Skip to main content
SpringerLink
Log in

Thulium fiber laser: ready to dust all urinary stone composition types?

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether stone dust can be obtained from all prevailing stone composition types using the thulium fiber laser (TFL) for lithotripsy. Where applicable, stone dust was further characterized by morpho-constitutional analysis.

Methods

Human urinary stones were submitted to in vitro lithotripsy using a FiberLase U2 TFL generator with 150 µm silica core fibers (IPG Photonics®, IPG Medical™, Marlborough, MA, USA). Laser settings were 0.05 J, 320 Hz and 200 μs. A total of 2400 J were delivered to each stone composition type. All evaluated stones had a > 90% degree of purity (calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite and cystine). Spontaneously floating stone particles were considered as stone dust and collected for analysis by scanning electron microscopy and Fourier transform infrared spectroscopy.

Results

Stone dust could be retrieved from all evaluated urinary stones after TFL lithotripsy. Most stone dust samples revealed changes in crystalline organization, except for calcium oxalate monohydrate and carbapatite, which conserved their initial characteristics. Mean maximal width of stone dust particles did not exceed 254 µm.

Conclusions

The TFL is capable to produce stone dust from all prevailing stone types. Morpho-constitutional changes found in stone dust suggest a photothermal interaction of laser energy with the stone matrix during TFL lithotripsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P (2000) Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs 2000. Eur Urol 44(6):709–713. https://doi.org/10.1016/s0302-2838(03)00415-9

    Article  Google Scholar 

  2. Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12(2–3):e86–96

    PubMed  PubMed Central  Google Scholar 

  3. Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3(1):18–26. https://doi.org/10.1016/j.euf.2017.04.001

    Article  PubMed  Google Scholar 

  4. Geraghty RM, Jones P, Somani BK (2017) Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol 31(6):547–556. https://doi.org/10.1089/end.2016.0895

    Article  PubMed  Google Scholar 

  5. Doizi S, Keller EX, De Coninck V, Traxer O (2018) Dusting technique for lithotripsy: what does it mean? Nat Rev Urol. https://doi.org/10.1038/s41585-018-0042-9

    Article  PubMed  Google Scholar 

  6. Wenzel M, Bultitude M, Salem J (2019) Dusting, fragmenting, popcorning or dustmenting? Curr Opin Urol 29(2):108–112. https://doi.org/10.1097/MOU.0000000000000580

    Article  PubMed  Google Scholar 

  7. Dauw CA, Simeon L, Alruwaily AF, Sanguedolce F, Hollingsworth JM, Roberts WW, Faerber GJ, Wolf JS Jr, Ghani KR (2015) Contemporary practice patterns of flexible ureteroscopy for treating renal stones: results of a worldwide survey. J Endourol 29(11):1221–1230. https://doi.org/10.1089/end.2015.0260

    Article  PubMed  Google Scholar 

  8. Weiss B, Shah O (2016) Evaluation of dusting versus basketing—can new technologies improve stone-free rates? Nat Rev Urol 13(12):726–733. https://doi.org/10.1038/nrurol.2016.172

    Article  CAS  PubMed  Google Scholar 

  9. Traxer O, Keller EX (2019) Thulium fiber laser the new player for kidney stone treatment? A comparison with Holmium: YAG laser. World J Urol. https://doi.org/10.1007/s00345-019-02654-5

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser—a systematic review. Transl Androl Urol 8(S4):S398–S417. https://doi.org/10.21037/tau.2019.08.01

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fried NM (2018) Recent advances in infrared laser lithotripsy. Biomed Opt Express. https://doi.org/10.1364/boe.9.004552

    Article  PubMed  PubMed Central  Google Scholar 

  12. Keller EX, de Coninck V, Audouin M, Doizi S, Bazin D, Daudon M, Traxer O (2019) Fragments and dust after Holmium laser lithotripsy with or without "Moses technology": how are they different? J Biophotonics 12(4):e201800227. https://doi.org/10.1002/jbio.201800227

    Article  CAS  PubMed  Google Scholar 

  13. Lee JW, Park MG, Cho SY (2018) How to perform the dusting technique for calcium oxalate stone phantoms during Ho: YAG laser lithotripsy. BMC Urol 18(1):103. https://doi.org/10.1186/s12894-018-0417-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Spore SS, Teichman JM, Corbin NS, Champion PC, Williamson EA, Glickman RD (1999) Holmium: YAG lithotripsy: optimal power settings. J Endourol 13(8):559–566. https://doi.org/10.1089/end.1999.13.559

    Article  CAS  PubMed  Google Scholar 

  15. Chan KF, Pfefer TJ, Teichman JM, Welch AJ (2001) A perspective on laser lithotripsy: the fragmentation processes. J Endourol 15(3):257–273. https://doi.org/10.1089/089277901750161737

    Article  CAS  PubMed  Google Scholar 

  16. Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ, Welch AJ (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol 13(3):181–190. https://doi.org/10.1089/end.1999.13.181

    Article  CAS  PubMed  Google Scholar 

  17. Ray ER, Rumsby G, Smith RD (2016) Biochemical composition of urolithiasis from stone dust—a matched-pair analysis. BJU Int 118(4):618–624. https://doi.org/10.1111/bju.13448

    Article  PubMed  Google Scholar 

  18. Daudon M, Dessombz A, Frochot V, Letavernier E, Haymann J-P, Jungers P, Bazin D (2016) Comprehensive morpho-constitutional analysis of urinary stones improves etiological diagnosis and therapeutic strategy of nephrolithiasis. C R Chim 19(11–12):1470–1491. https://doi.org/10.1016/j.crci.2016.05.008

    Article  CAS  Google Scholar 

  19. Daudon M, Jungers P (2012) Stone composition and morphology: a window on etiology. In: Talati JJTH, Albala DM, Ye Z (eds) Urolithiasis: basic science and clinical practice. Springer, London, pp 113–140. https://doi.org/10.1007/978-1-4471-4387-1_15

    Chapter  Google Scholar 

  20. Hardy LA, Vinnichenko V, Fried NM (2019) High power holmium: YAG versus thulium fiber laser treatment of kidney stones in dusting mode: ablation rate and fragment size studies. Lasers Surg Med 51(6):522–530. https://doi.org/10.1002/lsm.23057

    Article  PubMed  Google Scholar 

  21. Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O (2020) What is the exact definition of stone dust? An in vitro evaluation. World J Urol. https://doi.org/10.1007/s00345-020-03178-z

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank Prof. Dominique Bazin, PhD, Research Director at the French National Centre for Scientific Research (CNRS) in Orsay, France, for scanning electron microscopy assistance.

Funding

None.

Author information

Author notes

  1. Etienne Xavier Keller and Vincent De Coninck contributed equally.

Authors and Affiliations

  1. Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France

    Etienne Xavier Keller, Vincent De Coninck, Steeve Doizi & Olivier Traxer

  2. GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France

    Etienne Xavier Keller, Vincent De Coninck, Steeve Doizi & Olivier Traxer

  3. Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France

    Michel Daudon

  4. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Etienne Xavier Keller

  5. Department of Urology, AZ Klina, Brasschaat, Belgium

    Vincent De Coninck

Authors
  1. Etienne Xavier Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincent De Coninck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steeve Doizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michel Daudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivier Traxer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EXK: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. VDC: protocol/project development, data analysis and manuscript writing/editing. SD: data analysis and manuscript writing/editing. MD: protocol/project development, data collection or management, data analysis and manuscript writing/editing. OT: protocol/project development, data analysis and manuscript writing/editing.

Corresponding author

Correspondence to Olivier Traxer.

Ethics declarations

Conflict of interest

Dr. Etienne Xavier Keller is a consultant for Olympus, Debiopharm and Recordati. Dr. Vincent De Coninck is a consultant for Boston Scientific, BD Bard and Coloplast. Dr. Steeve Doizi is a consultant for Coloplast and Boston Scientific. Prof. Michel Daudon, PhD, is a consultant for Advicenne. Prof. Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific and IPG Medical.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keller, E.X., De Coninck, V., Doizi, S. et al. Thulium fiber laser: ready to dust all urinary stone composition types?. World J Urol 39, 1693–1698 (2021). https://doi.org/10.1007/s00345-020-03217-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03217-9

Keywords

Search

Navigation