The lithotripsy efficiency (LE) in vitro study requires artificial or human stone samples (AS, HS). With the development of dusting lithotripsy, less ex vivo HS are available. We aimed to compare Thulium Fiber Laser (TFL) and Holmium:YAG (Ho:YAG)'s LE and define the most accurate LE parameter.
Hard and soft homogenous- and heterogenous-AS (Ho-AS, He-AS) were made to reproduce calcium-oxalate monohydrate and uric acid stones, respectively by a rapid or slow brewing of BegostonePlus (Bego) and distilled water. One hundred and fifty and 272μm-laser fibers, connected to 50W-TFL and 30W-HoYAG generators, compared three settings for TFL (FD: 0.15J/100Hz; D: 0.5J/30Hz; Fr: 1J/15Hz) and two for Ho:YAG (D-Fr). An experimental setup consisted in immerged 10mm cubic stone phantoms with a 20 seconds' lasing spiral, in contact mode, repeated four times. Stones were dried, weighted and μ-scanned (ablation weight and volume [AW and AV]).
With He-AS, dusting AV were four- and three-fold higher with TFL compared to Ho:YAG against hard and soft (P<0.05). In fragmentation, AV were two-fold higher with TFL compared to Ho:YAG against hard (P<0.05) and soft (P<0.05). Experiments with Ho-AS were associated with non-significant differences when comparing TFL-150μm and TFL-272μm. The ablation weight-volume correlation coefficients was higher with Ho-AS than with He-AS (P<0.0001), and with hard than soft AS. If the LE can be estimated by the AW with hard AS, this approximation is not consistent for soft AS.
TFL presented higher ablation rates than Ho:YAG, significant with He-AS. If the AW is acceptable and less expensive for hard Ho-AS, AV are more accurate for He-AS, which are suggested to imitate closely HS.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2023 Jul 11 [Epub ahead of print]
S Kutchukian, S Doizi, P Lapouge, T Germain, L Dragos, L Berthe, C Solano, L Candela, M Corrales, M Chicaud, O Traxer, F Panthier
GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Service d'urologie, CHU de Poitiers, Poitiers, France., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France., PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Department of Endourology, Uroclin S.A.S., Medellin, Colombia., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vital-Salute San Raffaele University, Milan, Italy., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, CHU de Limoges, Limoges, France., GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: .