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How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

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Abstract

Introduction

Holmium:yttrium–aluminium–garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in vitro study evaluated the required energy to ablate 1 mm3 of various stone types with different laser settings using Ho:YAG.

Methods

272 µm core-diameter laser fibers (Boston Scientific©) were connected to a 30 Watt MH1 Ho:YAG generator (Rocamed®). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1 mm3 (RE).

Results

All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6 J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2 J, respectively The mean REs at 1 J PE for COM, Cys and UA were 14.7, 6.4 and 2 J, respectively. At 0.6 J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively.

Conclusion

This in vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice.

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Acknowledgements

In vivo imaging was performed at Life Imaging Facility of Paris Descartes University (Plateforme Imageries du Vivant), supported by France Life Imaging (grant ANR-11-INBS-0006) and Infrastructures Biologies-Santé.

Funding

Frédéric Panthier received a French Association of Urology Research Grant (2018).

Author information

Author notes

  1. Frédéric Panthier and Eugenio Ventimiglia Equal contribution

Authors and Affiliations

  1. GRC No 20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France

    Frédéric Panthier, Eugenio Ventimiglia, Michel Daudon, Steeve Doizi & Olivier Traxer

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

    Frédéric Panthier, Eugenio Ventimiglia, Steeve Doizi & Olivier Traxer

  3. PIMM, UMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l’Hôpital, 75013, Paris, France

    Frédéric Panthier & Laurent Berthe

  4. Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy

    Eugenio Ventimiglia

  5. Plateforme D’imagerie du Vivant, EA 2496 Orofacial Pathologies, Imagery and Biotherapies, Dental School Faculty, University Paris Descartes and Life Imaging Plateform (PIV), Montrouge, France

    Catherine Chaussain

  6. Service Des Explorations Fonctionnelles, Hopital TENON, 4 rue de la Chine, Paris, France

    Michel Daudon

Authors
  1. Frédéric Panthier
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  6. Steeve Doizi
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Contributions

FP and EV: equal contribution: protocol development, data collection and management, data analysis, manuscript writing and editing. LB: protocol development, data collection and management, manuscript editing. CC: protocol development, data collection. MD: protocol development, data collection. SD: protocol development, manuscript writing and editing. OT: protocol development, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Olivier Traxer.

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Conflicts of interest

The authors declare that they have no conflict of interest. However, Olivier Traxer has declared as being a consultant for Boston Scientific Corporation, Coloplast, Wolf, B-Braun, IPG photonics, Lumenis, Olympus and Rocamed. Steeve Doizi has declared as being a consultant for Boston Scientific Corporation and Coloplast.

Research involving human participants or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors. Human stone samples were used in this study, with the informed consent of each patient.

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Panthier, F., Ventimiglia, E., Berthe, L. et al. How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study. World J Urol 38, 2945–2953 (2020). https://doi.org/10.1007/s00345-020-03091-5

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