Stone retropulsion during holmium:yag lithotripsy

被引:125
作者
Lee, H [1 ]
Ryan, RT
Teichman, JMH
Kim, J
Choi, B
Arakeri, NV
Welch, AJ
机构
[1] Univ Texas, Hlth Sci Ctr, Div Urol, San Antonio, TX 78284 USA
[2] Univ Texas, Dept Engn Mech, Austin, TX USA
[3] Univ Texas, Dept Elect & Comp Engn, Austin, TX 78712 USA
[4] Univ Texas, Dept Biomed Engn, Austin, TX 78712 USA
关键词
ureter; ureteral calculi; lithotripsy; laser; movement;
D O I
10.1097/01.ju.0000046367.49923.c6
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We modeled retropulsion during holmium:YAG lithotripsy on the conservation of momentum, whereby the force of ejected fragment debris off of the calculous surface should equal the force of retropulsion displacing the stone. We tested the hypothesis that retropulsion occurs as a result of ejected stone debris. Materials and Methods: Uniform calculous phantoms were irradiated with holmium:YAG energy in air and. in water. Optical fiber diameter and pulse energy were varied. Motion of the phantom was monitored with high speed video imaging. Laser induced crater volume and geometry were characterized by optical coherence tomography. To determine the direction of plume laser burn paper was irradiated at various incident angles. Results: Retropulsion was greater for phantoms irradiated in air versus water. Retropulsion increased as fiber diameter increased and as pulse energy increased (p < 0.001). Crater volumes increased as pulse energy increased (p < 0.05) and generally increased as fiber diameter increased. Crater geometry was wide and shallow for larger fibers, and narrow and deeper for smaller fibers. The ejected plume propagated in the direction normal to the burn paper surface regardless of the laser incident angle. Conclusions: Retropulsion increases as pulse energy and optical fiber diameter increase. Vector analysis of the ejected plume and crater geometry explains increased retropulsion using larger optical fibers. Holmium:YAG lithotripsy should be performed with small optical fibers to limit retropulsion.
引用
收藏
页码:881 / 885
页数:5
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