Aldoukhi Ali H, Roberts William W, Hall Timothy L, Ghani Khurshid R
Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, MI, United States.
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.
Front Surg. 2017 Sep 29;4:57. doi: 10.3389/fsurg.2017.00057. eCollection 2017.
Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.
现代用于输尿管镜检查（URS）的钬激光系统为用户提供了一系列设置，即脉冲能量（PE）、脉冲频率（Fr）和脉冲宽度（PW）。这些变量使外科医生能够选择不同的组合，这些组合在URS碎石术中对结石破碎具有特定影响。接触式激光碎石术可使用破碎或粉末化设置进行。破碎采用低Fr和高PE设置来破碎结石，然后用取出装置将其取出。粉末化是利用高Fr和低PE设置将结石破碎成亚毫米级碎片以便自然排出，无需用网篮取出。在碎石术中使用长PW模式可减少结石后推，新一代激光越来越多地具备此功能。在非接触式激光碎石术中，结石碎片在肾盏内被激光脉冲迅速粉碎，导致结石破碎成细小碎片。在本综述中，我们讨论了不同钬激光设置对结石破碎的影响以及在这个不断发展的领域中的临床意义。
