The novel pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser was recently introduced. Current studies present promising p-Tm:YAG ablation efficiency, although all are based on non-human stone models or with unknown stone composition.
The present study aimed to evaluate p-Tm:YAG ablation efficiency for stone dust from human urinary stones of known compositions.
Calcium oxalate monohydrate (COM) and uric acid (UA) stones were subjected to lithotripsy in vitro using a p-Tm:YAG laser generator (Thulio®, Dornier MedTech GmbH, Germany). 200 J was applied at 0.1 J × 100 Hz, 0.4 J × 25 Hz or 2.0 J × 5 Hz (average 10W). Ablated stone dust mass was calculated from weight difference between pre-lithotripsy stone and post-lithotripsy fragments > 250 µm. Estimated ablated volume was calculated using prior known stone densities (COM: 2.04 mg/mm3, UA: 1.55 mg/mm3).
Mean ablation mass efficiency was 0.04, 0.06, 0.07 mg/J (COM) and 0.04, 0.05, 0.06 mg/J (UA) for each laser setting, respectively. This translated to 0.021, 0.029, 0.034 mm3/J (COM) and 0.026, 0.030, 0.039 mm3/J (UA). Mean energy consumption was 26, 18, 17 J/mg (COM) and 32, 23, 17 J/mg (UA). This translated to 53, 37, 34 J/mm3 (COM) and 50, 36, 26 J/mm3 (UA). There were no statistically significant differences for laser settings or stone types (all p > 0.05).
To our knowledge, this is the first study showing ablation efficiency of the p-Tm:YAG laser for stone dust from human urinary stones of known compositions. The p-Tm:YAG seems to ablate COM and UA equally well, with no statistically significant differences between differing laser settings.
World journal of urology. 2023 Oct 13 [Epub ahead of print]
Jia-Lun Kwok, Eugenio Ventimiglia, Vincent De Coninck, Frédéric Panthier, Yazeed Barghouthy, Alexandre Danilovic, Anil Shrestha, Niamh Smyth, Florian Alexander Schmid, Manuela Hunziker, Cédric Poyet, Michel Daudon, Olivier Traxer, Daniel Eberli, Etienne Xavier Keller
Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France., Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France., Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37831156