World Journal of Urology

, Volume 35, Issue 2, pp 313–318 | Cite as

Comparison of laser fiber passage in ureteroscopic maximum deflection and their influence on deflection and irrigation: Do we really need the ball tip concept?

  • Mohammed Baghdadi
  • Esteban EmilianiEmail author
  • Michele Talso
  • Pol Servián
  • Aaron Barreiro
  • Andrea Orosa
  • Silvia Proietti
  • Olivier Traxer
Original Article



To examine laser fiber passage capabilities through flexible ureterorenoscopes (fURSs) and to measure deflections and flow characteristics.


For this in vitro study, eight fURSs were examined (Olympus® URF-P6, URF-P6, URF-V, URF-V2; Storz® Xc and Flex-X2; Richard Wolf® Cobra Vision; and Lithovue). Four laser fibers standard 200- and 273-μm (uncleaved and cleaved), sheath-coated and ball-tip fibers were attempted to pass through each fURS while deflected at 120°, 180°, maximum deflection, and maximum deflection with reduced 9-mm radius. Measurements included maximal (up/down) deflections and irrigation flow rates achieved with each fiber.


Wolf Cobra Vision demonstrated minimal loss of deflections with mean differences of −2°/0° (p > 0.05) when loaded with the 200-μm fiber. The 273-μm fiber provoked utmost deflections that decline when loaded in Olympus URF-P5: mean differences of −52°/−35° (p < 0.001 for upward deflection). Of overall deflections, sheath-coated fiber induced least insult (p > 0.05), while standard 273-μm fiber incited maximum degradation (p < 0.00001). With few exceptions, sheath-coated and ball-tip fibers passed through all maximally deflected scopes. Uncleaved 200- and 273-μm fibers failed to pass through most maximally deflected fURS. However, cleaving their ends allowed 200- and 273-μm fiber to pass through all angles of deflections expect in the Olympus URF-P5 and Olympus URF-P5 and URF-V, respectively. The irrigation through all fURSs was significantly impaired (p < 0.00001).


fURS deflection was least affected by sheath-coated fibers and most affected by the 273-μm fiber. Uncleaved 200- and 273-μm fibers showed least passage capabilities; while removing the ends, the fibers greatly facilitated their passage capabilities as much as the other fibers tested.


Lasers Ureteroscopy Holmium laser Lithotripsy Laser fiber 



EUSP clinical fellowship program for supporting Dr. Esteban Emiliani.

Author contributions

M Baghdadi and P. Serviàn contributed to protocol/project development, data collection and management, and data analysis; E. Emiliani and O. Traxer were involved in protocol/project development, data collection and management, data analysis, and manuscript writing and editing; M. Talso participated in protocol/project development, data collection and management, data analysis, and manuscript editing; A. Barreiro was involved in protocol/project development and data collection and management; A. Orosa contributed to data collection and management and data analysis; S. Proietti was involved in protocol development.

Compliance with ethical standards

Conflict of interest

Professor Traxer is a consultant for the following companies: Coloplast, Rocamed, Olympus, Boston Scientific, Lumenis, BioHealth. No financing has been received to perform this study.

Ethical standard

The material in the manuscript has been acquired according to modern ethical standards and has been approved by the legally appropriate ethical committees.


  1. 1.
    Turk C, Knoll T, Petrik A et al (2015) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482. doi: 10.1016/j.eururo.2015.07.041 CrossRefPubMedGoogle Scholar
  2. 2.
    Aboumarzouk OM, Monga M, Kata SG et al (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26:1257–1263. doi: 10.1089/end.2012.0217 CrossRefPubMedGoogle Scholar
  3. 3.
    Al-Qahtani SM, Gil-deiz-de-Medina S, Traxer O (2012) Predictors of clinical outcomes of flexible ureterorenoscopy with Holmium laser for renal stone greater than 2 cm. Adv Urol 2012:543537. doi: 10.1155/2012/543537 CrossRefPubMedGoogle Scholar
  4. 4.
    Breda A, Ogunyemi O, Leppert JT et al (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater-is this the new frontier? J Urol 179:981–984. doi: 10.1016/j.juro.2007.10.083 CrossRefPubMedGoogle Scholar
  5. 5.
    Turney BW, Reynard JM, Noble JG et al (2012) Trends in urological stone disease. BJUI 109:1082–1087. doi: 10.1111/j.1464-410X.2011.10495.x CrossRefGoogle Scholar
  6. 6.
    Wiesenthal JD, Ghiculete D, DA Honey RJ et al (2011) A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? J Endourol 25:481–485. doi: 10.1089/end.2010.0208 CrossRefPubMedGoogle Scholar
  7. 7.
    Papatsoris AG, Kachrilas S, El Howairis M et al (2011) Novel technologies in flexible ureterorenoscopy. AJU 12:41–46. doi: 10.1016/j.aju.2011.03.011 Google Scholar
  8. 8.
    Sooriakumaran P, Kaba R, Andrews HO et al (2005) Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation. Asian J Androl 7:433–438CrossRefPubMedGoogle Scholar
  9. 9.
    Wright AE, Williams K, Rukin NJ (2015) What effect do different 200 μm laser fibres have on deflection and irrigation flow rates in a flexible ureterorenoscope? Lasers Med Sci 30:1565–1568. doi: 10.1007/s10103-015-1766-x CrossRefPubMedGoogle Scholar
  10. 10.
    Kronenberg P, Traxer O (2014) The truth about laser fiber diameters. Urology 84:1301–1307. doi: 10.1016/j.urology.2014.08.017 CrossRefPubMedGoogle Scholar
  11. 11.
    Traxer O (2008) Flexible ureterorenoscopic management of lower-pole stone: Does the scope make the difference? J Endourol 22:1847–1850. doi: 10.1089/end.2008.9792 CrossRefPubMedGoogle Scholar
  12. 12.
    Clayman RV (2003) Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence of different lithotripsy probes and stone extraction tools on scope reflection and irrigation flow. J Urol 170:686–687CrossRefGoogle Scholar
  13. 13.
    Shin RH, Lautz JM, Cabrera FJ et al (2015) Evaluation of novel ball-tip holmium laser fiber: impact on ureteroscope performance and fragmentation efficiency. J Endourol 30:189–194. doi: 10.1089/end.2015.0300 CrossRefPubMedGoogle Scholar
  14. 14.
    Kronenberg P, Traxer O (2015) Lithotripsy performance of specially designed laser fiber tips. J Urol. doi: 10.1016/j.juro.2015.10.135 Google Scholar
  15. 15.
    Khemees TA, Shore DM, Antiporda M, Teichman JM, Knudsen BE (2013) Evaluation of a new 240-μm single-use holmium:YAG optical fiber for flexible ureteroscopy. J Endourol 27:475–479. doi: 10.1089/end.2012.0513 CrossRefPubMedGoogle Scholar
  16. 16.
    Knudsen B, De S, Monga M (2014) Abstract pd37-05 Ball tipped holmium:YAG optical fiber: pulse energy settings increase degradation during clinical use. J Urol 191:947CrossRefGoogle Scholar
  17. 17.
    Kronenberg P, Traxer O (2015) Are we all doing it wrong? Influence of stripping and cleaving methods of laser fibers on laser lithotripsy performance. J Urol 193:10301035. doi: 10.1016/j.juro.2014.07.110 CrossRefGoogle Scholar
  18. 18.
  19. 19.
    Lusch A, Abdelshehid C, Liss MA et al (2013) In vitro evaluation of ScopeSafe fibers and the scope guardian sheath in prevention of ureteroscope endolumenal working damage. J Endourol 27:768–773. doi: 10.1089/end.2012.0487 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Mohammed Baghdadi
    • 1
  • Esteban Emiliani
    • 1
    Email author
  • Michele Talso
    • 1
  • Pol Servián
    • 1
  • Aaron Barreiro
    • 1
  • Andrea Orosa
    • 1
  • Silvia Proietti
    • 1
  • Olivier Traxer
    • 1
  1. 1.Tenon HospitalParisFrance

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