Caliceal Fluid Temperature During High-Power Holmium Laser Lithotripsy in an In Vivo Porcine Model

Abstract Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.

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Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction

Current Urology Reports ◽

10.1007/s11934-021-01072-8 ◽

2021 ◽

Vol 22 (12) ◽

Author(s):

Naveen K. Reddy ◽

Abhijit P. Patil ◽

Gopal R. Tak ◽

Darshit Shah ◽

Abhishek G. Singh ◽

...

Keyword(s):

Size Distribution ◽

High Power ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Holmium Laser Lithotripsy

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Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

World Journal of Urology ◽

10.1007/s00345-020-03452-0 ◽

2020 ◽

Author(s):

Daniel Schlager ◽

Antonia Schulte ◽

Jan Schütz ◽

Albrecht Brandenburg ◽

Christoph Schell ◽

...

Keyword(s):

Urinary Tract ◽

Real Time ◽

Target Identification ◽

Laser System ◽

Laser Lithotripsy ◽

Bladder Stone ◽

Holmium Laser ◽

Comparison Study ◽

Holmium Laser Lithotripsy

Abstract Introduction and objective Thermal injuries associated with Holmium laser lithotripsy of the urinary tract are an underestimated problem in stone therapy. Surgical precision relies exclusively on visual target identification when applying laser energy for stone disintegration. This study evaluates a laser system that enables target identification automatically during bladder stone lithotripsy, URS, and PCNL in a porcine animal model. Methods Holmium laser lithotripsy was performed on two domestic pigs by an experienced endourology surgeon in vivo. Human stone fragments (4–6 mm) were inserted in both ureters, renal pelvises, and bladders. Ho:YAG laser lithotripsy was conducted as a two-arm comparison study, evaluating the target identification system against common lithotripsy. We assessed the ureters’ lesions according to PULS and the other locations descriptively. Post-mortem nephroureterectomy and cystectomy specimens were examined by a pathologist. Results The sufficient disintegration of stone samples was achieved in both setups. Endoscopic examination revealed numerous lesions in the urinary tract after the commercial Holmium laser system. The extent of lesions with the feedback system was semi-quantitatively and qualitatively lower. The energy applied was significantly less, with a mean reduction of more than 30% (URS 27.1%, PCNL 52.2%, bladder stone lithotripsy 17.1%). Pathology examination revealed only superficial lesions in both animals. There was no evidence of organ perforation in either study arm. Conclusions Our study provides proof-of-concept for a laser system enabling automatic real-time target identification during lithotripsy on human urinary stones. Further studies in humans are necessary, and to objectively quantify this new system’s advantages, investigations involving a large number of cases are mandatory.

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MP04-02 THE ROLE OF PULSE DURATION AND PULSE ENERGY ON FIBER TIP DEGRADATION DURING HIGH-POWER HOLMIUM LASER LITHOTRIPSY

The Journal of Urology ◽

10.1097/ju.0000000000000818.02 ◽

2020 ◽

Vol 203 ◽

pp. e32

Author(s):

Brandon Levin* ◽

Ali Aldoukhi ◽

Kristian Black ◽

Timothy Hall ◽

William Roberts ◽

...

Keyword(s):

Pulse Duration ◽

High Power ◽

Pulse Energy ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Holmium Laser Lithotripsy

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Effects of Irrigation Fluid Temperature During Flexible Ureteroscopic Holmium Laser Lithotripsy on Postoperative Fever and Shivering: A Randomized Controlled Trial

10.21203/rs.3.rs-150281/v1 ◽

2021 ◽

Author(s):

Yue He ◽

Yougang Feng ◽

Jun He ◽

Bo Liang ◽

Mindong Jiang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Fluid Temperature ◽

Postoperative Fever ◽

Irrigation Fluid ◽

Suspected Infection ◽

Randomized Controlled ◽

Holmium Laser Lithotripsy

Abstract Background. Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods. This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17°C, 27°C or 37°C). Primary outcome was fever incidence (body temperature >37.5°C) within 48 hours after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature >38.5°C and PCT >0.5 µg/L). Results. There were 108 patients, (17°C group, n=36; 27°C group, n=35; 37°C group, n=37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17°C, 27°C and 37°C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p<0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37°C or 27°C group compared with 17°C group. One case each of flash pulmonary edema and bleeding occurred in 37°C group. Conclusion. Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature.

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