Department of Urology, Tenon Hospital, Université Paris VI, Pierre et Marie Curie, Paris, France; Group Recherche Clinique Lithiase, Université Paris VI, Pierre et Marie Curie, Paris, France; Fundación Puigvert, Department of Urology, Universidad Autonoma de Barcelona, Barcelona, Spain.
Department of Urology, Tenon Hospital, Université Paris VI, Pierre et Marie Curie, Paris, France.
J Urol. 2017 Sep;198(3):702-706. doi: 10.1016/j.juro.2017.02.3371. Epub 2017 Apr 23.
The purpose of this study was to evaluate the popcorn technique using a wide range of holmium laser settings and fiber sizes in a systematic in vitro assessment.
Evaluations were done with 4 artificial stones in a collection tube. A fixed ureteroscope was inserted through a ureteral access sheath to provide constant irrigation flow and the laser was placed 1 mm from the bottom. Combinations of 0.5 to 1.5 J, 10 to 20 and 40 Hz, and long and short pulses were tested for 2 and 4 minutes. We used 273 and 365 μm laser fibers. All tests were repeated 3 times. The stones were weighed before and after the experiments to evaluate the setting efficiency. Significant predictors of a highly efficient technique were assessed.
A total of 144 tests were performed. Mean starting weight of the stones was 0.23 gm, which was consistent among the groups. After the experiment the median weight difference was 0.07 gm (range 0.01 to 0.24). When designating a 50% reduction in stone volume as the threshold indicating high efficiency, the significant predictors of an efficient popcorn technique were a long pulse (OR 2.7, 95% CI 1.05-7.15), a longer duration (OR 11.4, 95% CI 3.88-33.29), a small (273 μm) laser fiber (OR 0.23, 95% CI 0.08-0.70) and higher power (W) (OR 1.14, 95% CI 1.09-1.20).
Higher energy, a longer pulse, frequencies higher than 10 Hz, a longer duration and a smaller laser fiber predict a popcorn technique that is more efficient at reducing stone volume.
本研究旨在通过系统的体外评估，使用多种钬激光设置和光纤尺寸来评估爆米花技术。
在收集管中的 4 个人造结石中进行评估。将固定输尿管镜插入输尿管进入鞘以提供恒定的冲洗流量，并将激光放置在距底部 1 毫米处。测试了 0.5 至 1.5 J、10 至 20 和 40 Hz 的组合，以及长脉冲和短脉冲，持续 2 分钟和 4 分钟。我们使用了 273μm 和 365μm 的激光光纤。所有测试均重复 3 次。实验前后对结石进行称重，以评估设定效率。评估了高效技术的显著预测因子。
共进行了 144 次测试。结石的初始平均重量为 0.23 克，各组之间一致。实验后，中位数重量差异为 0.07 克（范围 0.01 至 0.24）。当将结石体积减少 50%指定为表示高效的阈值时，爆米花技术高效的显著预测因子是长脉冲（OR 2.7，95%CI 1.05-7.15）、较长的持续时间（OR 11.4，95%CI 3.88-33.29）、较小的（273μm）激光光纤（OR 0.23，95%CI 0.08-0.70）和更高的功率（W）（OR 1.14，95%CI 1.09-1.20）。
更高的能量、更长的脉冲、频率高于 10 Hz、更长的持续时间和更小的激光光纤可预测能更有效地减少结石体积的爆米花技术。
