(UroToday.com) The 2024 World Congress of Endourology and Uro-Technology Conference in Seoul, Korea, continued its Wednesday afternoon plenary session, with a discussion on optimizing stone treatment. Moderated by Dr. Michelle Jo Semins, the session brought together leading experts to discuss different laser modalities.
Dr. Semins kicked off the session by taking the audience on a historical journey, starting with the world's first ureteroscopy and laser lithotripsy. She recounted how, in 1912, Dr. Hugh Hampton Young accidentally passed a scope into a pediatric ureter, paving the way for what would become a revolutionary technique in stone treatment. She also highlighted the milestone achieved in 1993 when Dr. Denstedt performed the world’s first ureteroscopy and laser lithotripsy, a procedure that has since evolved with the advent of various lasers, significantly improving patient outcomes.
The first panelist, Dr. Khurshid Ghani, MBChB, MS, FRCS, Professor and Co-Director of the Endourology Fellowship at the University of Michigan, discussed the evolution of the holmium laser, particularly the holmium laser with pulse modulation. Dr. Ghani outlined the progression from short pulse to long pulse lasers, emphasizing how pulse modulation or multi-pulse technology has enhanced stone fragmentation with reduced retropulsion.
Dr. Ghani introduced the MOSES technology, developed by Lumenis in 2017, which has increased frequency capabilities from 80Hz to an impressive 120Hz. He explained that the MOSES distance mode is particularly effective for fragmentation at a 1mm distance from the laser fiber to the stone, enhancing both fragmentation and contact efficiency. For large kidney stones, Dr. Ghani recommended using high-frequency dusting settings with a ureteral access sheath and high-flow irrigation, specifying settings of 0.3J x 50-120Hz for rapid and efficient stone removal. He also recommended the settings of 0.5J and 50-80Hz for pop-dusting. Additionally, he noted that MOSES contact mode offers more precise fragmentation, particularly useful in the setting of impacted ureteral stones.
Thulium Fiber LaserNext, Dr. Wilson R. Molina, MD, Professor at the University of Kansas, took the stage to discuss the Thulium Fiber Laser (TFL). While acknowledging that holmium remains the gold standard, Dr. Molina highlighted the TFL’s potential advantages, including its smaller operating fibers (ranging from 50 to 150 micrometers in diameter), greater scope flexibility, and improved energy distribution.
Dr. Molina presented several case studies, showcasing the TFL’s efficacy in treating various types of stones. For instance, he demonstrated excellent dusting results with calcium oxalate renal stones and highlighted the TFL’s precision in managing ureteral stones and cystine stones. His usual settings are 0.3J and 30 – 60Hz, depending on the composition and location of the stone. Dr. Molina also shared impressive outcomes from laser tumor ablation procedures, where the TFL provided excellent hemostasis and en bloc removal of tumors in the kidney renal pelvis (2J and 10 Hz) and ureter (1J and 10Hz).
Thulium:YAG LaserDr. Ravindra Sabnis, MD, Professor at Muljibhai Patel Urological Hospital, rounded out the session by discussing the Thulium YAG laser. Traditionally the continuous pulse thulium laser was not recommended for stone breakage. However, he introduced the audience to a new pulsed Thulium:YAG laser, which has shown promising results in in vitro studies, particularly in fragmenting calcium oxalate monohydrate and uric acid stones. Dr. Sabnis shared preliminary human study data suggesting that this new laser could be a viable alternative to both the holmium and TFL lasers, although he cautioned that further studies are needed to validate these findings.
ConclusionThe session concluded with a recognition of the ongoing advancements in laser technology, which continue to revolutionize the field of stone treatment. As Dr. Semins and her esteemed panelists highlighted, the evolution of these technologies promises to offer even more effective, precise, and patient-friendly treatment options in the near future. The ongoing research and introduction of new laser systems, like the pulsed Thulium YAG, are sure to be closely watched by the global urology community.
Presented by:
Moderator: Michelle Jo Semins, MD. Clinical Assistant Professor and Director of the Kidney Stone Clinic. University of Pittsburgh Medical Center
Panelists:
- Ho:YAG with Pulse Modulation – Khurshid Ghani, MBChB, MS, FRCS. Professor and Co-Director Endourology Fellowship, University of Michigan
- Thulium Fiber Laser – Wilson R. Molina, MD. University of Kansas
- Thulium YAG – Ravindra Sabnis, MD. Chairman, Muljibhai Patel Urological Hospital
Written by: Bruce Gao, MD, FRCSC, Endourology Fellow, Department of Urology, University of California Irvine, @b_gao on Twitter during the 2024 World Congress of Endourology and Uro-Technology (WCET) Annual Meeting, August 12 -16, 2024, Seoul, South Korea