Journal of endourology最新文献

{"title":"One Trocar-Assisted Retroperitoneoscopic Ureteroureterostomy for Ureteral Duplication.","authors":"Quang Thanh Nguyen, Dung Anh Le, Khoi Anh Nguyen, Thuy Linh Vu Nguyen, Trang Thu Dang, Liem Thanh Nguyen","doi":"10.1089/end.2024.0188","DOIUrl":"10.1089/end.2024.0188","url":null,"abstract":"<p><p><b><i>Aim:</i></b> To describe the operative technique and outcome of one trocar-assisted retroperitoneoscopic ureteroureterostomy (OTAU) in 40 cases of complete ureteral duplication in children. <b><i>Patients and Methods:</i></b> From September 2016 to December 2020, 40 patients (12 male and 28 female) less than 10 years of age underwent OTAU. A transverse skin incision of 12 mm in length was created approximately 1 cm above the iliac crest. Muscle was spared and retracted with stay sutures to expose the retroperitoneal space. Subsequently, a balloon trocar was then inserted, and pneumoperitoneum was achieved. A 10 mm operating laparoscope (Stema, Germany) with a Maryland was used to dissect and isolate the ureters from surrounding tissues. The ureters were then exteriorized and end-to-side ureteroureterostomy was performed using Polydioxanone (PDS) 6/0 running sutures. Patient's demographic, operative, and follow-up data were collected prospectively. <b><i>Results:</i></b> The mean age of patients was 25.2 months (range: 1-105 months). The mean operating time was 81.9 ± 11.3 minutes. There were no intraoperative conversions or complications. After a median follow-up time of 47.5 months, the differential renal function of the pathological upper pole moiety (UPM) was preserved in all patients. Ultrasound revealed a significant reduction in UPM's renal pelvis anterior-posterior diameter from 19.6 ± 9.1 mm preoperatively to 11.1 ± 6.7 mm postoperatively (<i>p</i> < 0.05), accompanied by a reduction in ureter's diameter from 10.8 ± 4.4 mm to 4.8 ± 1.2 mm (<i>p</i> < 0.05). Overall, all 32 patients with preoperative symptoms experienced complete symptom resolution. <b><i>Conclusion:</i></b> OTAU is a safe and feasible approach that yields excellent outcomes for complete ureteral duplication.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open and Robotic Uretero-enteric Stricture Repair: Early Outcomes and Complications.","authors":"Elizabeth N Bearrick, Bridget L Findlay, Anthony Fadel, Aaron M Potretzke, Katherine T Anderson, Boyd R Viers","doi":"10.1089/end.2024.0021","DOIUrl":"10.1089/end.2024.0021","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To characterize our single institutional experience with robotic and open uretero-enteric stricture (UES) repair. <b><i>Materials and Methods:</i></b> We queried our ureteral reconstructive database for UES repair between 01/2017 and 10/2023. Patients with <3 months follow-up were excluded. Prior to surgery, patients underwent ureteral rest (4 weeks) with conversion to nephrostomy tube. Clinical characteristics, complications, reconstructive success (uretero-enteric patency), need for repeat intervention, and renal function were assessed in patients undergoing open and robotic UES reconstruction. <b><i>Results:</i></b> Of 50 patients undergoing UES repair during the study period, 45 were included for analysis due to complete follow-up (34 [76%] robotic and 11 [24%] open repair). UES repair was performed in 50 renal units a median of 13 months (interquartile range 7-30) from index surgery, and most often involved the left renal unit (34/50; 68%). Compared with robotic, open cases were significantly more likely to have undergone open cystectomy (100% <i>vs</i> 68%, <i>p</i> = 0.04), have longer strictures (median 4 <i>vs</i> 1 cm, <i>p</i> < 0.001), require tissue substitution (27% <i>vs</i> 3%, <i>p</i> = 0.04), and have lengthier postoperative hospitalization (5 <i>vs</i> 2 days, <i>p</i> < 0.001). There was no significant difference in total operative time (410 <i>vs</i> 322 minutes) or 30d major complications (18% <i>vs</i> 21%). At a follow-up of 13 months, per patient reconstructive success was 100% (11/11) for open and 97% (33/34) for robotic, respectively. <b><i>Conclusion:</i></b> In select patients with short UES unlikely to require advanced reconstructive techniques, a robotic-assisted approach can be considered. Careful patient selection is associated with limited morbidity and high reconstructive success.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Ureteral Reconstruction in Children with Retrocaval Ureter: A Modern Single Center Retrospective Study.","authors":"Changkun Mao, Yongsheng Cao, Tao Zhang","doi":"10.1089/end.2024.0027","DOIUrl":"10.1089/end.2024.0027","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aims to report our experience in the treatment of children with retrocaval ureter (RCU) using laparoscopic ureteral reconstruction surgery. <b><i>Patients and Methods:</i></b> We retrospectively collected clinical data from 10 pediatric patients with RCU who underwent laparoscopic surgery at our hospital from April 2010 to April 2022. All patients underwent comprehensive preoperative radiological assessment and were diagnosed with RCU, subsequently undergoing laparoscopic ureteral reconstruction. Patient demographics, surgical data, and postoperative outcomes were recorded. Regular follow-ups were conducted postoperatively, evaluating clinical symptoms and radiological results. <b><i>Results:</i></b> The median age of the 10 patients was 8.8 years (range, 6-14 years). All surgeries were successfully performed laparoscopically without the need for open conversion, with an average surgical time of 153.3 minutes (range, 120-243 minutes). Intraoperative bleeding was minimal and no blood transfusions were required. No intraoperative complications were observed. The average hospital stay for the patients was 5.3 days (range, 4-7 days) and the Double-J (D-J) stent was removed 6 weeks postoperatively. Follow-up ultrasound results at 3 and 6 months postoperatively showed a reduction in renal pelvic dilatation, and all patients experienced significant relief of clinical symptoms related to flank and abdominal discomfort. <b><i>Conclusion:</i></b> Laparoscopic reconstruction for RCU demonstrates good feasibility and effectiveness in pediatric patients, offering a minimally invasive treatment option for the management of RCU in children.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Continence Restoration Through an Endourethral Device: A 3-Month Pilot Study on 10 Patients.","authors":"Massimo Cecchi, Gioia Lucarini, Tommaso Mazzocchi, Leonardo Marziale, Novello Pinzi, Francesco Prata, Giorgio Pomara, Francesca Manassero, Cinzia Traversi, Iacopo Pazzagli, Roberto M Scarpa, Rocco Papalia, Leonardo Ricotti","doi":"10.1089/end.2024.0084","DOIUrl":"10.1089/end.2024.0084","url":null,"abstract":"<p><p><b><i>Background:</i></b> Stress urinary incontinence (SUI) is a widespread and frustrating condition that affects millions of people worldwide, with severe consequences on patients' quality of life and health care systems' costs. Currently, the most severe cases of SUI are treated using implanted (and rather invasive) extraurethral artificial sphincters. The authors propose an innovative, minimally invasive endourethral device for the treatment of SUI. <b><i>Methods:</i></b> Ten patients with SUI were enrolled in three Italian centers and underwent device implantation. After 10, 30, 60, and 90 days, correct device position was confirmed by ultrasonography. Improvements in continence and quality of life were evaluated through a 24-hour pad-test, an International Consultation on Incontinence Questionnarie-Short Form (ICI-Q) and a custom checklist. The device was explanted after 90 days. <b><i>Results:</i></b> The proposed device was successfully implanted and explanted in 8 out of 10 patients. The results of the pad-test, ICI-Q, and custom checklist demonstrated remarkable improvements in continence (median improvement: 82% with respect to the initial condition) and quality of life (mean reduction of the impact of urine losses on the quality of life: 61%). No major pain or discomfort was reported. <b><i>Conclusions:</i></b> The results demonstrate the efficacy of the proposed endourethral artificial sphincter in addressing SUI. The proposed device was successfully implanted and explanted in a short time (∼10 minutes) without intrinsic side effects and without triggering pain or discomfort.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convective Water Vapor Energy Ablation (Rezum^®) Versus Prostatic Urethral Lift (Urolift^®): A 2-Year Prospective Study.","authors":"Yu Xi Terence Law, Wei Jing Kelven Chen, Liang Shen, Kyaw Lin, Chloe Shu Hui Ong, Qi Yang Lim, Gregory Xiang Wen Pek, Woon Chau Tsang, Yi Quan Tan, Jun Yang Chia, King Chien Joe Lee, Wei Jin Chua","doi":"10.1089/end.2024.0400","DOIUrl":"10.1089/end.2024.0400","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum^®) and prostatic urethral lift (Urolift^®). To identify predictive factors for treatment failures in both treatments. <b><i>Materials & Methods:</i></b> Prospective clinico-epidemiological data of patients who underwent Urolift^® or Rezum^® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. <b><i>Results:</i></b> From October 2019 to October 2022, 86 patients underwent Rezum^®, and 62 patients underwent Urolift^®. Rezum^® involved a longer indwelling catheter duration (12.38 ± 5.548 <i>vs</i> 1.39 ± 3.010 days, <i>p</i> < 0.001) compared with Urolift^®. Rezum^® was associated with more complications compared with Urolift^® (36 [41.9%] <i>vs</i> 10 [16.1%] cases, <i>p</i> < 0.001). Rezum^® had more cases of hematuria (17 [19.8%] <i>vs</i> 4 [6.5%] cases [<i>p</i> = 0.022]) and urinary tract infections (27 [31.4%] <i>vs</i> 3 [4.8%] cases, <i>p</i> < 0.001) compared with Urolift^®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift^® was associated with higher reoperation rates (5 [8.1%] <i>vs</i> 0 [0%] cases, <i>p</i> = 0.010) compared Rezum^®. Rezum^® had higher anticholinergic usage rates compared with Urolift^® post-operation (22 [25.6%] <i>vs</i> 8 [12.9%] cases, <i>p</i> = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. <b><i>Conclusions:</i></b> There was no difference in clinical outcomes of patients who underwent Rezum^® and Urolift^®. However, patients who had undergone Rezum^® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of Convolutional Neural Network Model for Bladder Tumor Classification of Cystoscopy Images and Comparison with Humans.","authors":"Ju Young Lee, Yong Seong Lee, Jong Hyun Tae, In Ho Chang, Tae-Hyoung Kim, Soon Chul Myung, Tuan Thanh Nguyen, Jae Hyeok Lee, Joongwon Choi, Jung Hoon Kim, Jin Wook Kim, Se Young Choi","doi":"10.1089/end.2024.0250","DOIUrl":"10.1089/end.2024.0250","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> An investigation of various convolutional neural network (CNN)-based deep learning algorithms was conducted to select the appropriate artificial intelligence (AI) model for calculating the diagnostic performance of bladder tumor classification on cystoscopy images, with the performance of the selected model to be compared against that of medical students and urologists. <b><i>Methods:</i></b> A total of 3,731 cystoscopic images that contained 2,191 tumor images were obtained from 543 bladder tumor cases and 219 normal cases were evaluated. A total of 17 CNN models were trained for tumor classification with various hyperparameters. The diagnostic performance of the selected AI model was compared with the results obtained from urologists and medical students by using the receiver operating characteristic (ROC) curve graph and metrics. <b><i>Results:</i></b> EfficientNetB0 was selected as the appropriate AI model. In the test results, EfficientNetB0 achieved a balanced accuracy of 81%, sensitivity of 88%, specificity of 74%, and an area under the curve (AUC) of 92%. In contrast, human-derived diagnostic statistics for the test data showed an average balanced accuracy of 75%, sensitivity of 94%, and specificity of 55%. Specifically, urologists had an average balanced accuracy of 91%, sensitivity of 95%, and specificity of 88%, while medical students had an average balanced accuracy of 69%, sensitivity of 94%, and specificity of 44%. <b><i>Conclusions:</i></b> Among the various AI models, we suggest that EfficientNetB0 is an appropriate AI classification model for determining the presence of bladder tumors in cystoscopic images. EfficientNetB0 showed the highest performance among several models and showed high accuracy and specificity compared to medical students. This AI technology will be helpful for less experienced urologists or nonurologists in making diagnoses. Image-based deep learning classifies bladder cancer using cystoscopy images and shows promise for generalized applications in biomedical image analysis and clinical decision making.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Bigger Better? Comparison of 150 µm and 200 µm Thulium Fiber for <i>In Situ</i> Lower-Pole Lithotripsy.","authors":"Akin S Amasyali, Toby Clark, Natalie Chen, Ala'a Farkouh, Daniel Jhang, Kai Wen Cheng, Ruby Kuang, D Daniel Baldwin, Arthur Goyne, Elizabeth Baldwin, Zhamshid Okhunov, D Duane Baldwin","doi":"10.1089/end.2024.0223","DOIUrl":"10.1089/end.2024.0223","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The thulium fiber laser (TFL) generates a focused beam, which can be transmitted to laser fibers with small core diameters and may facilitate <i>in situ</i> lower-pole lithotripsy. This study compares lithotripsy performance of the 150 and 200 µm TFL in a lower pole benchtop kidney model. <b><i>Materials and Methods:</i></b> Using a 3D model printed from an actual kidney, <i>in situ</i> laser lithotripsy was performed on 1 cm lower-pole BegoStones (calcium oxalate monohydrate consistency) using four different settings (all 20W) and two fiber sizes (150 and 200 µm). Procedure time, laser time, total pulse energy, and fiber stripping were compared between the two fibers using an ANOVA or independent <i>t-test</i>. <b><i>Results:</i></b> The 150 µm fiber at 0.2 J × 100 Hz had the shortest lasing and procedure time (17.3 and 18.5 minutes) and lowest total pulse energy (20.75 kJ) compared with other study arms (<i>p</i> < 0.001). Overall procedure time, lasing time, and total pulse energy were significantly different between the 8 settings (<i>p</i> < 0.001 for all). At higher frequency (100 and 200 Hz), lasing time was significantly faster compared with 20 and 50 Hz (19.9 <i>vs</i> 27.3 minutes; <i>p</i> < 0.001). Furthermore, the average total procedure time was shorter with 150 µm compared with 200 µm regardless of settings (23.2 <i>vs</i> 29.8 minutes; <i>p</i> < 0.001). <b><i>Conclusion:</i></b> The 150 µm fiber results in shorter procedure and lasing time at lower total energy levels during lower-pole <i>in situ</i> lithotripsy. Overall, the fastest setting was 0.2 J and 100 Hz with the 150 µm fiber. Smaller laser fibers can potentially allow more efficient <i>in situ</i> laser lithotripsy with better irrigation and visibility at higher deflection angles.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Kidney Stones in Pregnancy: A Worldwide Survey of Practice Patterns.","authors":"Patrick Juliebø-Jones, Michelle J Semins, Christian Seitz, Amy Krambeck, Etienne Xavier Keller, Niall F Davis, Lazaros Tzelves, Robert Geraghty, Christian Beisland, Øyvind Ulvik, Mathias Sørstrand Æsøy, Ewa Bres-Niewada, B M Zeeshan Hameed, Vineet Gauhar, Pablo Contreras, Andreas Skolarikos, Bhaskar K Somani","doi":"10.1089/end.2024.0012","DOIUrl":"10.1089/end.2024.0012","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Kidney stones in pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. <b><i>Methods:</i></b> Through an iterative process, 19-item survey was devised. This contained the following five sections: (1) Demographics, (2) General items, (3) Diagnosis and Imaging, (4) Initial management, (5) Surgery. It was disseminated via social media and email chains. <b><i>Results:</i></b> A total of 355 responses were collected, and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non-contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to magnetic resonance imaging. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal ultra sound results, only 19.4% would proceed to ureteroscopy (URS) but 40.9% would opt for CT. Twenty-four-48 hours were the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effective, and 6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intraoperatively. A total of 3.94% had previously performed percutaneous nephrolithotomy during pregnancy. <b><i>Conclusion:</i></b> Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giuseppe Simone, MD, PhD, FEBU Rome, Italy.","authors":"","doi":"10.1089/end.2024.59235.spot","DOIUrl":"https://doi.org/10.1089/end.2024.59235.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>In Vitro</i> Comparison of Pulsed-Thulium:YAG, Holmium:YAG, and Thulium Fiber Laser.","authors":"Marie Chicaud, Stessy Kutchukian, Laurent Berthe, Mariela Corrales, Catalina Solano, Luigi Candela, Steeve Doizi, Daron Smith, Olivier Traxer, Frédéric Panthier","doi":"10.1089/end.2024.0424","DOIUrl":"10.1089/end.2024.0424","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To characterize the pulse characteristics and risk of fiber fracture (ROF) of the pulsed-Thulium:YAG (p-Tm:YAG) laser and to compare its ablation volumes (AVs) against Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser and Thulium fiber laser (TFL). <b><i>Materials and Methods:</i></b> p-Tm:YAG (100 W-Thulio, Dornier-Medtech^©, Germany) was characterized using single-use 272 μm core-diameter-fibers. p-Tm:YAG characterization included pulse shape, duration, and peak power (PP) studies. ROF was assessed after 5 minutes of continuous laser activation (CLA) at five decreasing fiber bend radii (1, 0.9, 0.75, 0.6, and 0.45 cm). p-Tm:YAG, Ho:YAG (120 W-Cyber-Ho, Quanta^®, USA), and TFL (60 W-TFLDrive, Coloplast^®, Denmark) AVs were compared using a 20-mm linear CLA at 2 mm/second velocity in contact with 20 mm³ hard stone phantoms (HSP) and soft stone phantoms (SSP) (15:3 and 15:5 water to powder ratio, respectively) fully submerged in saline at 0.5 J-20 Hz or 1 J-10 Hz. After CLA, phantoms underwent three-dimensional (3D) micro-scanning (CT) and subsequent 3D segmentation to estimate the AVs, using 3DSlicer^©. Each experiment was performed in triplicate. <b><i>Results:</i></b> p-Tm:YAG presents a uniform pulse profile in all of the available preset modes. PP ranged from 564 to 2199 W depending on pulse mode. No laser fiber fracture occurred at any bend radius. p-Tm:YAG achieved similar mean AVs to TFL and Ho:YAG for HSP (8.96 ± 3.1 <i>vs</i> 9.78 ± 1.1 <i>vs</i> 8.8 ± 2.8 mm³, <i>p</i> = 0.67) but TFL was associated with higher AVs compared with p-Tm:YAG and Ho:YAG (12.86 ± 1.85 <i>vs</i> 10.12 ± 1.89 <i>vs</i> 7.56 ± 2.21 mm³, <i>p</i> = 0.002) against SSP. AVs for HSP increased with pulse energy for p-Tm:YAG and Ho:YAG and (11.56 ± 1.8 <i>vs</i> 6.36 ± 0.84 mm³ and 11.27 ± 1.98 <i>vs</i> 6.34 ± 0.55 mm³, <i>p</i> = 0.03 and <i>p</i> = 0.02), whereas AVs for SSP were similar across laser settings for all laser sources. AVs with TFL were similar across laser settings for both phantom types. <b><i>Conclusion:</i></b> p-Tm:YAG combines intermediate PP between Ho:YAG and TFL, a uniform pulse profile, no ROF with increasing deflection and effective ablation rates. Further clinical studies are needed to confirm these <i>in vitro</i> results.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}