TY - JOUR
T1 - Experts’ recommendations in laser use for the treatment of urolithiasis
T2 - a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
AU - Ortner, Gernot
AU - Somani, Bhaskar Kumar
AU - Güven, Selcuk
AU - Kitzbichler, Gerhard
AU - Traxer, Olivier
AU - Giusti, Guido
AU - Proietti, Silvia
AU - Liatsikos, Evangelos
AU - Kallidonis, Panagiotis
AU - Krambeck, Amy
AU - Goumas, Ioannis Kartalas
AU - Duvdevani, Mordechai
AU - Kamphuis, Guido M.
AU - Ferretti, Stefania
AU - Dragos, Laurian
AU - Ghani, Khurshid
AU - Miernik, Arkadiusz
AU - Juliebø-Jones, Patrick
AU - Jung, Helene
AU - Tailly, Thomas
AU - Pietropaolo, Amelia
AU - Hamri, Saeed Bin
AU - Papatsoris, Athanasios
AU - Sarica, Kemal
AU - Scoffone, Cesare Marco
AU - Cracco, Cecilia Maria
AU - Keller, Etienne Xavier
AU - Durutovic, Otas
AU - Pereira, Sergio
AU - Herrmann, Thomas R. W.
AU - Nagele, Udo
AU - Gözen, Ali Serdar
AU - Tokas, Theodoros
N1 - Publisher Copyright: © 2024, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Purpose: To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. Methods: After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. Results: Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. Conclusions: Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse’s and generator settings’ physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
AB - Purpose: To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. Methods: After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. Results: Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. Conclusions: Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse’s and generator settings’ physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
KW - Laser
KW - Lithiasis
KW - Settings
KW - Stone
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85182216107&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00345-023-04726-z
DO - https://doi.org/10.1007/s00345-023-04726-z
M3 - Article
C2 - 38217743
SN - 0724-4983
VL - 42
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
M1 - 33
ER -