Experts' recommendations in laser use for the treatment of urolithiasis: 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

doi:10.1007/s00345-023-04726-z

. 2024 Jan 13;42(1):33.

doi: 10.1007/s00345-023-04726-z.

Experts' recommendations in laser use for the treatment of urolithiasis: 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

Gernot Ortner^{1

2}, Bhaskar Kumar Somani³, Selcuk Güven⁴, Gerhard Kitzbichler⁵, Olivier Traxer⁶, Guido Giusti⁷, Silvia Proietti⁷, Evangelos Liatsikos⁸, Panagiotis Kallidonis⁸, Amy Krambeck⁹, Ioannis Kartalas Goumas¹⁰, Mordechai Duvdevani¹¹, Guido M Kamphuis¹², Stefania Ferretti¹³, Laurian Dragos¹⁴, Khurshid Ghani¹⁵, Arkadiusz Miernik¹⁶, Patrick Juliebø-Jones¹⁷, Helene Jung¹⁸, Thomas Tailly¹⁹, Amelia Pietropaolo³, Saeed Bin Hamri²⁰, Athanasios Papatsoris²¹, Kemal Sarica²², Cesare Marco Scoffone²³, Cecilia Maria Cracco²³, Etienne Xavier Keller²⁴, Otas Durutovic²⁵, Sergio Pereira²⁶, Thomas R W Herrmann^{27

28}, Udo Nagele^{5

27}, Ali Serdar Gözen²⁹, Theodoros Tokas^{27

30}

Affiliations

¹ Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria. gerni_o@hotmail.com.
² Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. gerni_o@hotmail.com.
³ Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England.
⁴ Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
⁵ Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
⁶ Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France.
⁷ Department of Urology, San Raffaele Hospital, Milan, Italy.
⁸ Department of Urology, University of Patras, Patras, Greece.
⁹ Northwestern Medicine, Chicago, IL, USA.
¹⁰ Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy.
¹¹ Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel.
¹² Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Urology, Hospital, University of Modena, Modena, Italy.
¹⁴ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Department of Urology, University of Michigan, Ann Arbor, USA.
¹⁶ Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁷ Department of Urology, Haukeland University Hospital, Bergen, Norway.
¹⁸ Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark.
¹⁹ Department of Urology, University Hospital Ghent, Ghent, Belgium.
²⁰ Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia.
²¹ 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey.
²³ Department of Urology, Cottolengo Hospital, Turin, Italy.
²⁴ Department of Urology, University Hospital Zürich, Zurich, Switzerland.
²⁵ Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia.
²⁶ Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal.
²⁷ Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
²⁸ Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
²⁹ Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany.
³⁰ Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.

PMID: 38217743
DOI: 10.1007/s00345-023-04726-z

Experts' recommendations in laser use for the treatment of urolithiasis: 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

Gernot Ortner et al. World J Urol. 2024.

. 2024 Jan 13;42(1):33.

doi: 10.1007/s00345-023-04726-z.

Authors

Affiliations

¹ Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria. gerni_o@hotmail.com.
² Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. gerni_o@hotmail.com.
³ Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England.
⁴ Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
⁵ Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
⁶ Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France.
⁷ Department of Urology, San Raffaele Hospital, Milan, Italy.
⁸ Department of Urology, University of Patras, Patras, Greece.
⁹ Northwestern Medicine, Chicago, IL, USA.
¹⁰ Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy.
¹¹ Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel.
¹² Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Urology, Hospital, University of Modena, Modena, Italy.
¹⁴ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Department of Urology, University of Michigan, Ann Arbor, USA.
¹⁶ Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁷ Department of Urology, Haukeland University Hospital, Bergen, Norway.
¹⁸ Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark.
¹⁹ Department of Urology, University Hospital Ghent, Ghent, Belgium.
²⁰ Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia.
²¹ 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey.
²³ Department of Urology, Cottolengo Hospital, Turin, Italy.
²⁴ Department of Urology, University Hospital Zürich, Zurich, Switzerland.
²⁵ Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia.
²⁶ Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal.
²⁷ Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
²⁸ Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland.
²⁹ Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany.
³⁰ Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.

PMID: 38217743
DOI: 10.1007/s00345-023-04726-z

Abstract

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.

Keywords: Laser; Lithiasis; Settings; Stone; Survey.

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References

1. Emiliani E, Kanashiro A, Angerri O (2023) Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 33(4):302–307. https://doi.org/10.1097/mou.0000000000001092 - DOI - PubMed
1. Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15(9):563–573. https://doi.org/10.1038/s41585-018-0035-8 - DOI - PubMed
1. Ryan JR, Nguyen MH, Linscott JA, Nowicki SW, James E, Jumper BM et al (2022) Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings. World J Urol 40(8):2077–2082. https://doi.org/10.1007/s00345-022-04037-9 - DOI - PubMed - PMC
1. Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C (2022) Thulium fibre laser versus holmium:YAG for ureteroscopic lithotripsy: outcomes from a prospective randomised clinical trial. Eur Urol 82(1):73–79. https://doi.org/10.1016/j.eururo.2022.02.027 - DOI - PubMed
1. Sierra A, Corrales M, Somani B, Traxer O (2022) Laser efficiency and laser safety: holmium YAG vs thulium fiber laser. J Clin Med. https://doi.org/10.3390/jcm12010149 - DOI - PubMed - PMC

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[1] Emiliani E, Kanashiro A, Angerri O (2023) Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 33(4):302–307. https://doi.org/10.1097/mou.0000000000001092 - DOI - PubMed

[2] Emiliani E, Kanashiro A, Angerri O (2023) Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 33(4):302–307. https://doi.org/10.1097/mou.0000000000001092 - DOI - PubMed

[3] Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15(9):563–573. https://doi.org/10.1038/s41585-018-0035-8 - DOI - PubMed

[4] Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15(9):563–573. https://doi.org/10.1038/s41585-018-0035-8 - DOI - PubMed

[5] Ryan JR, Nguyen MH, Linscott JA, Nowicki SW, James E, Jumper BM et al (2022) Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings. World J Urol 40(8):2077–2082. https://doi.org/10.1007/s00345-022-04037-9 - DOI - PubMed - PMC

[6] Ryan JR, Nguyen MH, Linscott JA, Nowicki SW, James E, Jumper BM et al (2022) Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings. World J Urol 40(8):2077–2082. https://doi.org/10.1007/s00345-022-04037-9 - DOI - PubMed - PMC

[7] Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C (2022) Thulium fibre laser versus holmium:YAG for ureteroscopic lithotripsy: outcomes from a prospective randomised clinical trial. Eur Urol 82(1):73–79. https://doi.org/10.1016/j.eururo.2022.02.027 - DOI - PubMed

[8] Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C (2022) Thulium fibre laser versus holmium:YAG for ureteroscopic lithotripsy: outcomes from a prospective randomised clinical trial. Eur Urol 82(1):73–79. https://doi.org/10.1016/j.eururo.2022.02.027 - DOI - PubMed

[9] Sierra A, Corrales M, Somani B, Traxer O (2022) Laser efficiency and laser safety: holmium YAG vs thulium fiber laser. J Clin Med. https://doi.org/10.3390/jcm12010149 - DOI - PubMed - PMC

[10] Sierra A, Corrales M, Somani B, Traxer O (2022) Laser efficiency and laser safety: holmium YAG vs thulium fiber laser. J Clin Med. https://doi.org/10.3390/jcm12010149 - DOI - PubMed - PMC

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Experts' recommendations in laser use for the treatment of urolithiasis: 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

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Experts' recommendations in laser use for the treatment of urolithiasis: 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

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