Introduction Ureteroscopy is the gold standard for most urinary tract calculi. Our institute recently incorporated a powerful 120w holmium laser machine integrating innovative technology (Lumenis® MOSES PulseTM120H Holmium:YAG laser, Lumenis Ltd. ). In this retrospective comparative study, we evaluated the influence of stone density on laser dusting time in a high power 120W laser machine vs. a standard 20W machine (Dornier Medilas® H20 Holmium: YAG laser, Dornier Ltd.) Methods We conducted a retrospective review of medical records of patients who underwent ureteroscopy during the years 2013-2018 for a solitary stone. Stone and clinical characteristics, among other parameters, have been evaluated, including the total laser time until complete stone dusting. Results Among 631 eligible patients, 462 were treated with a 20w standard laser and 169 patients with a p120w laser machine. Overall laser time was less than half with P120w laser vs. d20w (195 sec vs. 397.14 sec, p-value <0.001). Multivariate regression demonstrated 234.91 seconds shorter laser time with a p120w laser while controlling confounders as stone volume, hydronephrosis and location (p=value<0.0001). This pattern was demonstrated in all stone densities. The association between laser dusting time per stone volume and stone density demonstrated relatively constant laser time when using P120w laser, even for hard stones. When the standard 20w laser was used, laser time was longer in each stone density. Moreover, a stone density of 1164 Hounsfield units and above, demonstrated an upward shift of laser time to stone density curve in standard d20w laser group only. Conclusions Time to complete stone dusting using P120w laser is extremely shorter, approximately half, comparing to the standard 20W laser. This pattern is robust and even exponential when evaluating laser time per stone density, especially in hard stones. A new horizon of powerful, innovative laser technology will enable to improve endourology practice and patients' care.
Journal of endourology. 2019 May 14 [Epub ahead of print]
Matan Mekayten, Amitay Lorber, Ioannis Katafigiotis, Stavros Sfoungaristos, Ioannis Leotsakos, Eliyahu Meir Heifetz, Vladimir Yutkin, Ofer N Gofrit, Mordechai Duvdevani
Hadassah University Hospital, 58884 , Kiryat Hadassah , P.O.B. 12000 , Jerusalem, Israel , 9112001 ; ., Hadassah University Hospital, Urology, Jerusalem, Israel ; ., Laiko Geniko Nosokomeio, 58836, Urology , Agiou Thoma 17 , Athens, Attiki, Greece , 11527 ; ., Hadassah Medical Center, 58884, Urology Department , Jerusalem , Jerusalem, Israel , 91999., Hadassah Medical Center, 58884, Urology , Kiryat Hadassah , POB 12000 , Jerusalem, 91120 , Jerusalem, Israel , 91999 ; ., Jerusalem College of Technology, 42730, Yerushalayim, Israel ; ., Hadassah and Hebrew University Medical Center, Urology , POB 12000 , Ein Kerem Campus , Jerusalem, Israel , 91120 ; ., Hadassah Hebrew University Hospital, Urology , POBox 12000 , Ein Kerem , Jerusalem, Israel , 91120 ; ., Hadassah University Hospital in Jerusalem, Urology , Hadassah Hebrew University Hospital , Ein Kerem, Jerusalem , Jerusalem, Israel , 91120 ; .