Panthier Frédéric, Sierra Alba, Keller Etienne Xavier, Chicaud Marie, Ventimiglia Eugenio, Kwok Jia-Lun, De Coninck Vincent, Corrales Mariela, Daudon Michel, Gorny Cyril, Doizi Steeve, Berthe Laurent, Smith Daron, Traxer Olivier
Sorbonne University GRC Urolithiasis no. 20, Tenon Hospital Paris France.
PIMM UMR 8006 CNRS-Arts et Métiers ParisTech Paris France.
BJUI Compass. 2025 Aug 18;6(8):e70067. doi: 10.1002/bco2.70067. eCollection 2025 Aug.
To compare in vitro the ablation rates of p-Tm:YAG, TFL and Ho:YAG against synthetic and human stones.
p-Tm:YAG, TFL and Low-Power (LP) Ho:YAG were compared using 270 μm core-diameter laser fibres (CDF); experiments with 200 μm(p-Tm:YAG) and 150 μm-CDF (TFL) were also included. A continuous laser emission was applied through a spiral trajectory for 20 seconds with the laser fibre tip in contact with synthetic hard (HSP) and soft stone phantoms (SSP) submerged in saline. "Dusting" settings for p-Tm:YAG(0,6 J-20 Hz-Flex Long Pulse), TFL(0,5 J-30 Hz-Short Pulse) and Ho:YAG(0,5 J-30 Hz-Long Pulse) and "Fragmentation" settings for p-Tm:YAG(1 J-15 Hz-Captive), TFL(1 J-15 Hz-Short Pulse) and Ho:YAG(1 J-15 Hz-Long Pulse) were analysed. Then, experiments for human calcium oxalate monohydrate (COM), uric acid (UA) and cystine (CYS) stones were performed with single laser pulses at 0.6 J, 0.8 J and 1.0 J for p-Tm:YAG (Captive Fragmenting mode), TFL (Short Pulse) and Ho:YAG (Long Pulse). Synthetic and human stone samples were dried before three-dimensional scanning to measure ablation rates (ARs) and ablation volume per pulse (AVP).
For synthetic stones with 270 μm-CDF, the p-Tm:YAG and TFL presented similar ARs, except in Fragmentation against HSP (95,1 ± 13,6vs67 ± 14 p = 0,02, respectively). Both p-Tm:YAG and TFL achieved higher ARs than Ho:YAG in all settings. p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented similar ARs, except in Fragmentation against HSP(78,4 ± 8vs42,5 ± 2,6 mm/min,p = 0,0002). Both p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented at least 50% higher ARs than 270 μm-Ho:YAG. For human stones with COM, TFL exhibited higher AVP compared to p-Tm:YAG and Ho:YAG across all pulse energies (258,2 ± 213vs81,7 ± 31,9vs41,5 ± 25,4 μm p = 0,01, respectively). Against UA, Ho:YAG demonstrated higher AVP compared to TFL and p-Tm:YAG (355,2 ± 161vs99,8 ± 76,7vs292,9 ± 203,1 μm p = 0,0005, respectively). For CYS, Ho:YAG presented higher AVP but without significance (99,8 ± 76,7 vs 49,3 ± 36,3 vs 38,8 ± 12,2 μm, p = 0,09).
p-Tm:YAG and TFL achieved higher ARs than LP-Ho:YAG against synthetic stones in vitro. For human stones, TFL achieved the highest AVP against COM while LP-Ho:YAG delivered higher AVPs against UA and CYS, for which TFL performed worst.
在体外比较p-Tm:YAG、TFL和Ho:YAG对合成结石和人体结石的消融率。
使用芯径为270μm的激光光纤（CDF）对p-Tm:YAG、TFL和低功率（LP）Ho:YAG进行比较；还纳入了使用200μm（p-Tm:YAG）和150μm-CDF（TFL）的实验。将激光光纤尖端与浸没在盐水中的合成硬结石模型（HSP）和软结石模型（SSP）接触，通过螺旋轨迹施加连续激光发射20秒。分析了p-Tm:YAG（0.6J-20Hz-柔性长脉冲）、TFL（0.5J-30Hz-短脉冲）和Ho:YAG（0.5J-30Hz-长脉冲）的“粉末化”设置以及p-Tm:YAG（1J-15Hz-俘获）、TFL（1J-15Hz-短脉冲）和Ho:YAG（1J-15Hz-长脉冲）的“破碎”设置。然后，使用p-Tm:YAG（俘获破碎模式）、TFL（短脉冲）和Ho:YAG（长脉冲），分别以0.6J、0.8J和1.0J进行单激光脉冲对人体草酸钙一水合物（COM）、尿酸（UA）和胱氨酸（CYS）结石的实验。在进行三维扫描以测量消融率（ARs）和每脉冲消融体积（AVP）之前，将合成结石和人体结石样本干燥。
对于使用270μm-CDF的合成结石，p-Tm:YAG和TFL的ARs相似，但在针对HSP的破碎模式下除外（分别为95.1±13.6对67±14，p=0.02）。在所有设置下，p-Tm:YAG和TFL的ARs均高于Ho:YAG。p-Tm:YAG-200μm-CDF和TFL-150μm-CDF的ARs相似，但在针对HSP的破碎模式下除外（78.4±8对42.5±2.6mm/min，p=0.0002）。p-Tm:YAG-200μm-CDF和TFL-150μm-CDF的ARs均比270μm-Ho:YAG至少高50%。对于含有COM的人体结石，在所有脉冲能量下，TFL的AVP均高于p-Tm:YAG和Ho:YAG（分别为258.2±213对81.7±31.9对41.5±25.4μm，p=0.01）。对于UA结石，Ho:YAG的AVP高于TFL和p-Tm:YAG（分别为355.2±161对99.8±76.7对292.9±203.1μm，p=0.0005）。对于CYS结石，Ho:YAG的AVP较高但无统计学意义（99.8±76.7对49.3±36.3对38.8±12.2μm，p=0.09）。
在体外，p-Tm:YAG和TFL对合成结石的ARs高于LP-Ho:YAG。对于人体结石，TFL对COM的AVP最高，而LP-Ho:YAG对UA和CYS的AVP较高，TFL在这方面表现最差。
