Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG)

Abstract

Purpose

The holmium-YAG (Ho:YAG) Laser system is the current gold standard for laser lithotripsy (LL). Super Pulse Thulium Fiber Laser (SPTF) has emerged as an effective alternative. We compared the temperature profile of both the 120 W Ho:YAG and the 60 W SPTF systems during ureteral lithotripsy.

Methods

Antegrade ureteroscopy with LL was performed in ex-vivo porcine kidneys with 3 mm Begostones. Intra-ureteral temperature was measured using one probe proximal and one distal to the site of lithotripsy. LL was performed using a 200 μm core fiber at dusting (SPTF—0.1 J, 200 Hz, SP; Ho:YAG—0.3 J, 70 Hz, LP) and fragmenting (0.8 J, 8 Hz, SP for both) settings for 5 s. Fifteen repetitions were recorded for each laser at each setting. Tissue samples of the ureter were collected for histological analysis.

Results

There was a rise in temperature at the site of lithotripsy using both systems at every setting evaluated. The median temperatures were greater for the SPTF on the fragmenting setting (33.3 °C vs 30.0 °C, p = 0.004). On the dusting setting, the median temperature was not statistically greater for Ho:YAG (40.6 °C vs 35.8 °C, p = 0.064), (Graphic 1). Histological analysis did not show any signs of injury or necrosis in any of the tested settings.

Conclusion

Higher power settings used for dusting have a higher temperature rise in the ureter during lasering. Median ureteral intra-luminal temperature rise during LL was equivalent during dusting and higher in the SPTF during fragmentation, but neither reached the threshold for thermal injury based on the duration of exposure.

This is a preview of subscription content, access via your institution.

Fig. 1
Graphic 1

Abbreviations

SPTF:

Super Pulse Thulium Fiber Laser

NADH:

Nicotinamide adenine dinucleotide

LL:

Laser Lithotripsy

Ho:YAG:

Holmium YAG Laser

References

  1. 1.

    Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt J (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3(1):18–26. https://doi.org/10.1016/j.euf.2017.04.001

    Article  PubMed  Google Scholar 

  2. 2.

    Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC (2015) Contemporary surgical trends in the management of upper tract calculi. J Urol 193(3):880–884. https://doi.org/10.1016/j.juro.2014.09.006

    Article  PubMed  Google Scholar 

  3. 3.

    Leijte JAP, Oddens JR, Lock TM (2008) Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success. J Endourol 22(2):257–260. https://doi.org/10.1089/end.2007.0299

    Article  PubMed  Google Scholar 

  4. 4.

    Traxer O, Keller EX (2019) Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser. World J Urol. https://doi.org/10.1007/s00345-019-02654-5

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Winship B, Wollin D, Carlos E, Peters C, Li J, Terry R, Boydston K, Preminger GM, Lipkin ME (2019) The rise and fall of high temperatures during ureteroscopic holmium laser lithotripsy. J Endourol. https://doi.org/10.1089/end.2019.0084

    Article  PubMed  Google Scholar 

  6. 6.

    Wollin DA, Carlos EC, Tom W, Neal Simmons W, Preminger GM, Lipkin ME (2017) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol. https://doi.org/10.1089/end.2017.0658

    Article  PubMed  Google Scholar 

  7. 7.

    Aldoukhi AH, Hall TL, Ghani KR, Maxwell AD, MacConaghy B, Roberts WW (2018) caliceal fluid temperature during high-power holmium laser lithotripsy in an in vivo porcine model. J Endourol 32(8):724–729. https://doi.org/10.1089/end.2018.0395

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME (2018) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol 32:59–63. https://doi.org/10.1089/end.2017.0658

    Article  PubMed  Google Scholar 

  9. 9.

    Hein S, Petzold R, Schoenthaler M, Wetterauer U, Miernik A (2018) Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model. World J Urol. https://doi.org/10.1007/s00345-018-2303-x

    Article  PubMed  Google Scholar 

  10. 10.

    Fried NM (2018) Recent advances in infrared laser lithotripsy [Invited]. Biomed Opt Express 9(9):4552–4568. https://doi.org/10.1364/BOE.9.004552

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Traxer O, Rapoport L, Tsarichenko D et al (2018) First clinical study on superpulse thulium fiber laser lithotripsy. J Urol 199:e321. https://doi.org/10.1016/j.juro.2018.02.827 (Abstract)

    Article  Google Scholar 

  12. 12.

    Andreeva V, Vinarov A, Yaroslavsky I et al (2019) Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol. https://doi.org/10.1007/s00345-019-02785-9

    Article  PubMed  Google Scholar 

  13. 13.

    Sherwood ME, Flotte TJ (2007) Improved staining method for determining the extent of thermal damage to cells. Lasers Surg Med 39(2):128–131. https://doi.org/10.1002/lsm.20450

    Article  PubMed  Google Scholar 

  14. 14.

    Kronenberg P, Somani B (2018) Advances in laser for the treatment of stones—a systematic review. Curr Urol Rep 19(6):45. https://doi.org/10.1007/s11934-018-0807-y

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Kronenberg P, Traxer O (2015) Update on lasers in urology 2014: current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 33(4):463–469. https://doi.org/10.1007/s00345-014-1395-1

    Article  PubMed  Google Scholar 

  16. 16.

    Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 8(Suppl 4):S398–S417. https://doi.org/10.21037/tau.2019.08.01

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Giambattista A, Richardson BM, Richardson RC (2004) College physics. McGraw-Hill, Boston

    Google Scholar 

  18. 18.

    Molina WR, Silva IN, da Silva RD, Gustafson D, Sehrt D, Kim FJ (2015) Influence of saline on temperature profile of laser lithotripsy activation. J Endourol 29(2):235–239. https://doi.org/10.1089/end.2014.0305

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Aschoff AJ, Sulman A, Martinez M, Duerk JL, Resnick MI, MacLennan GT, Lewin JS (2001) Perfusion-modulated MR imaging-guided radiofrequency ablation of the kidney in a porcine model. Am J Roentgenol 177(1):151–158. https://doi.org/10.2214/ajr.177.1.1770151

    CAS  Article  Google Scholar 

  20. 20.

    Sapareto SA, Dewey WC (1984) Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys 10(6):787–800. https://doi.org/10.1016/0360-3016(84)90379-1

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Sampaio FJ, Pereira-Sampaio MA, Favorito LA (1998) The pig kidney as an endourologic model: anatomic contribution. J Endourol 12(1):45–50. https://doi.org/10.1089/end.1998.12.45

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Ringe KI, Lutat C, Rieder C, Schenk A, Wacker F, Raatschen HJ (2015) Experimental evaluation of the heat sink effect in hepatic microwave ablation. PLoS ONE 10(7):e0134301. https://doi.org/10.1371/journal.pone.0134301

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Olympus—OSTA.

Author information

Affiliations

Authors

Contributions

WRM: protocol/project development, data analysis, manuscript writing/editing; RVC: manuscript writing/editing; BHC: data analysis, manuscript writing/editing; BEK: data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Wilson R. Molina.

Ethics declarations

Conflict of interest

W Molina, BH Chew and BE Knudsen are medical consultants for Olympus. RV Carrera has no conflicts of interest to declare.

Ethical approval

The authors did not perform any procedures on living humans or animals. Only fresh ex-vivo porcine kidneys were utilized in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Molina, W.R., Carrera, R.V., Chew, B.H. et al. Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG). World J Urol (2021). https://doi.org/10.1007/s00345-021-03619-3

Download citation

Keywords

  • Thulium fiber laser
  • Temperature
  • Kidney stones
  • Holmium:YAG laser
  • Lithotripsy