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Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate

Received: 10 September 2020    Accepted: 25 September 2020    Published: 7 October 2020
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Abstract

OBJECTIVE: To assess the outcome of variable laser settings verses fixed setting on the stone free rate and complications. MATERIAL AND METHOD: We conducted a prospective, single-blind randomized controlled study. Solitary renal non lower pole stones 10 to 20 cm were included. A total of 113 Patients were randomly divided in to two groups. In group A, fixed laser setting was used at 1.0J energy and 12Hz frequency during the entire procedure. In Group B, variable laser settings were used; initial fine fragmentation was performed @ 1.0J X 12Hz. Once the residual stone reduced enough to wobble, the energy was reduced to 0.8 J and 8Hz. Settings were further reduced to 0.5J and 5Hz as required to complete the fragmentation process with minimal migration. RESULT: Group A had 58 patients and Group B 55 patients for analysis of perioperative variables. Stone free rate (<2mm) is in favor of systematic stone dusting with variable frequency (95.8% vs 83.6%, p=0.05). Post-operative fever and pain were not statistically significant between the groups (fever 10.3% vs 9.1%, p=1.00) (pain mean VAS 1/10 in group A vs 2/10 in group B). CONCLUSION: The solitary hard stones of 10 to 20 mm can be treated with more than 95% SFR using variable laser settings producing fine dust, without increase in significant postoperative complications or hospital stay.

Published in International Journal of Clinical Urology (Volume 4, Issue 2)
DOI 10.11648/j.ijcu.20200402.18
Page(s) 68-72
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Retrograde Intra Renal Surgery, Dusting, Popcorn, Laser Settings, Stone Free Rate

References
[1] Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 2013; 112: 355-361.
[2] Lee JW, Park J, Lee SB, Son H, Cho SY, Jeong H. Mini-percutaneous Nephrolithotomy vs Retrograde Intrarenal Surgery for Renal Stones Larger Than 10 mm: A Prospective Randomized Controlled Trial. Urology 2015; 86: 873-877.
[3] Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A. Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy in the Management of Lower-Pole Renal Stones with a Diameter of 15 to 20 mm. J Endourol July 2011; 25: 1131-1135.
[4] Kronenberg P, Traxer O. In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy – a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters. BJU Int 2014; 114: 261–267.
[5] Matlaga BR, Chew BH, Eisner B, et al. Ureteroscopic Laser Lithotripsy: A Review of Dusting Versus Fragmentation With Extraction. J Endourol 2018; 32: 1-6.
[6] Wollin DA, Ackerman A, Yang C, et al. Variable Pulse Duration From a New Holmium:YAG Laser: The Effect on Stone Comminution, Fiber Tip Degradation, and Retropulsion in a Dusting Model. Urology 2017; 103: 47-51.
[7] Emiliani E, Talso M, Cho SY, et al. Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique. J Urol 2017; 198: 702-706.
[8] Bader MJ, Pongratz T, Khoder W, et al. Impact of pulse duration on Ho:YAG laser lithotripsy: fragmentation and dusting performance. World J Urol 2015; 33: 471-477.
[9] Wezel F, Häcker A, Gross AJ, Michel MS, Bach T. Effect of pulse energy, frequency and length on holmium:yttrium-aluminum-garnet laser fragmentation efficiency in non-floating artificial urinary calculi. J Endourol 2010; 24: 1135-1140.
[10] Netsch C, Knipper S, Tiburtius C, et al. Systematic evaluation of a holmium: yttrium-aluminumgarnet laser lithotripsy device with variable pulse peak power and pulse duration. Asian J Urol 2014; 1: 57-61.
[11] Li R, Ruckle D, Keheila M, et al. High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi. J Endourol 2017; 31: 272-277.
[12] Chew BH, Shah O, Sur RL, et al. Dusting vs basketing during ureteroscopic lithotripsy–what is more efficacious? interim analysis from a multi-centre prospective trial from the edge research consortium. J Urol suppl 2015; 193: e261-262.
[13] SW Gamal G, Mmdouh A. RIRS: Dusting vs fragmentation for renal stone < 2 cm. J Urol Suppl 2016; 195; e254.
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  • APA Style

    Chandra Mohan Vaddi, Siddalinga Swamy Panchekante Matha, Ramakrishna Paidakula, Soundarya Ganesan, Manas Babu, et al. (2020). Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate. International Journal of Clinical Urology, 4(2), 68-72. https://doi.org/10.11648/j.ijcu.20200402.18

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    ACS Style

    Chandra Mohan Vaddi; Siddalinga Swamy Panchekante Matha; Ramakrishna Paidakula; Soundarya Ganesan; Manas Babu, et al. Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate. Int. J. Clin. Urol. 2020, 4(2), 68-72. doi: 10.11648/j.ijcu.20200402.18

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    AMA Style

    Chandra Mohan Vaddi, Siddalinga Swamy Panchekante Matha, Ramakrishna Paidakula, Soundarya Ganesan, Manas Babu, et al. Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate. Int J Clin Urol. 2020;4(2):68-72. doi: 10.11648/j.ijcu.20200402.18

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  • @article{10.11648/j.ijcu.20200402.18,
      author = {Chandra Mohan Vaddi and Siddalinga Swamy Panchekante Matha and Ramakrishna Paidakula and Soundarya Ganesan and Manas Babu and Hemnath Anandan},
      title = {Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate},
      journal = {International Journal of Clinical Urology},
      volume = {4},
      number = {2},
      pages = {68-72},
      doi = {10.11648/j.ijcu.20200402.18},
      url = {https://doi.org/10.11648/j.ijcu.20200402.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20200402.18},
      abstract = {OBJECTIVE: To assess the outcome of variable laser settings verses fixed setting on the stone free rate and complications. MATERIAL AND METHOD: We conducted a prospective, single-blind randomized controlled study. Solitary renal non lower pole stones 10 to 20 cm were included. A total of 113 Patients were randomly divided in to two groups. In group A, fixed laser setting was used at 1.0J energy and 12Hz frequency during the entire procedure. In Group B, variable laser settings were used; initial fine fragmentation was performed @ 1.0J X 12Hz. Once the residual stone reduced enough to wobble, the energy was reduced to 0.8 J and 8Hz. Settings were further reduced to 0.5J and 5Hz as required to complete the fragmentation process with minimal migration. RESULT: Group A had 58 patients and Group B 55 patients for analysis of perioperative variables. Stone free rate (<2mm) is in favor of systematic stone dusting with variable frequency (95.8% vs 83.6%, p=0.05). Post-operative fever and pain were not statistically significant between the groups (fever 10.3% vs 9.1%, p=1.00) (pain mean VAS 1/10 in group A vs 2/10 in group B). CONCLUSION: The solitary hard stones of 10 to 20 mm can be treated with more than 95% SFR using variable laser settings producing fine dust, without increase in significant postoperative complications or hospital stay.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate
    AU  - Chandra Mohan Vaddi
    AU  - Siddalinga Swamy Panchekante Matha
    AU  - Ramakrishna Paidakula
    AU  - Soundarya Ganesan
    AU  - Manas Babu
    AU  - Hemnath Anandan
    Y1  - 2020/10/07
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcu.20200402.18
    DO  - 10.11648/j.ijcu.20200402.18
    T2  - International Journal of Clinical Urology
    JF  - International Journal of Clinical Urology
    JO  - International Journal of Clinical Urology
    SP  - 68
    EP  - 72
    PB  - Science Publishing Group
    SN  - 2640-1355
    UR  - https://doi.org/10.11648/j.ijcu.20200402.18
    AB  - OBJECTIVE: To assess the outcome of variable laser settings verses fixed setting on the stone free rate and complications. MATERIAL AND METHOD: We conducted a prospective, single-blind randomized controlled study. Solitary renal non lower pole stones 10 to 20 cm were included. A total of 113 Patients were randomly divided in to two groups. In group A, fixed laser setting was used at 1.0J energy and 12Hz frequency during the entire procedure. In Group B, variable laser settings were used; initial fine fragmentation was performed @ 1.0J X 12Hz. Once the residual stone reduced enough to wobble, the energy was reduced to 0.8 J and 8Hz. Settings were further reduced to 0.5J and 5Hz as required to complete the fragmentation process with minimal migration. RESULT: Group A had 58 patients and Group B 55 patients for analysis of perioperative variables. Stone free rate (<2mm) is in favor of systematic stone dusting with variable frequency (95.8% vs 83.6%, p=0.05). Post-operative fever and pain were not statistically significant between the groups (fever 10.3% vs 9.1%, p=1.00) (pain mean VAS 1/10 in group A vs 2/10 in group B). CONCLUSION: The solitary hard stones of 10 to 20 mm can be treated with more than 95% SFR using variable laser settings producing fine dust, without increase in significant postoperative complications or hospital stay.
    VL  - 4
    IS  - 2
    ER  - 

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Author Information
  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

  • Department of Urology, Preeti Urology and Kidney Hospital, Hyderbad, Telangana, India

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