In vitro fragmentation performance of a novel, pulsed Thulium solid-state laser compared to a Thulium fibre laser and standard Ho:YAG laser

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Abstract

The aim of this work was to compare the fragmentation efficiency of a novel, pulsed Thulium solid-state laser (p-Tm:YAG) to that of a chopped Thulium fibre laser (TFL) and a pulsed Holmium solid-state laser (Ho:YAG). During the fragmentation process, we used a silicone mould to fixate the hemispherical stone models under water in a jar filled with room-temperature water. Each laser device registered the total energy applied to the stone model to determine fragmentation efficiency. Our study examined laser settings with single pulse energies ranging from 0.6 to 6 J and pulse frequencies ranging from 5 to 15 Hz. Similar laser settings were applied to explicitly compare the fragmentation efficiency of all three devices. We experimented with additional laser settings to see which of the three devices would perform best. The fragmentation performance of the three laser devices differed statistically significantly ( p < 0.05). The average total energy required to fragment the stone model was 345.96 J for Ho:YAG, 372.43 J for p-Tm:YAG and 483.90 J for TFL. To fragment the stone models, both Ho:YAG and p-Tm:YAG needed similar total energy ( p = 0.97). TFL’s fragmentation efficiency is significantly lower than that of Ho:YAG and p-Tm:YAG. Furthermore, we found the novel p-Tm:YAG’s fragmentation efficiency to closely resemble that of Ho:YAG. The fragmentation efficiency is thought to be influenced by the pulse duration. TFL’s shortest possible pulse duration was considerably longer than that of Ho:YAG and p-Tm:YAG, resulting in Ho:YAG and p-Tm:YAG exhibiting better fragmenting efficiency.

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Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000.

A. Hesse, E. Brändle, D Wilbert … (2003)

In 1979, we conducted a representative study to determine the prevalence and incidence of urolithiasis in Germany. Significant progress in stone therapy and changes in nutritional and environmental factors since then consequently led to a second study in 2001 under the same conditions as in 1979. A representative sample of 7500 persons from all over Germany was questioned on the occurrence of urinary stones during their lifetimes (prevalence) and on acute urolithiasis in 2000 (incidence). Additionally, data were collected on urinary stone therapy and metaphylaxis. The current data were then compared with those from 1979. Prevalence has risen from 4% to 4.7% from 1979 to 2001. 9.7% of the 50-64 year old males in 2000 had already had urinary stones (females: 5.9%). The current recurrence rate of urinary stones was estimated to be 42%. In the year 2000, the incidence of urolithiasis in Germany was found to be 1.47% (1979: 0.54%). Over 40% of the stones were passed spontaneously. There has been a marked increase in the prevalence and incidence of urolithiasis in Germany within the last 22 years. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors and a general apathy towards metabolic clarification and metaphylaxis.

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Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser

Olivier Traxer, Etienne Keller (2019)

Purpose To compare the operating modes of the Holmium:YAG laser and Thulium fiber laser. Additionally, currently available literature on Thulium fiber laser lithotripsy is reviewed. Materials and methods Medline, Scopus, Embase, and Web of Science databases were searched for articles relating to the operating modes of Holmium:YAG and Thulium fiber lasers, including systematic review of articles on Thulium fiber laser lithotripsy. Results The laser beam emerging from the Holmium:YAG laser involves fundamental architectural design constraints compared to the Thulium fiber laser. These differences translate into multiple potential advantages in favor of the Thulium fiber laser: four-fold higher absorption coefficient in water, smaller operating laser fibers (50–150 µm core diameter), lower energy per pulse (as low as 0.025 J), and higher maximal pulse repetition rate (up to 2000 Hz). Multiple comparative in vitro studies suggest a 1.5–4 times faster stone ablation rate in favor of the Thulium fiber laser. Conclusions The Thulium fiber laser overcomes the main limitations reported with the Holmium:YAG laser relating to lithotripsy, based on preliminary in vitro studies. This innovative laser technology seems particularly advantageous for ureteroscopy and may become an important milestone for kidney stone treatment. Electronic supplementary material The online version of this article (10.1007/s00345-019-02654-5) contains supplementary material, which is available to authorized users.

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Epidemiology of urolithiasis: an update.

A Trinchieri (2008)

Background & Aim. Changing socio-economic conditions generated changes in the prevalence, incidence and distribution for age, sex and type of urolithiasis in terms of both the site and the chemical-physical composition of the calculi.In the latter part of the 20(th) century the prevalence of upper urinary tract stones was increasing in Western countries whereas endemic infantile bladder stone disease was fairly widespread in huge areas of developing countries. The aim of this paper was to update previous epidemiological reports of urolithiasis by reviewing the more recent literature.Methods. Citations were extracted using PubMed database from January 2003 through December 2007 on the basis of the key words epidemiology AND urinary calculi. Results. An increase in the prevalence and incidence of urolithiasis was described in Germany whereas data from the United States were contradictory with stone disease rates increased only for women with a change of male-to-female ratio. Prevalence figures of stone disease observed in some developing country in tropical regions were similar to rates of Western countries with incidence of renal colic particularly high in warm months. African Americans had a reduced risk of stone disease compared to other racial groups but in renal stone patients all racial groups demonstrated a similarity in the incidence of underlying metabolic abnormalities. Upper urinary tract stones in children were associated more frequently with metabolic disturbances rather than with urinary tract anomalies and infection. Endemic childhood bladder stones are still present in some developing countries.Dietary risk factors for stone disease were shown different by age and sex. In particular in younger women dietary calcium, phytate and fluid intake were associated with a reduced risk of stone formation whereas animal protein and sucrose increased the risk of stone incidence. In older adults there was no association between dietary calcium and stone formation whereas magnesium, potassium and fluid intakes decreased and total vitamin C intake increased the risk of symptomatic nephrolithiasis. Animal protein was associated with risk only in men with a body mass index < 25 kg/m(2). Type 2 diabetes and several other coronary heart disease risk factors, including hypertension and obesity are associated with nephrolithiasis.

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Author and article information

Contributors

Arkadiusz Miernik:

ORCID: http://orcid.org/0000-0001-5894-9647

arkadiusz.miernik@uniklinik-freiburg.de

Journal

Journal ID (nlm-ta): Lasers Med Sci

Journal ID (iso-abbrev): Lasers Med Sci

Title: Lasers in Medical Science

Publisher: Springer London (London )

ISSN (Print): 0268-8921

ISSN (Electronic): 1435-604X

Publication date (Electronic): 14 December 2021

Publication date PMC-release: 14 December 2021

Publication date (Print): 2022

Volume: 37

Issue: 3

Pages: 2071-2078

Affiliations

GRID grid.5963.9, Department of Urology, Faculty of Medicine, , University of Freiburg—Medical Centre, ; Hugstetter Str. 55, 79106 Freiburg, Germany

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Arkadiusz Miernik http://orcid.org/0000-0001-5894-9647

Article

Publisher ID: 3495

DOI: 10.1007/s10103-021-03495-8

PMC ID: 8971152

PubMed ID: 34905141

SO-VID: 3ee85a8e-caa9-4f0d-ab2c-007b648108b7

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 22 April 2021

Date accepted : 8 December 2021

Funding

Funded by: Dornier MedTech Laser GmbH (DE)

Award ID: ZVK20200072801 (1040185101)

Funded by: Albert-Ludwigs-Universität Freiburg im Breisgau (1016)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

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ScienceOpen disciplines: Medical physics

Keywords: holmium laser,laser lithotripsy,pulsed thulium laser,thulium fibre laser,urinary stone,urolithiasis

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ScienceOpen disciplines: Medical physics

Keywords: holmium laser, laser lithotripsy, pulsed thulium laser, thulium fibre laser, urinary stone, urolithiasis

In vitro fragmentation performance of a novel, pulsed Thulium solid-state laser compared to a Thulium fibre laser and standard Ho:YAG laser

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Most cited references 24

Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000.

Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser

Epidemiology of urolithiasis: an update.

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