A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

doi:10.1016/j.ajur.2022.05.011

Asian Journal of Urology, 2023, 10 (1): 89-95 doi: 10.1016/j.ajur.2022.05.011

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A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

Xiaoliang Zhu^a,b,1,Feiping Li^a,1,Xixi Hu^b,Haiping Li^a,Songjiang Wu^a,Haihong Jiang^b,*(

)

^a Department of Urology and Andrology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
^b Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

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Abstract

Objective: Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter. The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the “ureter” during the ureteroscopic holmium laser lithotripsy in vitro.

Methods:An in vitro lithotripsy was performed using a modified catheter (5 Fr) as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet. Different laser power settings (10 W, 20 W, and 30 W) with various firing times (3 s, 5 s, and 10 s) and rates of irrigation (15 mL/min, 20 mL/min, and 30 mL/min) were applied in the experiment. Temperature changes in the “ureter” were recorded with a thermometer during and after the lithotripsy.

Results:During the lithotripsy, the local highest mean temperature was 60.3 °C and the lowest mean temperature was 26.7 °C. When the power was set to 10 w, the temperature was maintained below 43 °C regardless of laser firing time or irrigation flow. Regardless of the power or firing time selected, the temperature was below 43 °C at the rate of 30 mL/min. There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing (3 s, 5 s, or 10 s) compared to with not drainage (p<0.05) except for two conditions of 0.5 J×20 Hz, 30 mL/min, firing 5 s, and 1.0 J×10 Hz, 30 mL/min, firing 5 s.

Conclusion: Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect, especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Key words： Modified catheter Holmium laser Lithotripsy Thermal injury

Received: 29 December 2021 Available online: 20 January 2023

Corresponding Authors: Haihong Jiang E-mail: jianghh.md@foxmail.com

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Cite this article:

Xiaoliang Zhu,Feiping Li,Xixi Hu, et al. A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy[J]. Asian Journal of Urology, 2023, 10(1): 89-95.

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http://www.ajurology.com/EN/10.1016/j.ajur.2022.05.011 OR http://www.ajurology.com/EN/Y2023/V10/I1/89

Flow chart of the assembly of a modified ureteral catheter. (A) The holmium laser fiber and the modified catheter in the ureteroscope; (B) Magnification of the modified catheter in the ureteroscope; (C) Magnification of the tail end of the modified catheter; (D) A 50 mL syringe needle; (E) A three-branch pipe; (F) A screw cap.

Schematic diagram of the flow of irrigation and the modified catheter in the ureteroscope. (A) The flow diagram of irrigation (the direction of the red arrows represented the outflow of hot irrigation); (B) The modified catheter.

The ureteroscopic holmium laser lithotripsy performed using a 5 Fr modified catheter in a rubber tube. The region temperature was recorded by the thermocouple.

Flow rate	Different power	Drainage situation	Change in temperature (°C)
Flow rate	Different power	Drainage situation	3 s^a	3s^b	5s^b	5 s^a	3 s^b	5s^b	10 s^a	3 s^b	5 s^b
15 mL/min	0.5 J×20 Hz	Drainage	36.5	26.6	26.6	31.2	28.7	26.8	32.3	28.9	28.0
	0.5 J×20 Hz	Not drainage	36.5	36.2	36.1	31.2	31.0	30.8	32.3	32.1	31.8
	1.0 J×10 Hz	Drainage	32.4	27.2	26.8	30.5	28.0	26.9	39.0	32.7	28.2
	1.0 J×10 Hz	Not drainage	32.4	32.3	31.9	30.5	30.0	29.8	39.0	38.5	38.2
	1.0 J×20 Hz	Drainage	36.7	29.8	26.8	45.0	32.6	27.9	43.7	32.7	28.6
	1.0 J×20 Hz	Not drainage	36.7	36.0	35.7	45.0	44.8	44.5	43.7	43.2	43.1
	2.0 J×10 Hz	Drainage	36.9	26.9	26.6	57.6	38.6	32.1	60.3	39.6	31.8
	2.0 J×10 Hz	Not drainage	36.9	36.6	36.3	57.6	57.4	57.3	60.3	60.1	60.1
	1.5 J×20 Hz	Drainage	55.6	33.6	31.9	58.2	39.2	31.8	59.9	39.1	32.3
	1.5 J×20 Hz	Not drainage	55.6	55.3	55.2	58.2	58.0	57.9	59.9	59.7	59.5
	3.0 J×10 Hz	Drainage	54.1	33.3	27.1	38.7	28.6	26.9	44.0	32.8	28.1
	3.0 J×10 Hz	Not drainage	54.1	53.9	53.7	38.7	38.5	38.4	44.0	43.9	43.8
20 mL/min	0.5 J×20 Hz	Drainage	34.7	32.1	28.9	36.9	31.6	29.4	37.0	32.7	30.1
	0.5 J×20 Hz	Not drainage	34.7	34.5	34.0	36.9	36.5	36.1	37.0	36.9	36.6
	1.0 J×10 Hz	Drainage	28.8	26.8	26.8	33.8	29.1	26.6	35.1	30.6	28.8
	1.0 J×10 Hz	Not drainage	28.8	28.6	28.2	33.8	33.3	33.1	35.1	34.7	34.2
	1.0 J×20 Hz	Drainage	38.9	31.2	28.2	35.6	28.7	26.8	41.7	33.1	28.1
	1.0 J×20 Hz	Not drainage	38.9	38.5	38.2	35.6	35.4	35.1	41.7	41.5	41.3
	2.0 J×10 Hz	Drainage	43.1	33.5	28.3	41.2	31.6	28.1	45.0	32.7	27.9
	2.0 J×10 Hz	Not drainage	43.1	43.0	42.8	41.2	40.5	39.9	45.0	45.0	44.8
	1.5 J×20 Hz	Drainage	44.7	30.7	27.2	48.2	36.7	31.2	52.3	37.8	31.5
	1.5 J×20 Hz	Not drainage	44.7	44.5	44.3	48.2	48.0	47.9	52.3	52.1	50.0
	3.0 J×10 Hz	Drainage	42.6	31.5	27.8	41.3	33.5	27.1	39.6	31.2	26.8
	3.0 J×10 Hz	Not drainage	42.6	42.4	42.1	41.3	41.0	40.8	39.6	39.4	39.1
30 mL/min	0.5 J×20 Hz	Drainage	27.8	26.8	26.8	27.1	26.9	26.6	26.7	26.6	26.6
	0.5 J×20 Hz	Not drainage	27.8	27.6	27.4	27.1	27.0	26.8	26.7	26.7	26.7
	1.0 J×10 Hz	Drainage	26.9	26.6	26.6	27.2	26.6	26.6	27.0	26.6	26.6
	1.0 J×10 Hz	Not drainage	26.9	26.9	26.7	27.2	26.7	26.7	27.0	27.0	26.8
	1.0 J×20 Hz	Drainage	35.4	29.1	26.7	36.5	27.9	27.0	36.1	28.2	27.3
	1.0 J×20 Hz	Not drainage	35.4	35.3	35.1	36.5	36.1	35.9	36.1	35.8	35.6
	2.0 J×10 Hz	Drainage	33.6	26.8	26.6	38.7	31.5	27.3	31.1	26.9	26.7
	2.0 J×10 Hz	Not drainage	33.6	33.5	33.1	38.7	38.4	38.2	31.1	30.7	30.5
	1.5 J×20 Hz	Drainage	34.5	28.1	26.9	37.4	31.6	28.6	38.8	30.4	26.9
	1.5 J×20 Hz	Not drainage	34.5	34.0	33.8	37.4	37.2	37.0	38.8	38.6	38.4
	3.0 J×10 Hz	Drainage	39.1	30.6	26.8	38.8	29.3	26.8	36.7	27.6	26.6
	3.0 J×10 Hz	Not drainage	39.1	39.0	38.8	38.8	38.6	38.4	36.7	36.5	36.3

The local mean temperature varied with the laser working mode and irrigation flow rate.

The temperature difference when stopping different power of ureteroscopic laser lithotripsy (stop firing 3 s) between drainage group and not drainage group. (A) Firing 3 s, and irrigation of 15 mL/min; (B) Firing 5 s, and irrigation of 15 mL/min; (C) Firing 10 s, and irrigation of 15 mL/min; (D) Firing 3 s, and irrigation of 20 mL/min; (E) Firing 5 s, and irrigation of 20 mL/min; (F) Firing 10 s, and irrigation of 20 mL/min; (G) Firing 3 s, and irrigation of 30 mL/min; (H) Firing 5 s, and irrigation of 30 mL/min, except for two conditions (red boxes, p>0.05, not significant); (I) Firing 10 s, and irrigation of 30 mL/min. ? p<0.05.

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