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Evaluation of the Spies? modalities image quality
摘要： Introduction: The Spies? system (Karl-Storz?) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies? modalities (SM) to the standard white light in an in-vitro model. Materials and Methods: Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urology evaluated each video on a scale of 1 (very bad) to 5 (very good). Results: Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023)). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists. Conclusion: In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.
关键词： Lithotripsy,Diagnosis,Ureteroscopy,Technology
更新于2025-09-23 15:22:29
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Thulium fiber laser: ready to dust all urinary stone composition types?
摘要： Purpose To evaluate whether stone dust can be obtained from all prevailing stone composition types using the thulium fiber laser (TFL) for lithotripsy. Where applicable, stone dust was further characterized by morpho-constitutional analysis. Methods Human urinary stones were submitted to in vitro lithotripsy using a FiberLase U2 TFL generator with 150 μm silica core fibers (IPG Photonics?, IPG Medical?, Marlborough, MA, USA). Laser settings were 0.05 J, 320 Hz and 200 μs. A total of 2400 J were delivered to each stone composition type. All evaluated stones had a > 90% degree of purity (calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite and cystine). Spontaneously floating stone particles were considered as stone dust and collected for analysis by scanning electron microscopy and Fourier transform infrared spectroscopy. Results Stone dust could be retrieved from all evaluated urinary stones after TFL lithotripsy. Most stone dust samples revealed changes in crystalline organization, except for calcium oxalate monohydrate and carbapatite, which conserved their initial characteristics. Mean maximal width of stone dust particles did not exceed 254 μm. Conclusions The TFL is capable to produce stone dust from all prevailing stone types. Morpho-constitutional changes found in stone dust suggest a photothermal interaction of laser energy with the stone matrix during TFL lithotripsy.
关键词： Urolithiasis,Stone dust,Fourier transform infrared spectroscopy,Lithotripsy,Scanning electron microscopy,Thulium fiber laser
更新于2025-09-23 15:21:01
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Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using Holmium:YAG and Super Pulse Thulium Fiber lasers
摘要： Objective: To investigate the effects of laser temporal pulse shaping of the super pulse Thulium fiber laser (SPTFL) and to compare them in controlled in vitro conditions with various Ho:YAG pulse delivery modes. Materials and methods: SPTFL (Urolase SP, IRE-Polus, Fryazino, Russia) with an emission wavelength of 1.94 μm and a Ho:YAG laser (P120H, Lumenis, Yokneam, Israel) with Moses technology were compared. Pulse shape, stone retropulsion, and ablation efficiency were evaluated using Begostones and compared for each laser modality: short (SP), long (LP), and Moses pulse (MP) for Ho:YAG, regular pulse (RP) and dual pulse (DP) for SPTFL. Results: Ho:YAG SP mode exhibited an asymmetrical pulse shape with steep leading slope and much more gradual trailing slope, without any flat section. Pulses generated by SPTFL were significantly longer and therefore had lower peak power (Ppeak) than those generated by Ho:YAG laser at equivalent energy settings. Retropulsion for Ho:YAG LP and MP modes was similar and lower than that of SP, but higher than for SPTFL (all p ≤0.02), with an average stone displacement about 4 times and 2 times lower for SPTFL as compared to Ho:YAG. Comparison of ablation volumes indicated that SPTFL induced significantly higher (2-fold) ablation than Ho:YAG laser. Conclusions: Magnitude and initial velocity of stone retropulsion decrease with longer pulse duration and lower pulse peak power, but without sacrificing ablation efficiency. These observations are manifest when comparing Ho:YAG laser with SPTFL. The novel SPTFL provides greater versatility and control of pulse parameters than Ho:YAG laser. Further clinical investigation of practical benefits achievable with pulse-shaping SPTFL modes is warranted.
关键词： retropulsion,lithotripsy,ablation,Ho:YAG,Thulium fiber laser
更新于2025-09-23 15:21:01
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Comparison of the ablation rates, fissures and fragments produced with 150???μm and 272???μm laser fibers with superpulsed thulium fiber laser: an in vitro study
摘要： Introduction Holmium:YAG(Ho:YAG) is currently the standard for lithotripsy. Superpulsed Thulium Fiber Laser(TFL) has been evaluated as an alternative for lithotripsy, using laser fibers with core-diameters(CDF) down to 50 μm and additional available settings suitable for “dusting” technique. This in-vitro study compared ablation rates, fissures and fragments’ size with 150μmCDF or 272μmCDF with different laser settings using TFL and Ho:YAG. Methods 150CDF and 272CDF were compared using three settings for TFL “fine dusting”(FD:0.15 J/100 Hz); “dusting”(D:0.5 J/30 Hz); “fragmentation”(Fr:1 J/15 Hz) and Ho:YAG(D and Fr). An experimental setup consisting of immerged 10 mm cubes of artificial hard(H) or soft(S) stone phantoms was used with a 20 s’ lasing time and a spiral trajectory, in contact mode. Fragments (acquired through sieves) and stones were observed under optical microscopy before three-dimensional scanning to measure fragments and fissures(DOF) mean diameters and ablation volumes. Results Ablation volumes in with 150CDF-TFL and 272CDF-TFL were higher than those for 272CDF-Ho:YAG in both “dusting” (twofold and threefold) and “fragmentation”(1,5-fold and twofold). “Fine dusting” ablation rates with 150CDF-TFL and 272CDF-TFL were respectively at least 1,5-fold and twofold higher than those for 272CDF-Ho:YAG in “dusting”. 150CDF produced significantly smaller DOF than 272CDF in all settings against S and H except in fragmentation. 150CDF produced lower fragments’ diameter than 272CDF in all settings except dusting. Conclusion These preliminary studies demonstrate that at equal settings and CDF, TFL ablation rates are at least two-fold higher than those with Ho:YAG. 150CDF produces smaller fissures and fragments (that meets the definition of “dusting” lithotripsy) than 272CDF and higher ablation volumes than Ho:YAG.
关键词： Laser,Lithotripsy,Endourology,Thulium fiber laser
更新于2025-09-23 15:21:01
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“VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes
摘要： “VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes. A prospective trial was conducted for patients undergoing holmium laser lithotripsy for ureteral stones. Patients were randomly assigned to have holmium laser lithotripsy with or without Vapor Tunnel technology. All procedures were performed by four experienced urologists. Quanta Cyber Ho 100 W generator with 365 μ fiber was used for all cases. Demographic data, stone parameters, perioperative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero-no retropulsion to 3-maximum retropulsion. Results: A total of 80 patients were included in the study (40 per each group). Both groups were comparable in terms of age, and pre-operative stone size (1.2 vs. 1.1 cm, p > 0.05). When compared with the Regular mode, Vapor Tunnel Technology was associated with significantly lower fragmentation time (20.4 vs. 16.1 min, p < 0.05) and total procedural time (49 vs. 35.7 min, p < 0.05). However, there were no significant differences in terms of total energy applied to the stones (9.9 vs. 10.7 KJ, p > 0.05). Vapor Tunnel technology was associated with significantly less retropulsion. There was no significant difference between both modes in terms of intraoperative complications. The success rate at the end of 1 month was comparable between both groups (92.3 vs. 88.3%, p > 0.05). Discussion: Vapor Tunnel technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy; thus improving stone fragmentation efficiency.
关键词： holmium laser lithotripsy,intraoperative,VaporTunnel,ureteroscopic,postoperative outcomes
更新于2025-09-23 15:19:57
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Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy
摘要： Introduction: Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use. Aim: To evaluate the risk factors for HLU failure. Material and methods: The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery. Results: Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred. Conclusions: Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.
关键词： lithotripsy,complication,ureteroscopy,ureteral stone
更新于2025-09-23 15:19:57
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Temperature changes during laser lithotripsy with Ho:YAG laser and novel Tm-fiber laser: a comparative in-vitro study
摘要： Aim The aim of this study was to compare the thermal effects of Ho:YAG and Tm-fiber lasers during lithotripsy in an in-vitro model via real-time temperature measurement. Methods We compared a Ho:YAG laser (pav up to 100 W, Lumenis, Yokneam, Israel) and a superpulse Tm-fiber laser (SP TFL, pav up to 40 W, NTO IRE-Polus, Fryazino, Russia), both equipped with 200 μm bare-ended fibers. The following settings were used: 0.2 J, 40 Hz (nominal pav 8 W). Power meter FieldMaxII-TO (Coherent, Santa Clara, CA, USA) was used to verify output laser power (pav). Each laser was fired for 60 s in two setups: (1) thermos-insulated (quasi-adiabatic) cuvette; (2) actively irrigated setup with precise flow control (irrigation rates 0, 10, 35 mL/min). Results Power measurements performed before the test revealed a 10% power drop in Ho:YAG (up to 7.2 ± 0.1 W) and 6.25% power drop in SP TFL (up to 7.5 ± 0.1). At the second step of our experiment, irrigation reduced the respective temperatures in the same manner for both lasers (e.g., at 35 mL/s SP TFL ? 1.9 °C; for Ho:YAG laser ? 2.8 °C at 60 s). Conclusion SP TFL and Ho:YAG lasers are not different in terms of volume-averaged temperature increase when the same settings are used in both lasers. Local temperature rises may fluctuate to some degree and differ for the two lasers due to varying jet streaming caused by non-uniform heating of the aqueous medium by laser light.
关键词： Ho:YAG laser,Laser lithotripsy,Thermal effect,Thulium fiber laser,In-vitro
更新于2025-09-23 15:19:57
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Re: Safety of a Novel Thulium Fibre Laser for Lithotripsy: An In Vitro Study on the Thermal Effect and Its Impact Factor
摘要： Peng et al present for the first time data regarding the temperature rise following activation of a thulium fibre laser (TFL) for lithotripsy. In an in vitro setting, the thermal effect of TFL was evaluated at different laser power settings and irrigation rates with the safety temperature threshold set to 43°C. Without irrigation, laser power >10 W caused an increase in temperature above this safety threshold. When low-flow irrigation (15 ml/min) was used, only laser power of 30 W exceeded the safety threshold. Higher flow rates prevented a rise in temperature above the threshold for any of the laser settings tested.
关键词： Thermal Effect,Thulium Fibre Laser,Lithotripsy,Safety Temperature Threshold
更新于2025-09-19 17:13:59
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Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy
摘要： Objective: To compare Regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and methods: After obtaining ethics approval, a prospective double‐blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either Regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, peri‐ operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero‐no retropulsion to 3‐maximum retropulsion. Results: A total of 72 patients were included in the study (36 per each arm). Both groups were comparable in terms of age, and pre‐operative stone size (1.4 vs. 1.7 cm, p>0.05). When compared with the Regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 vs. 14.2 min; p=0.03) and procedural time (50.9 vs. 41.1 min, p=0.03). However, there were no significant differences in terms of lasing time (7.4 vs. 6.1 min, p>0.05) and total energy applied to the stones (11.1 vs. 10.8 KJ, p>0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs. 0.5, p=0.01). There were no significant differences between both modes in terms of intra‐operative complications (11.1% vs. 8.3%, p>0.05), with one patient requiring endo‐ureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs. 88.4%, p> 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
关键词： technology assessment,ureteroscopy,randomized clinical trial,holmium laser,Laser lithotripsy,outcomes assessment
更新于2025-09-19 17:13:59
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Pulse Modulation for Holmium Laser: Vapor Tunnela??Virtual Basketa??Bubble Blast
摘要： Introduction: New pulse modulations for holmium laser (vapor tunnel, virtual basket, and bubble blast) have been introduced, seeking energy optimization and better ef?ciency for stone lithotripsy. We aim to assess vapor tunnel, virtual basket, and bubble blast effects for stone lithotripsy during ureteroscopy and retrograde intra-renal surgery. Materials and Methods: Seven patients (10 stones) were treated using a 100 W holmium laser generator (Cyber Ho; Quanta System). Three, 272, 372, and 550 lm, ?bers were used. The settings used were 0.3–1.2 J/15–50 Hz, combined with short, medium, and long pulse length. Vapor tunnel, virtual basket, and bubble blast modulations were used during lithotripsy. Results: A smaller retropulsion and a more ef?cient ablation were observed with long pulse in combination with vapor tunnel and virtual basket effects, compared with regular mode fragmentation. No patient presented Clavien III/IV complications. The vapor tunnel technology consists in a long pulse, using the minimum peak power in accordance with selected output settings. The pulse creates a vapor tunnel, the remaining energy passes straight through the previously created tunnel, generating an elliptical shape bubble allowing less retropulsion. Virtual basket is composed of a double pulse emission. The time duration separating the two pulses is chosen so that the second pulse is emitted from the distal tip of the ?ber when the bubble size, and the corresponding amount of displaced ?uid, is at a maximum. The virtual basket emission mode combines a low retropulsion with a fragment suction effect. Bubble blast is a high-energy pulse resulting in the generation of a strong mechanical effect. The physical principle is that the ?rst pulse generates a spherical bubble, the second pulse is emitted after the complete collapse of the ?rst bubble generating a second bubble with bigger volume than the ?rst pulse. This translates theoretically into a frontal and lateral increasing of the shock wave effects on the target. Conclusion: New pulse modulations vapor tunnel, virtual basket, bubble blast lead to retropulsion reduction, lithotripsy optimization, and theoretically to a shorter stone ablation time. Large clinical trials are needed to con?rm their ef?ciency, advantages, and limitations.
关键词： virtual basket,ureteroscopy,bubble blast,vapor tunnel,holmium,laser lithotripsy
更新于2025-09-19 17:13:59