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Optimal power settings for Holmium:YAG lithotripsy.
Jason Sea1, Lee M Jonat, Ben H Chew
1Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
The Journal of Urology
|January 24, 2012
Summary
Optimal Holmium:YAG laser settings for lithotripsy depend on desired outcomes. Lower pulse energy yields less fragmentation and retropulsion with smaller fragments, while higher settings increase fragmentation and retropulsion.
Area of Science:
- Urology
- Laser Lithotripsy
- Medical Device Technology
Background:
- Holmium:YAG (Ho:YAG) laser lithotripsy is a common procedure for stone removal.
- Optimizing laser parameters is crucial for effective stone fragmentation and minimizing complications like stone retropulsion.
Purpose of the Study:
- To determine the optimal Ho:YAG laser power settings for maximal stone fragmentation.
- To achieve minimal fragment size during lithotripsy.
- To minimize stone retropulsion during Ho:YAG laser lithotripsy.
Main Methods:
- Stone phantoms were irradiated with a Ho:YAG laser using a 365 μm fiber at various power settings (0.2-2.0 J, 10-40 Hz).
- Experiments were conducted with and without phantom stabilization.
- Fragmentation, fragment size, retropulsion, crater volume, and pressure transients were measured.
Main Results:
- Higher pulse energy increased fragmentation and retropulsion (p <0.0001) without stabilization.
- Smallest fragments were observed at 0.2 J pulse energy (p <0.02).
- Stabilization increased fragmentation and retropulsion but also fragment size (p <0.0001).
Conclusions:
- Ho:YAG lithotripsy outcomes vary significantly with pulse energy settings.
- Low pulse energy (0.2 J) results in less fragmentation and retropulsion with smaller fragments.
- High pulse energy (2.0 J) increases fragmentation and retropulsion, producing larger fragments. Anti-retropulsion devices enhance efficiency, especially at high pulse energy.
