Skip to main content
SpringerLink
Log in

Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

A superpulse (500 W peak power) thulium fiber laser operating at a 1940 nm wavelength, suitable for lithotripsy, has recently been developed. The goal of this study was to compare stone fragmentation and dusting performance of the prototype superpulse thulium fiber laser with leading commercially available, high-power holmium:YAG lithotripters (wavelength 2100 nm) in a controlled in vitro environment.

Methods

Two experimental setups were designed for investigating stone ablation rates and retropulsion effects, respectively. In addition, the ablation setup enabled water temperature measurements during stone fragmentation in the laser–stone interaction zone. Human uric acid (UA) and calcium oxalate monohydrate (COM) stones were used for ablation experiments, whereas standard BegoStone phantoms were utilized in retropulsion experiments. The laser settings were matched in terms of pulse energy, pulse repetition rate, and average power.

Results

At equivalent settings, thulium fiber laser ablation rates were higher than those for holmium:YAG laser in both dusting mode (threefold for COM stones and 2.5-fold for UA stones) and fragmentation mode (twofold for UA stones). For single-pulse retropulsion experiments, the threshold for onset of stone retropulsion was two to four times higher for thulium fiber laser. The holmium:YAG laser generated significantly stronger retropulsion effects at equal pulse energies. The water temperature elevation near the laser-illuminated volume did not differ between the two lasers.

Conclusions

Distinctive features of the thulium fiber laser (optimal wavelength and long pulse duration) resulted in faster stone ablation and lower retropulsion in comparison to the holmium:YAG laser.

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

Similar content being viewed by others

References

  1. Giusti G, Proietti S, Villa L et al (2016) Current standard technique for modern flexible ureteroscopy: tips and tricks. Eur Urol 70:188–194

    Article  Google Scholar 

  2. Bell JR, James P, Rane A et al (2016) International Holmium laser lithotripsy settings: an international survey of endourologists. J Am Coll Surg 223:e123

    Article  Google Scholar 

  3. Aldoukhi AH, Roberts WW, Hall TL et al (2017) Holmium laser lithotripsy in the new stone age: dust or bust? Front Surg 4:57. https://doi.org/10.3389/fsurg.2017.00057

    Article  PubMed  PubMed Central  Google Scholar 

  4. Teichman JM, Vassar GJ, Bishoff JT et al (1998) Holmium: YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol 159:17–23

    Article  CAS  Google Scholar 

  5. Larizgoitia I, Pons JM (1999) A systematic review of the clinical efficacy and effectiveness of the holmium: YAG laser in urology. BJU Int 84:1–9

    Article  CAS  Google Scholar 

  6. Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium: YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167:1972–1976

    Article  Google Scholar 

  7. Sea J, Jonat LM, Chew BH et al (2012) Optimal power settings for Holmium:YAG lithotripsy. J Urol 187:914–919

    Article  Google Scholar 

  8. Patel AP, Knudsen BE (2014) Optimizing use of the holmium: YAG laser for surgical management of urinary lithiasis. Curr Urol Rep 15(4):397. https://doi.org/10.1007/s11934-014-0397-2

    Article  PubMed  Google Scholar 

  9. Elhilali MM, Badaan S, Ibrahim A et al (2017) Use of the moses technology to improve holmium laser lithotripsy outcomes: a preclinical study. J Endourol 31:598–604

    Article  Google Scholar 

  10. Yaroslavsky I, Vinnichenko V, McNeill T et al (2018) Optimization of a novel TFL lithotripter in terms of stone ablation efficiency and retropulsion reduction. Therapeutics and diagnostics in urology 2018. International society for optics and photonics 10468:104680H

  11. Zamyatina V, Gapontsev V, Enikeev D et al (2016) Super pulse thulium fiber laser for lithotripsy. Lasers Surg Med 48:10 (Abstract)

    Google Scholar 

  12. Jackson SD, Lauto A (2002) Diode-pumped fibre lasers: a new clinical tool? Lasers Surg Med 30:184–190

    Article  Google Scholar 

  13. Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15:563–573

    Article  Google Scholar 

  14. Blackmon RL, Irby PB, Fried NM (2011) Comparison of Holmium:YAG and Thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. J Biomed Opt 16:071403

    Article  Google Scholar 

  15. Ergakov D, Martov A, Guseynov M (2018) The comparative clinical study of Ho:YAG and superpulse TFL lithotripters. Europ Urol Suppl 17:e1391 (Abstract)

    Article  Google Scholar 

  16. Martov A, Ergakov D, Guseinov M et al (2018) Initial experience in clinical application of thulium laser contact lithotripsy for transurethral treatment of urolithiasis. Urologiia Mar 1:112–120

    Article  Google Scholar 

  17. Traxer O, Rapoport L, Tsarichenko D et al (2018) First clinical study on superpulse thulium fiber laser lithotripsy. J Urol 199:e321 (Abstract)

    Article  Google Scholar 

  18. Hale GM, Querry MR (1973) Optical constants of water in the 200-nm to 200-μm wavelength region. Appl Opt 12:555–563

    Article  CAS  Google Scholar 

  19. Hardy LA, Irby PB, Fried NM (2018) Scanning electron microscopy of real and artificial kidney stones before and after thulium fiber laser ablation in air and water. Therapeutics and diagnostics in urology. Int Soc Opt Photon 10468:104680G

    Google Scholar 

  20. Kronenberg P, Traxer O (2014) In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy - a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters. BJU Int 114:261–267

    Article  Google Scholar 

  21. Vassar GJ, Teichman JM, Glickman RD (1998) Holmium:YAG lithotripsy efficiency varies with energy density. J. Urol 160:471–476

    Article  CAS  Google Scholar 

  22. Wezel F, Hacker A, Gross AJ et al (2010) Effect of pulse energy, frequency, and length on holmium:yttrium–aluminum–garnet laser fragmentation efficiency in non-floating artificial urinary calculi. J Endourol 24:1135–1140

    Article  Google Scholar 

  23. Pasqui F, Dubosq F, Tchala K et al (2004) Impact on active scope deflection and irrigation flow of all endoscopic working tools during flexible ureteroscopy. Eur Urol 45:58–64

    Article  Google Scholar 

  24. Li R, Ruckle D, Keheila M et al (2017) High-frequency dusting versus conventional holmium laser lithotripsy for intrarenal and ureteral calculi. J Endourol 31:272–277

    Article  Google Scholar 

  25. 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. https://doi.org/10.1002/lsm.23057

  26. Greif R (1988) Natural circulation loops. J Heat Transf 110:1243–1258

    Article  Google Scholar 

  27. Lee HO, Ryan RT, Teichman JM et al (2003) Stone retropulsion during holmium: YAG lithotripsy. J Urol 169:881–885

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. NTO “IRE-POLUS”, One Vvedenskogo Sq, Fryazino, Moscow Region, 141120, Russia

    Viktoria Andreeva & Anastasia Kovalenko

  2. Institute for Urology and Reproductive Health, Sechenov University, 19 Bolshaya Pirogovskaya Ul, Moscow, 119146, Russia

    Andrey Vinarov, Leonid Rapoport, Dmitry Enikeev, Nikolay Sorokin, Alim Dymov, Dmitry Tsarichenko & Petr Glybochko

  3. IPG Medical, 377 Simarano Dr, Marlborough, MA, 01752, USA

    Ilya Yaroslavsky, Alexander Vybornov & Gregory Altshuler

  4. Department of Physics and Optical Science, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA

    Nathaniel Fried

  5. University Pierre et Marie Curie Paris VI, 4 Place Jussieu, 75005, Paris, France

    Olivier Traxer

  6. IPG Photonics, 50 Old Webster Rd, Oxford, MA, 01540, USA

    Valentin Gapontsev

Authors
  1. Viktoria Andreeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrey Vinarov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilya Yaroslavsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anastasia Kovalenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexander Vybornov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonid Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dmitry Enikeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nikolay Sorokin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alim Dymov
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dmitry Tsarichenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Petr Glybochko
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nathaniel Fried
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Olivier Traxer
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Gregory Altshuler
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Valentin Gapontsev
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VA: project development, data collection and management. AV: data collection, manuscript editing. IY: project development, data analysis, manuscript writing. AK: project development, data collection and management. AV: data analysis, manuscript editing. LR: data analysis, manuscript editing. DE: project development, data analysis, manuscript editing. NS: data analysis. AD: data analysis, manuscript editing. DT: data analysis. PG: data analysis. OT: data analysis, manuscript editing. NF: data analysis, manuscript writing and editing. GA: project development, data analysis, manuscript editing. VG: data analysis, manuscript editing.

Corresponding author

Correspondence to Ilya Yaroslavsky.

Ethics declarations

Conflict of interest

V Andreeva: employee of NTO “IRE-Polus”; A. Vinarov: no competing interests exist; I. Yaroslavsky: employee, stockholder of IPG Medical; A. Kovalenko: employee of NTO “IRE-Polus”; A. Vybornov: employee, stockholder of IPG Medical; L. Rapoport: no competing interests exist; D. Enikeev: no competing interests exist; N. Sorokin: no competing interests exist; A. Dymov: no competing interests exist; D. Tsarichenko: no competing interests exist; P. Glybochko: no competing interests exist; O. Traxer: consultant to IPG Medical; N. Fried: consultant to IPG Medical; G. Altshuler: employee, stockholder of IPG Medical; V. Gapontsev: founder, employee, stockholder of IPG Photonics.

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

Andreeva, V., Vinarov, A., Yaroslavsky, I. et al. Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 38, 497–503 (2020). https://doi.org/10.1007/s00345-019-02785-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02785-9

Keywords

Search

Navigation