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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...

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Optimizing Fragmentation while Minimizing Thermal Injury Risk with the Thulium Fiber Laser in Ureteral Stone

Arpit Mishra1, Ezra J Margolin2, Aaron W Stewart2

  • 1Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.

Journal of Endourology
|May 10, 2025
PubMed
Summary
This summary is machine-generated.

Optimizing thulium fiber laser (TFL) settings is crucial for safe and effective ureteral stone fragmentation. Lower power settings (10W) with appropriate irrigation minimize thermal injury risk while achieving efficient stone removal.

Keywords:
fragmentationirrigation flow ratethermal injurythulium fiber laserureteral stones

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Area of Science:

  • Urology
  • Laser Medicine
  • Biomedical Engineering

Background:

  • Ureteral stone treatment often involves laser lithotripsy.
  • Minimizing thermal injury during thulium fiber laser (TFL) procedures in confined ureteral spaces is a significant clinical challenge.
  • Optimizing laser parameters is essential for balancing stone fragmentation efficiency and patient safety.

Purpose of the Study:

  • To determine optimal thulium fiber laser (TFL) settings for effective ureteral stone fragmentation.
  • To evaluate and minimize thermal injury risks associated with TFL use in a simulated ureteral environment.
  • To investigate the impact of irrigation parameters on temperature and treatment outcomes.

Main Methods:

  • A three-dimensional hydrogel-based ureter model was utilized, maintained at body temperature.
  • BegoStone phantoms simulated ureteral stones.
  • Thulium fiber laser (TFL) parameters (power, frequency, pulse energy) and irrigation (rate, temperature) were systematically varied.
  • Maximum sustained temperature (MST) and cumulative thermal dose were measured against a 120-minute safety threshold.
  • Stone fragmentation efficiency was assessed by measuring treated stone mass.

Main Results:

  • At 6.4W and 10W TFL settings, MST remained below body temperature and thermal doses were minimal (<1 minute), indicating a low thermal risk.
  • At 20W with 20 mL/min irrigation, MST rapidly exceeded 43°C, and thermal doses surpassed the 120-minute safety threshold.
  • Treatment efficiency was highest at 20W (1.58 mg/s), followed by 10W (1.15 mg/s) and 6.4W (0.78 mg/s).
  • 10W settings using 1.0 J/10 Hz were more efficient than 2.0 J/5 Hz or 3.0 J/3 Hz.
  • Safe settings (10W) produced 95.5% fine dust, while higher energy pulses (2-3 J) generated more larger fragments.
  • Increased irrigation (40 mL/min) or colder irrigation (15°C) reduced MST and improved efficiency, especially at 20W.

Conclusions:

  • High-power TFL treatment (20W) poses a significant risk of thermal injury in ureteral spaces.
  • 10W TFL settings, particularly at 2.0 J/5 Hz with adequate irrigation, offer a safe and effective option for ureteral stone fragmentation.
  • Further clinical validation of these optimized settings is warranted for human stone treatment.