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. 2021 Mar;28(3):261-265.
doi: 10.1111/iju.14443. Epub 2020 Nov 30.

Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: A single-center experience

Dmitry Enikeev  1 , Vagarshak Grigoryan  1 , Igor Fokin  1 , Andrey Morozov  1 , Mark Taratkin  1 , Roman Klimov  1 , Vasiliy Kozlov  2 , Svetlana Gabdullina  3 , Petr Glybochko  1
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Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: A single-center experience

Dmitry Enikeev et al. Int J Urol. 2021 Mar.

Abstract

Objectives: To estimate the efficacy and safety of SuperPulsed thulium-fiber laser ureteral lithotripsy and to identify optimal laser settings.

Methods: Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium-fiber laser (NTO IRE-Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser-on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three-point Likert scale. Complications were assessed using the Clavien-Dindo classification system.

Results: A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94-357) mm3 . The median (interquartile range) total energy was 1 (0.4-2) kJ, and laser-on time 1.2 (0.5-2.7) min. The median (interquartile range) stone ablation speed was 140 (80-279) mm3 /min, energy for ablation of 1 mm3 was 5.6 (3-9.9) J/mm3 and energy consumption was 0.9 (0.6-1) J/min. A correlation was found between retropulsion and the energy used (r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6-2774.1; P = 0.028). No predictors for worse visibility were identified.

Conclusion: The SuperPulsed thulium-fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting.

Keywords: kidney stone disease; lithotripsy; thulium fiber laser; ureteral stones.

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