Skip to main content
SpringerLink
Log in

Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model

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

Abstract

Purpose

To evaluate the thermal effect of Ho:YAG laser lithotripsy in a standardized in vitro model via real-time temperature measurement.

Methods

Our model comprised a 20 ml test tube simulating the renal pelvis that was immersed in a 37 °C water bath. Two different laser fibers [FlexiFib (15–45 W), RigiFib 1000 (45–100 W), LISA laser products OHG, Katlenburg-Lindau, Germany] were placed in the test tube. An Ho:YAG 100 W laser was used in all experiments (LISA). Each experiment involved 120 s of continuous laser application, and was repeated five times. Different laser settings (high vs. low frequency, high vs. low energy, and long vs. short pulse duration), irrigation rates (0 up to 100 ml/min, realized by several pumps), and human calcium oxalate stone samples were analyzed. Temperature data were acquired by a real-time data logger with thermocouples (PICO Technology, Cambridgeshire, UK). Real-time measurements were assessed using MatLab®.

Results

Laser application with no irrigation results in a rapid increase in temperature up to ∆28 K, rising to 68 °C at 100 W. Low irrigation rates yield significantly higher temperature outcomes. Higher irrigation rates result immediately in a lower temperature rise. High irrigation rates of 100 ml/min result in a temperature rise of 5 K at the highest laser power setting (100 W).

Conclusions

Ho:YAG laser lithotripsy might be safe provided that there is sufficient irrigation. However, high power and low irrigation resulted in potentially tissue-damaging temperatures. Laser devices should, therefore, always be applied in conjunction with continuous, closely monitored irrigation whenever performing Ho:YAG laser lithotripsy.

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: a

Similar content being viewed by others

Abbreviations

CEM43 :

Cumulative equivalent at 43 °C

PNL:

Percutaneous nephrolithotomy

RIRS:

Retrograde intrarenal surgery

References

  1. Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC (2015) Contemporary surgical trends in the management of upper tract calculi. J Urol 193(3):880–884. https://doi.org/10.1016/j.juro.2014.09.006

    Article  PubMed  Google Scholar 

  2. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482. https://doi.org/10.1016/j.eururo.2015.07.041

    Article  PubMed  Google Scholar 

  3. Kronenberg P, Traxer O (2014) Update on lasers in urology 2014: current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol. https://doi.org/10.1007/s00345-014-1395-1

    Article  PubMed  Google Scholar 

  4. Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2015) EAU guidelines on urolithiasis 2015

  5. Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ, Welch AJ (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol Endourol Soc 13(3):181–190. https://doi.org/10.1089/end.1999.13.181

    Article  CAS  Google Scholar 

  6. Chan KF, Vassar GJ, Pfefer TJ, Teichman JM, Glickman RD, Weintraub ST, Welch AJ (1999) Holmium:YAG laser lithotripsy: a dominant photothermal ablative mechanism with chemical decomposition of urinary calculi. Lasers Surg Med 25(1):22–37

    Article  PubMed  CAS  Google Scholar 

  7. Molina WR, Silva IN, Donalisio da Silva R, Gustafson D, Sehrt D, Kim FJ (2015) Influence of saline on temperature profile of laser lithotripsy activation. J Endourol Endourol Soc 29(2):235–239. https://doi.org/10.1089/end.2014.0305

    Article  Google Scholar 

  8. Cordes J, Nguyen F, Sievert K-D (2015) First intraluminal temperature measurement during Ho:YAG-laser exposure at an in vitro URS. Open J Urol 05(01):1–5. https://doi.org/10.4236/oju.2015.51001

    Article  Google Scholar 

  9. Thomsen S, Pearce JA (2011) Thermal damage and rate processes in biologic tissues. In: Welch AJ, van Gemert MJC (eds) Optical-thermal response of laser-irradiated tissue. Springer, Dordrecht, pp 487–549. https://doi.org/10.1007/978-90-481-8831-4_13

    Chapter  Google Scholar 

  10. Bauer KD, Henle KJ (1979) Arrhenius analysis of heat survival curves from normal and thermotolerant CHO cells. Radiat Res 78(2):251–263. https://doi.org/10.2307/3575042

    Article  PubMed  CAS  Google Scholar 

  11. van Rhoon GC, Samaras T, Yarmolenko PS, Dewhirst MW, Neufeld E, Kuster N (2013) CEM43°C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels? Eur Radiol 23(8):2215–2227. https://doi.org/10.1007/s00330-013-2825-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sapareto SA, Dewey WC (1984) Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys 10(6):787–800

    Article  PubMed  CAS  Google Scholar 

  13. Kallidonis P, Amanatides L, Panagopoulos V, Kyriazis I, Vrettos T, Fligou F, Kamal W, Liatsikos EN (2015) Does the heat generation by the Thulium:Yttrium aluminum garnet laser in the irrigation fluid allow its use on the upper urinary tract? An experimental study. J Endourol 30(4):422–427. https://doi.org/10.1089/end.2015.0252

    Article  PubMed  Google Scholar 

  14. Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME (2017) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol. https://doi.org/10.1089/end.2017.0658

    Article  PubMed  Google Scholar 

  15. Buttice S, Sener TE, Proietti S, Dragos L, Tefik T, Doizi S, Traxer O (2016) Temperature changes inside the kidney: what happens during holmium:yttrium-aluminium-garnet laser usage? J Endourol Endourol Soc 30(5):574–579. https://doi.org/10.1089/end.2015.0747

    Article  Google Scholar 

  16. Kallidonis P, Kamal W, Panagopoulos V, Vasilas M, Amanatides L, Kyriazis I, Vrettos T, Fligou F, Liatsikos E (2016) Thulium laser in the upper urinary tract: does the heat generation in the irrigation fluid pose a risk? Evidence from an in vivo experimental study. J Endourol 30(5):555–559. https://doi.org/10.1089/end.2015.0768

    Article  PubMed  Google Scholar 

  17. Aldoukhi AH, Ghani KR, Hall TL, Roberts WW (2017) Thermal response to high-power holmium laser lithotripsy. J Endourol Endourol Soc 31(12):1308–1312. https://doi.org/10.1089/end.2017.0679

    Article  Google Scholar 

  18. Ng YH, Somani BK, Dennison A, Kata SG, Nabi G, Brown S (2010) Irrigant flow and intrarenal pressure during flexible ureteroscopy: the effect of different access sheaths, working channel instruments, and hydrostatic pressure. J Endourol 24(12):1915–1920. https://doi.org/10.1089/end.2010.0188

    Article  PubMed  Google Scholar 

  19. Nair CGR, Ninan KN (1978) Thermal decomposition studies: Part X. Thermal decomposition kinetics of calcium oxalate monohydrate—correlations with heating rate and samples mass. Thermochim Acta 23(1):161–169. https://doi.org/10.1016/0040-6031(78)85122-3

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank Michaela von Aichberger for illustration of Fig. 1.

Funding

Institutional funding, Faculty of Medicine, University of Freiburg, Germany.

Author information

Author notes

    Authors and Affiliations

    1. Division of Urotechnology, Department of Urology, Faculty of Medicine, Medical Centre – University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

      Simon Hein, Ralf Petzold, Martin Schoenthaler, Ulrich Wetterauer & Arkadiusz Miernik

    Authors
    1. Simon Hein
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Ralf Petzold
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Martin Schoenthaler
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Ulrich Wetterauer
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Arkadiusz Miernik
      View author publications

      You can also search for this author in PubMed Google Scholar

    Contributions

    SH: protocol/project development, data collection and management, data analysis, and manuscript writing/editing. RP: data collection and management, data analysis, manuscript and figure writing/editing, and performed experiments. MS: manuscript writing/editing and supervision. UW: manuscript writing/editing and supervision. AM: protocol/project development, manuscript writing/editing, and supervision.

    Corresponding author

    Correspondence to Simon Hein.

    Ethics declarations

    Conflict of interest

    This work was supported by material support of LISA Laser products (Katlenburg-Lindau, Germany). Ulrich Wetterauer advisory board, DR. KADE Pharmazeutische Fabrik GmbH, Berlin, Germany (unrelated to the presented work). Martin Schoenthaler consultant contract with and NeoTract Inc., Pleasanton, USA (unrelated to the present work). Arkadiusz Miernik consultant contract with KLS Martin GmbH, Tuttlingen, Germany (unrelated to the present work).

    Ethical approval

    IRB approved protocol number: 79/16 leading ethics committee: Ethik-Kommission der Albert-Ludwigs-Universität Freiburg, Germany.

    Research involved in human and animals rights

    There are no human participants or animals involved into the study. Human stone probes were analyzed after ethical approval (79/16 leading ethics committee: Ethik-Kommission der Albert-Ludwigs-Universität Freiburg, Germany) and written informed consent.

    Additional information

    Simon Hein and Ralf Petzold have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Hein, S., Petzold, R., Schoenthaler, M. et al. Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model. World J Urol 36, 1469–1475 (2018). https://doi.org/10.1007/s00345-018-2303-x

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-018-2303-x

    Keywords

    Search

    Navigation