Diode Laser Lithotription Technique Based on Optothermal Converter

Abstract

Purpose: evaluation of the efficiency of the “hot spot” method for the fragmentation of urinary stones. Materials and methods: A retrospective analysis of clinical records of 1666 patients with urolithiasis who underwent percutaneous nephrolithoextraction/tripsy and contact ureterolithotripsy/extraction in the period from 2014 to 2017 at the urology clinic was performed to assess the incidence of postoperative infectious and inflammatory complications. The research objects were postoperative urinary stones (n-78). The X-ray density and linear dimensions of the stones were determined. Stone fragmentation was performed with a continuous-wave diode laser operating at wavelengths of 0.81 μm, 0.97 μm, and 1.47 μm. An absorbing coating of micro-size graphite powder was applied on the working tip of the optical fiber. In vitro fragmentation was carried out in liquid. Results: A group of patients (224/1666) (13.4 ± 0.86%) was identified, who developed infectious and inflammatory complications after: percutaneous nephrolithotripsy, 123/361 (34.1 ± 2.5%) cases; percutaneous nephrolithoextraction, 59/240 (24.6 ± 2.78%); contact ureterolithotripsy, 23/294 (7.8 ± 1.57%); and ureterolithoextraction, 19/771 (2.5 ± 0.56%). In liquid, the “hot spot” technique made it possible to fragment stones with an X-ray density of up to 1000 HU at a laser wavelength of 0.81 µm, up to 1400 HU at 0.97 µm, and up to 1400 HU at 1.47 µm.

Keywords

• micro size graphite optothermal convertor
• hot-spot lithotripsy
• diode lasers
• urolithiasis
• infection lithiasis