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. 2020 Jul;126(1):159-167.
doi: 10.1111/bju.15079. Epub 2020 May 18.

Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium:YAG and super-pulse thulium fibre lasers

Eugenio Ventimiglia  1   2 , Steeve Doizi  1   2 , Anastasiya Kovalenko  3 , Viktoria Andreeva  3 , Olivier Traxer  1   2
Affiliations

Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium:YAG and super-pulse thulium fibre lasers

Eugenio Ventimiglia et al. BJU Int. 2020 Jul.

Abstract

Objective: To investigate the effects of laser temporal pulse shaping of the super-pulse thulium fibre laser (SPTFL) and to compare these in controlled in vitro conditions with various holmium: yttrium aluminium garnet (Ho:YAG) pulse delivery modes.

Materials and methods: The SPTFL (Urolase SP, IRE-Polus, Fryazino, Russia), with an emission wavelength of 1.94 μm, and a Ho:YAG laser (P120H; Lumenis, Yokneam, Israel) with Moses technology were compared. Pulse shape, stone retropulsion and ablation efficiency were evaluated using BegoStones and compared for each laser mode: short (SP), long (LP), and Moses pulse (MP) for Ho:YAG, regular pulse (RP) and dual pulse (DP) for SPTFL.

Results: The Ho:YAG SP mode exhibited an asymmetrical pulse shape, with a steep leading slope and a much more gradual trailing slope, without any flat section. Pulses generated by the SPTFL were significantly longer and therefore had lower peak power than those generated by the Ho:YAG laser at equivalent energy settings. Retropulsion for the holmium:YAG LP and MP modes was similar and lower than that for the SP mode, but higher than for the SPTFL (all P ≤ 0.02), with an average stone displacement approximately four times and two times lower for SPTFL as compared to the Ho:YAG laser. Comparison of ablation volumes indicated that the SPTFL induced significantly higher (twofold) ablation than the Ho:YAG laser.

Conclusions: The magnitude and initial velocity of stone retropulsion decreased with longer pulse duration and lower pulse peak power, without sacrificing ablation efficiency. These observations are manifest when comparing the Ho:YAG laser with the SPTFL. The novel SPTFL provides greater versatility and control of pulse variables than the Ho:YAG laser. Further clinical investigation of practical benefits achievable with pulse-shaping SPTFL modes is warranted.

Keywords: ablation; holmium:YAG; lithotripsy; retropulsion; thulium fibre laser.

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