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Ureteroscopy pp 161-167 | Cite as

Flexible Ureteroscopy: Holmium:YAG Laser and Optical Fibers

  • Bodo E. KnudsenEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

The holmium:YAG has become that gold standard for intracorporeal lithotripsy during flexible ureteroscopy. The combination of the wide margin of safety when working in a fluid environment coupled with its ability to urinary stones regardless of their chemical composition has led to its widespread adoption. However urologists are being offered an ever widening area of holmium:YAG lasers and laser fibers. In this chapter the clinical utility of the holmium:YAG laser as applied to flexible ureteroscopy is addressed. In addition a review of laser optical fibers and how their differing properties can impact performance and safety is presented.

Keywords

Pulse Energy Laser Energy Laser Fiber Fiber Failure Laser Lithotripsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

272467_1_En_14_MOESM1_ESM.mp4 (5.2 mb)
Video 14.1. Dusting the stone with a 240 micron core fiber at settings of 0.2J at 50Hz (MP4 23,454 KB)

References

  1. 1.
    Denstedt JD, et al. Preliminary experience with holmium:YAG laser lithotripsy. J Endourol. 1995;9(3):255–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Sofer M, Denstedt J. Flexible ureteroscopy and lithotripsy with the holmium:YAG laser. Can J Urol. 2000;7(1):952–6.PubMedGoogle Scholar
  3. 3.
    Vassar GJ, et al. Holmium:YAG lithotripsy: photothermal mechanism. J Endourol. 1999;13(3):181–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Pierre S, Preminger GM. Holmium laser for stone management. World J Urol. 2007;25(3):235–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Marguet CG, et al. In vitro comparison of stone retropulsion and fragmentation of the frequency doubled, double pulse Nd:YAG laser and the holmium:YAG laser. J Urol. 2005;173(5):1797–800.PubMedCrossRefGoogle Scholar
  6. 6.
    Leveillee RJ, Lobik L. Intracorporeal lithotripsy: which modality is best? Curr Opin Urol. 2003;13(3):249–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Sea J, et al. Optimal power settings for holmium:YAG lithotripsy. J Urol. 2012;187(3):914–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Spore SS, et al. Holmium:YAG lithotripsy: optimal power settings. J Endourol. 1999;13(8):559–66.PubMedCrossRefGoogle Scholar
  9. 9.
    Finley DS, et al. Effect of holmium:YAG laser pulse width on lithotripsy retropulsion in vitro. J Endourol. 2005;19(8):1041–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Albala DM, et al. Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol. 2001;166(6):2072–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Afane JS, et al. Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr. J Urol. 2000;164(4):1164–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Mues AC, Teichman JM, Knudsen BE. Evaluation of 24 holmium:YAG laser optical fibers for flexible ureteroscopy. J Urol. 2009;182(1):348–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Knudsen BE, et al. Performance and safety of holmium:YAG laser optical fibers. J Endourol. 2005;19(9):1092–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Traxer O. Flexible ureterorenoscopic management of lower-pole stone: does the scope make the difference? J Endourol. 2008;22(9):1847–50. discussion 1855.PubMedCrossRefGoogle Scholar
  15. 15.
    Clayman RV. 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. 2003;170(2 Pt 1):686–7.Google Scholar
  16. 16.
    Marks AJ, et al. Holmium:yttrium-aluminum-garnet lithotripsy proximal fiber failures from laser and fiber mismatch. Urology. 2008;71(6):1049–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Shore DM, Antiporda M, Teichman JM, Knudsen BE Evaluation of a new 240 μm single-use holmium:YAG optical fiber for flexible ureteroscopy. In: Engineering and Urology Society Annual Meeting. Washington, DC; 2011.Google Scholar
  18. 18.
    Sooriakumaran P, et al. Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation. Asian J Androl. 2005;7(4):433–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Knudsen BE Ball-tip holmium:YAG optical fiber. In: Engineering and Urology Society Annual Meeting. Washington, DC; 2011.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Urology, Wexner Medical CenterThe Ohio State UniversityColumbusUSA

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