Temperature profiles of calyceal irrigation fluids during flexible ureteroscopic Ho:YAG laser lithotripsy
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UROLOGY - ORIGINAL PAPER
Temperature profiles of calyceal irrigation fluids during flexible ureteroscopic Ho:YAG laser lithotripsy Jingfei Teng1 · Yi Wang2 · Zhuomin Jia1 · Yawei Guan1 · Weiwei Fei3 · Xing Ai1,4 Received: 15 August 2020 / Accepted: 21 September 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate calyceal irrigation fluid temperature changes during flexible ureteroscopic Ho:YAG laser lithotripsy. Methods Between May 2019 and January 2020, patients with kidney stones undergoing flexible ureteroscopic Ho:YAG laser lithotripsy were enrolled. A K-type thermocouple was applied for intraoperative temperature measurement. Laser was activated at different power (1 J/20 Hz and 0.5 J/20 Hz) and irrigation (0 ml/min, 15 ml/min and 30 ml/min) settings, temperature–time curve was drawn and time needed to reach 43 °C without irrigation was documented. Results Thirty-two patients were enrolled in our study. The temperature–time curve revealed a quick temperature increase followed by a plateau. With 15 ml/min or 30 ml/min irrigation, 43 °C was not reached after 60 s laser activation at both 1 J/20 Hz and 0.5 J/20 Hz. At the power setting of 1 J/20 Hz and irrigation flow rate of 15 ml/min, the temperature rise was significantly higher than other groups. Without irrigation, the time needed to reach 43 °C at 1 J/20 Hz was significantly shorter than that at 0.5 J/20 Hz (8.84 ± 1.41 s vs. 13.71 ± 1.53 s). Conclusion Ho:YAG laser lithotripsy can induce significant temperature rise in calyceal fluid. With sufficient irrigation, temperatures can be limited so that a toxic thermal dose is not reached, when irrigation is closed, the temperature increased sharply and reached 43 °C in a few seconds. Keywords Ho:YAG laser · Ureteroscopy · Lithotripsy · Temperature · Thermal injury Abbreviations SWL Shockwave lithotripsy URS Ureteroscopy PCNL Percutaneous nephrolithotomy RIRS Retrograde intrarenal surgeries Ho:YAG Holmium:yttrium aluminum garnet SD Standard deviation ANOVA Analysis of variance BMI Body mass index CEM43 Cumulative equivalent minutes at 43 °C * Xing Ai [email protected] 1
Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing 100700, China
2
Department of Urology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
3
Department of Anesthesiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing 100700, China
4
The Second School of Clinical Medicine, Southern Medical University, Beijing 100700, China
Background The incidence of urolithiasis is increasing worldwide [1]. Currently, shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) constitute the mainstream procedures. It is reported that retrograde intrarenal surgeries (RIRS) including semi-rigid and flexible ureteroscopy have encountered a drastic growth in the past few years [2]. Holmium:yttrium aluminum garnet (Ho:YAG) laser is recognized as the optimum standard for URS and flexible
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