Morais Nuno, Terribile Marco, Mota Paulo, Cicione Antonio, Dionísio Sílvia, Carvalho-Dias Emanuel, Cordeiro Agostinho, Torres João N, Oliveira Carlos, Lima Estêvão
Department of Urology, Hospital of Braga, Braga, Portugal -
Department of Urology, University of Campania Luigi Vanvitelli, Naples, Italy.
Minerva Urol Nefrol. 2018 Dec;70(6):624-629. doi: 10.23736/S0393-2249.18.03050-3. Epub 2018 Aug 29.
In urology, lasers are used in a variety of endoscopic procedures such as ureteroscopy and retrograde renal surgery for stone fragmentation of urinary calculi and ablation of urothelial tumors. To perform these procedures, guidewires are used as a preliminary safe-mainstay for referencing the urinary tract. This study aims to determine the effect of two different lasers: holmium:YAG (Ho:YAG) and thulium:YAG (Tm:YAG) lasers on metal guidewires with PTFE coating (PTFE), nitinol guidewires with hydrophilic coating (Hydrophilic) and nitinol guidewires with hydrophilic listed coating (Zebra).
Different combinations of frequency (5, 10 and 12 Hz) and energy per pulse (0.5, 1.5, and 2.6 J) of Ho:YAG laser were applied on the three kinds of guidewires in two experiments (50 J vs. 100 J of total energy). For the Tm:YAG laser three power levels (5, 35, and 70 W) with a total energy of 100 J were applied to the guidewires. The degree of damage (0 to 5) of the guidewire was assessed after each laser application.
A higher degree of injury of guidewires was related to higher values of total energy used for the Ho:YAG laser (P=0.036), and to higher values of power applied with the Tm:YAG (P=0.051). The most resistant guidewire to Ho:YAG laser energy was Zebra, followed by PTFE and Hydrophilic (P<0.001). With the Tm:YAG laser, PTFE guidewire appears to be the most resistant and the Hydrophilic the most fragile, although without reaching the statistical significance (P=0.223).
Both lasers revealed a harmful effect on the three tested guidewires. There was an association between the degree of injury and the amount of Ho:YAG laser energy and Tm:YAG laser power. The guidewire Zebra proved to be the safest when using Ho:YAG laser and the PTFE guidewire the most resistant to laser Tm:YAG. Further studies are necessary to confirm these results.
在泌尿外科中，激光被用于多种内镜手术，如输尿管镜检查和逆行肾脏手术，用于尿路结石的碎石和尿路上皮肿瘤的消融。为了进行这些手术，导丝被用作参考尿路的初步安全支柱。本研究旨在确定两种不同的激光：钬激光（Ho:YAG）和铥激光（Tm:YAG）对带有聚四氟乙烯涂层的金属导丝（PTFE）、带有亲水涂层的镍钛诺导丝（亲水型）和带有亲水标记涂层的镍钛诺导丝（斑马导丝）的影响。
在两个实验中（总能量分别为50 J和100 J），将Ho:YAG激光的不同频率（5、10和12 Hz）和每个脉冲能量（0.5、1.5和2.6 J）的不同组合应用于三种导丝上。对于Tm:YAG激光，将三种功率水平（5、35和70 W），总能量为100 J应用于导丝上。每次激光照射后评估导丝的损伤程度（0至5级）。
导丝的更高损伤程度与Ho:YAG激光使用的更高总能量值相关（P = 0.036），并且与Tm:YAG激光施加的更高功率值相关（P = 0.051）。对Ho:YAG激光能量最具抗性的导丝是斑马导丝，其次是PTFE和亲水型导丝（P < 0.001）。对于Tm:YAG激光，PTFE导丝似乎最具抗性，亲水型导丝最脆弱，尽管未达到统计学意义（P = 0.223）。
两种激光都对三种测试导丝显示出有害影响。损伤程度与Ho:YAG激光能量和Tm:YAG激光功率之间存在关联。在使用Ho:YAG激光时，斑马导丝被证明是最安全的，而PTFE导丝对Tm:YAG激光最具抗性。需要进一步研究来证实这些结果。
