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How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

Type
Articles dans des revues avec comité de lecture
Author
PANTHIER, Frédéric
86289 Laboratoire Procédés et Ingénierie en Mécanique et Matériaux [PIMM]
VENTIMIGLIA, Eugenio
19483 Service d'urologie [CHU Tenon]
BERTHE, Laurent
86289 Laboratoire Procédés et Ingénierie en Mécanique et Matériaux [PIMM]
CHAUSSAIN, Catherine
557618 Paris Descartes University
DAUDON, Michel
328304 CHU Tenon [APHP]
DOIZI, Steeve
19483 Service d'urologie [CHU Tenon]
TRAXER, Olivier
19483 Service d'urologie [CHU Tenon]

URI
http://hdl.handle.net/10985/19572
DOI
10.1007/s00345-020-03091-5
Date
2020
Journal
World Journal of Urology

Abstract

Introduction: Holmium:yttrium–aluminium–garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in vitro study evaluated the required energy to ablate 1 mm3 of various stone types with different laser settings using Ho:YAG. Methods: 272 µm core-diameter laser fibers (Boston Scientific©) were connected to a 30 Watt MH1 Ho:YAG generator (Rocamed®). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1 mm3 (RE). Results: All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6 J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2 J, respectively The mean REs at 1 J PE for COM, Cys and UA were 14.7, 6.4 and 2 J, respectively. At 0.6 J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively. Conclusion: This in vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice.

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