Optimizing the Appropriate Mode of the Pulse-modulated Holmium Laser in a Pop-dusting Benchtop Model
Issued Date
2025-01-01
Resource Type
ISSN
00904295
eISSN
15279995
Scopus ID
2-s2.0-85214334896
Pubmed ID
39724965
Journal Title
Urology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Urology (2025)
Suggested Citation
Tominaga K., Inoue T., Usuda T., Ketsuwan C. Optimizing the Appropriate Mode of the Pulse-modulated Holmium Laser in a Pop-dusting Benchtop Model. Urology (2025). doi:10.1016/j.urology.2024.12.032 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/102981
Title
Optimizing the Appropriate Mode of the Pulse-modulated Holmium Laser in a Pop-dusting Benchtop Model
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Corresponding Author(s)
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Abstract
Objective: To investigate the effectiveness of different holmium:yttrium-aluminum-garnet (Ho:YAG) laser modes for lithotripsy in the “dusting era” and identify the optimal laser mode for producing stone fragments measuring ≤0.5 mm. Methods: We used plaster of Paris-made artificial stones crushed into 2-3 mm pieces, weighing 1 g in total. The primary endpoint was the mass of stone fragments ≤0.5 mm produced by different laser modes. The secondary endpoints were size categories, fragment mass, and changes in irrigation fluid temperature. The Lumenis Pulse 120 H Ho:YAG laser, with a 200-μm fiber, was used in 3 modes (Moses contact [MC], Moses distance [MD], and long pulse [LP], all at 0.5 J × 80 Hz). Laser lithotripsy involved a 20-second exposure with a 10-second pause for 15 cycles, conducted 7 times per mode while measuring the maximum irrigation fluid temperatures for each cycle. Results: The MC mode demonstrated superior performance in producing fragments ≤0.5 mm (P = .0034) compared with the MD mode. No notable differences were observed for other size categories. The MD and LP modes showed higher rates of mass loss in fluid (MD, P = .023; LP, P = .046) compared with the MC mode. In addition, the increase in irrigation fluid temperature was more pronounced in the MD and LP modes than in the MC mode (MD, P = .015; LP, P = .010). Conclusion: In renal stone lithotripsy during the “dusting era,” the MC mode is preferable for generating smaller stone fragments ≤0.5 mm. These insights are valuable for optimizing stone fragmentation techniques.