Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
World J Urol. 2024 Jan 13;42(1):33. doi: 10.1007/s00345-023-04726-z.
PURPOSE: To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. METHODS: After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS: Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. CONCLUSIONS: Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
目的:确定专家在特定临床情况下使用的激光碎石术设置,并确定预防措施以减少并发症。
方法:通过文献研究确定相关问题后,进行了一项调查,并将其发送给激光专家。要求参与者针对特定的临床碎石术情况,给出他们首选的激光设置。比较了不同设置下报告的激光类型,并确定了常见的设置和预防措施。
结果:26 名激光专家完整地返回了调查。钬:石榴石(Ho:YAG)激光器是主要使用的激光(88%),其次是掺铥光纤激光(TFL)(42%)和脉冲掺钬石榴石(Tm:YAG)(23%)。对于大多数情况,我们无法确定激光设置之间的相关差异。然而,在输尿管中段(p=0.027)、骨盆(p=0.047)和下极结石(p=0.018)碎石术方面,激光功率存在显著差异。Ho:YAG 和脉冲 Tm:YAG 激光器更常采用碎石或碎石加扬尘的组合方式,而 TFL 激光器更常采用扬尘或扬尘加碎石的组合方式。专家更喜欢 Ho:YAG 激光的长脉冲模式而不是 TFL 激光的短脉冲模式。由于碎石过程中温度升高而导致的热损伤被专家们严重考虑,并常规应用预防措施。
结论:激光碎石术常用的激光之间,激光设置没有显著差异。碎石术技术和设置主要取决于产生的激光脉冲和发生器设置的物理特性。专家们通常使用最大功率限制、间歇性激光激活和输尿管接入鞘等预防措施来减少热损伤引起的并发症。
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