Are We Cutting Ourselves Short? Laser Lithotripsy Performance Based on Differences in Fiber-tip Preparation

Area of Science:

• Urology
• Biomedical Engineering
• Laser Medicine

Background:

• Holmium laser lithotripsy is a common procedure for kidney stone removal.
• Laser fiber-tip configuration can influence treatment efficacy.
• Standardization of fiber preparation is essential for reproducible outcomes.

Purpose of the Study:

• To compare the lithotripsy performance of different laser fiber-tip configurations.
• To evaluate the impact of fiber preparation methods on energy delivery and stone fragmentation.
• To determine the optimal fiber-tip configuration for Ho:YAG laser lithotripsy.

Main Methods:

• In vitro study using BegoStones and a Ho:YAG laser.
• Tested three fiber-tip configurations: new (single-use), cleaved (reusable), and coated (cut with scissors).
• Evaluated fragmentation and dusting settings (1 J × 10 Hz and 0.5 J × 20 Hz) with a laser fiber speed of 1 mm/s.

Main Results:

• New and cleaved fibers showed significantly greater stone fragmentation than coated fibers (P <.05).
• Fragmentation was 59-75% higher with new fibers and 51-45% higher with cleaved fibers compared to coated fibers.
• Higher power output was maintained at the end of activation for new and cleaved fiber-tips.

Conclusions:

• New and cleaved laser fibers offer superior lithotripsy performance over coated fibers.
• Cutting single-use laser fibers can damage the tip, leading to energy dispersion and reduced efficiency.
• Optimizing laser fiber preparation is critical for maximizing lithotripsy effectiveness.