , Bartley CilentoBartley Cilento More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Michael KurtzMichael Kurtz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been the laser lithotripsy gold standard for several decades. The Thulium fiber laser is a new technology with unique technical properties emerging as a safe and effective alternative to Ho:YAG in adult series. Our free-standing children’s hospital recently adopted the Super Pulsed Thulium Fiber Laser (SPTF) from Olympus, which is the first such platform on the market in North America. Our objective was to compare clinical outcomes in consecutive pediatric ureteroscopies using a low-power Ho:YAG laser or the SPTF system at our center. METHODS: This is a retrospective cohort study of all unilateral ureteroscopies with laser lithotripsy performed by 3 surgeons for renal or ureteral stones at our center from 2016-2021. Demographics and procedure characteristics were compared between SPTF and Ho:YAG cases using Fisher’s Exact and Mann-Whitney U tests. Complications within 30 days of surgery and stone free status, defined as the absence of a stone fragment on follow-up imaging within 90 days of surgery, were analyzed using logistic regression. Operative times were compared using linear regression. Propensity scores using stone burden, stone location, and surgeon were constructed. Inverse probability of treatment weighting was used to account for imbalance between the cohorts. RESULTS: 125 ureteroscopies with laser lithotripsy were performed on 109 pediatric patients: 93 with Ho:YAG and 32 with SPTF. No significant difference was noted in age (p=0.36), gender (p=0.55), stone burden (p=0.96), or stone location (p=0.14). For the 92 ureteroscopies with 90 day follow-up imaging, the stone free rate (SFR) was 62%; 70% with SPTF and 59% with Ho:YAG. The odds of having a residual stone fragment were significantly lower with SPTF than with Ho:YAG (OR=0.46 (95% CI: 0.24-0.84), p=0.01). There was no significant difference in operative time (p=0.46). 7 (25%) complications were noted with SPTF and 19 (22%) with Ho:YAG (p=0.84). 2 complications were Clavien-Dindo ≥III; but were not directly attributed to a laser. CONCLUSIONS: For ureteroscopies in children, the SPTF using Thulium fiber laser technology improves the SFR achieved with low-power Ho:YAG lasers without compromising operative time or safety. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e799 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Jaeger More articles by this author Caleb Nelson More articles by this author Bartley Cilento More articles by this author Tanya Logvinenko More articles by this author Michael Kurtz More articles by this author Expand All Advertisement PDF DownloadLoading ...

V09-02 THULIUM FIBER LASER FOR BLADDER LEIOMYOMA TREATMENT

You have accessJournal of UrologyCME1 May 2022V09-02 THULIUM FIBER LASER FOR BLADDER LEIOMYOMA TREATMENT Alim Dymov, Evgeny Shpot, Alexandra Proskura, Roman Sukhanov, Vladimir Lekarev, Temirlan Karakotov, Yuliya Lee, and Leonid Rapoport Alim DymovAlim Dymov More articles by this author , Evgeny ShpotEvgeny Shpot More articles by this author , Alexandra ProskuraAlexandra Proskura More articles by this author , Roman SukhanovRoman Sukhanov More articles by this author , Vladimir LekarevVladimir Lekarev More articles by this author , Temirlan KarakotovTemirlan Karakotov More articles by this author , Yuliya LeeYuliya Lee More articles by this author , and Leonid RapoportLeonid Rapoport More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas are very rare, representing only 0.43% of all bladder tumors. Today the most common surgical treatment options for bladder leiomyoma are transurethral, open, laparoscopic and robotic resection. Due to very low incidence rate the assessment of efficacy and safety of different surgical techniques is yet to be done. We present a series of 6 cases of bladder leiomyoma treated with Thulium Fiber laser (TFL) en bloc resection. This report aims to investigate the feasibility, safety and efficacy of TFL en bloc resection for the treatment of bladder leiomyoma and to present our surgical technique. METHODS: From January 2019 up to present time 6 female patients with bladder leiomyoma (size 1.5 cm - 4.0 cm) underwent TFL en bloc resection. All surgeries were performed with regular laser resectoscope (Richard Wolf GmbH, Knittlingen, Germany; Karl Storz, Tuttlingen, Germany), 600 μm laser fiber and TFL («FiberLase» IRE-Polus, Russia) operating at wavelength 1.94 µm. Laser settings - 1 J, 10 Hz, 10 W. Two out of six resected tumors were morcellated, three were removed with a bipolar loop, and one 2 cm tumor was extracted with Allis clamp. Intra- and postoperative complications were evaluated. RESULTS: All tumors were resected as a whole. Mean operative time was 24 min (10 - 40 min). Mean catheter time was 28 hours (24 - 48 hrs), mean length of hospital stay was 76 hours (72 - 96 hrs). No bladder perforation, obturator nerve stimulation, significant bleeding and postoperative complications were recorded. Morphological examination of resected tissues confirmed leiomyoma. CONCLUSIONS: Based on our experience TFL en bloc resection is an effective and safe option for the surgical treatment of bladder leiomyoma. Moreover, it seems to provide fast recovery from the surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e805 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alim Dymov More articles by this author Evgeny Shpot More articles by this author Alexandra Proskura More articles by this author Roman Sukhanov More articles by this author Vladimir Lekarev More articles by this author Temirlan Karakotov More articles by this author Yuliya Lee More articles by this author Leonid Rapoport More articles by this author Expand All Advertisement PDF DownloadLoading ...

V23 - En-bloc encoscopic enculeation of the prostate with thulium fiber laser with minimal mechanical traction

V23 - En-bloc encoscopic enculeation of the prostate with thulium fiber laser with minimal mechanical traction

V09-01 THULIUM FIBER LASER EN BLOC RESECTION FOR BLADDER TUMOUR. TIPS AND TRICKS

You have accessJournal of UrologyCME1 May 2022V09-01 THULIUM FIBER LASER EN BLOC RESECTION FOR BLADDER TUMOUR. TIPS AND TRICKS Dmitry Enikeev, Andrey Morozov, Mark Taratkin, Diana Babaevskaya, Roman Sukhanov, and Petr Glybochko Dmitry EnikeevDmitry Enikeev More articles by this author , Andrey MorozovAndrey Morozov More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Diana BabaevskayaDiana Babaevskaya More articles by this author , Roman SukhanovRoman Sukhanov More articles by this author , and Petr GlybochkoPetr Glybochko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to a number of guidelines, en bloc resection of bladder tumor has been considered standard procedure since 2018 along with conventional transurethral resection with electric loop. It may improve grading and even oncological outcomes due to the presence of the muscle layer. Moreover, piecemeal resection may lead to tumor re-implantation and relapse due to long contact with the bladder walls. However, despite its advantages, en bloc resection is considered to be a more difficult procedure. With this video we want to share our experience with en bloc and provide data on its outcomes. METHODS: We provide outcomes of 71 consecutive en bloc resections of bladder tumor with thulium fiber laser in the Institute for Urology and Reproductive Health, Sechenov University. A comparison group consisted of 58 consecutive monopolar TURBTs. All the procedures were recorded. RESULTS: In the video we address different aspects of the en bloc technique and provide step-by-step guidance. We also offer advice on how to successfully perform en bloc in case of tumor larger than 3 cm, or tumor invading the ureteric orifice. At 6 months, recurrence was detected in 19 patients after TURBT and in 6 patients after Tm fiber en bloc, OR 6.1 (95% CI 1.6 – 23.8, p=0.009). Univariate analysis also showed association between muscle layer presence and relapse rate, OR 4.63 (95% CI 1.1 – 19.4, p=0.36). CONCLUSIONS: With the presented videos we intend to highlight that en bloc is no more difficult than TURBT and it is applicable in different cases including large tumors. We believe this will help surgeons to master this technique. Our data suggest that en bloc offers improved oncological outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e805 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Enikeev More articles by this author Andrey Morozov More articles by this author Mark Taratkin More articles by this author Diana Babaevskaya More articles by this author Roman Sukhanov More articles by this author Petr Glybochko More articles by this author Expand All Advertisement PDF DownloadLoading ...

Linearly polarized 2044-nm pulsed laser generation in Ho:YAG active medium

We demonstrated the efficient generation of a linearly polarized Ho:YAG laser pumped by a thulium fiber laser. Independent of the pumping power and without utilizing any dispersive optical element, the output radiation remained stable with a high degree of linear polarization. The output with 2044 nm wavelength and 0.12 nm bandwidth was measured. In the free-running generation, with respect to the incident pump power, we recorded more than 9 W of output power with 59% slope efficiency. In addition, in the pulsed generation, we obtained more than 2.2 mJ pulses with 50 ns time duration, and 44 kW peak power.