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Optimal parameter settings of thulium fiber laser for ureteral stone lithotripsy: a comparative study in two different testing environments

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Abstract

This study aims to identify optimal parameters for using Thulium fiber lasers (TFL) in ureteral stone lithotripsy to ensure laser safety and maximize efficacy. Our goal is to improve the outcomes of single-use semi-rigid ureteroscopy for treating stones located in the proximal ureter. A clinically relevant thermal testing device was designed to investigate heating effects during TFL stone fragmentation. The device was utilized to identify safe power thresholds for TFL at various irrigation rates. Three other devices were used to assess varying pulse energy effects on stone fragmentation efficiency, dusting, retropulsion, and depth of tissue vaporization. Comparative experiments in fresh porcine renal units were performed to validate the efficacy and safety of optimal TFL parameters for semi-rigid ureteroscopy in proximal ureteral stone procedures. Our study found that the improved device generated a higher thermal effect. Furthermore, the safe power threshold for laser lithotripsy increased as the irrigation rate was raised. At an irrigation rate of 40 ml/min, it is safe to use an average power of less than 30 watts. Although increasing pulse energy has a progressively lower effect on fragmentation and dust removal efficiency, it did lead to a linear increase in stone displacement and tissue vaporization depth. Thermal testing showed 20 W (53.87 ± 2.67 °C) indicating potential urothelial damage. In our study of laser lithotripsy for proximal ureteral stones, the group treated with 0.3 J pulses had several advantages compared to the 0.8 J group: Fewer large fragments (> 4 mm): 0 vs. 1.67 fragments (1-2.25), p = 0.002, a lower number of collateral tissue injuries: 0.50 (0-1.25) vs. 2.67 (2–4), p = 0.011, and lower stone retropulsion grading: 0.83 (0.75-1) vs. 1.67 (1–2), p = 0.046. There was no significant difference in operating time between the groups (443.33 ± 78.30 s vs. 463.17 ± 75.15 s, p = 0.664). These findings suggest that TFL irradiation generates a greater thermal effect compared to non-irradiated stones. Furthermore, the thermal effect during laser lithotripsy is influenced by both power and irrigation flow rate. Our study suggests that using a power below 15 W with an irrigation flow rate of 20 ml/min is safe. Moreover, a pulse energy of 0.3 J appears to be optimal for achieving the best overall stone fragmentation effect.

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Data availability

The data used to support the findings of this study are available from the corresponding authors upon reasonable request.

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Acknowledgements

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Funding

This study was supported by the Key Research and Development Program of Hubei province (2023BCB001), the Fundamental Research Funds for the Central Universities (2042024YXB011).

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Authors and Affiliations

  1. Department of Urology, Cancer Precision Diagnosis and Treatment and Translational Medicine, Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China

    Zhilong Li, Shaojie Wu, Tongzu Liu, Sheng Li & Xinghuan Wang

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Contributions

X.W. S.L. and T.L. were responsible for the concept and design. Z.L. and S.W. collected the data and the data analysis. Z.L. interpreted the results and wrote the manuscript. X.W. S.L. T.L. and S.W. assisted in revising the manuscript. All authors have read and approved this manuscript.

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Correspondence to Tongzu Liu, Sheng Li or Xinghuan Wang.

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Li, Z., Wu, S., Liu, T. et al. Optimal parameter settings of thulium fiber laser for ureteral stone lithotripsy: a comparative study in two different testing environments. Urolithiasis 52, 78 (2024). https://doi.org/10.1007/s00240-024-01585-0

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