Technical considerations using a pulsed neodym-YAG laser for endoscopic shock wave lithotripsy. 1989

J Rassweiler, and U Irion, and R Strauss, and P Bub, and F Eisenberger
Urologic Clinic, Katharinenhospital, Stuttgart, FRG.

First clinical experience with the use of a Q-switched pulsed Neodym-YAG Laser showed promising results. This paper focuses on two problems with respect to the optimal use of this laser: (1) is there any need for a special iron (Fe3+)-enriched irrigant, and (2) what is the best frequency for laser lithotripsy? To answer these questions, we used an in vitro model, measuring the laser-induced breakdown (LIB) photographically utilizing sodium chloride as an irrigant enriched with different amounts of Fe3+ ions. The disintegrative efficacy of the laser was tested utilizing a standard stone model (plaster cube) and working at different frequencies (1, 10, 40 Hz). The addition of Fe3+ ions resulted in significant improvement of LIB. However, in the presence of a test stone no difference between sodium chloride and Fe3+-enriched irrigants was noted. The use of lower frequencies (1, 10 Hz) lead to a remarkable improvement in the disintegrative efficacy of the laser compared to the standard frequencies (40, 50 Hz). For clinical use, addition of Fe3+ ions seems only necessary if optical breakdown (LIB) is insufficient despite the increase in generator voltage. In such a situation, we recommend the addition of an 1-ml Fe3+ solution to 10 liters of sodium chloride irrigant (= 0.5 mg Fe3+/dl). Moreover, the standard frequency for laser-induced intracorporeal lithotripsy should be 1-10 Hz.

UI MeSH Term Description Entries
D007507 Therapeutic Irrigation The washing of a body cavity or surface by flowing water or solution for therapy or diagnosis. Douching,Lavage,Douchings,Irrigation, Therapeutic,Irrigations, Therapeutic,Lavages,Therapeutic Irrigations
D008096 Lithotripsy The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is LITHOTRIPSY, LASER. ESWL (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsy,Extracorporeal Shockwave Lithotripsy,Litholapaxy,Noninvasive Litholapaxy,Percutaneous Ultrasonic Lithotripsy,Ultrasonic Lithotripsy,ESWLs (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsies,Extracorporeal Shockwave Lithotripsies,Litholapaxies,Litholapaxies, Noninvasive,Litholapaxy, Noninvasive,Lithotripsies,Lithotripsies, Electrohydraulic Shockwave,Lithotripsies, Extracorporeal Shockwave,Lithotripsies, Percutaneous Ultrasonic,Lithotripsies, Ultrasonic,Lithotripsy, Electrohydraulic Shockwave,Lithotripsy, Extracorporeal Shockwave,Lithotripsy, Percutaneous Ultrasonic,Lithotripsy, Ultrasonic,Noninvasive Litholapaxies,Percutaneous Ultrasonic Lithotripsies,Shockwave Lithotripsies, Electrohydraulic,Shockwave Lithotripsies, Extracorporeal,Shockwave Lithotripsy, Electrohydraulic,Shockwave Lithotripsy, Extracorporeal,Ultrasonic Lithotripsies,Ultrasonic Lithotripsies, Percutaneous,Ultrasonic Lithotripsy, Percutaneous
D008961 Models, Structural A representation, generally small in scale, to show the structure, construction, or appearance of something. (From Random House Unabridged Dictionary, 2d ed) Model, Structural,Structural Model,Structural Models
D005290 Ferric Compounds Inorganic or organic compounds containing trivalent iron. Compounds, Ferric
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014545 Urinary Calculi Low-density crystals or stones in any part of the URINARY TRACT. Their chemical compositions often include CALCIUM OXALATE, magnesium ammonium phosphate (struvite), CYSTINE, or URIC ACID. Urinary Stones,Urinary Tract Stones,Calculi, Urinary,Calculus, Urinary,Stone, Urinary,Stone, Urinary Tract,Stones, Urinary,Stones, Urinary Tract,Urinary Calculus,Urinary Stone,Urinary Tract Stone
D017602 Lithotripsy, Laser Fragmentation of CALCULI, notably urinary or biliary, by LASER. Laser Lithotripsy,Laser-Induced Shockwave Lithotripsy,Shockwave Lithotripsy, Laser-Induced,Laser Induced Shockwave Lithotripsy,Lithotripsies, Laser,Lithotripsy, Laser-Induced Shockwave,Shockwave Lithotripsy, Laser Induced
D053685 Laser Therapy The use of photothermal effects of LASERS to coagulate, incise, vaporize, resect, dissect, or resurface tissue. Laser Knife,Laser Scalpel,Surgery, Laser,Vaporization, Laser,Laser Ablation,Laser Knives,Laser Photoablation of Tissue,Laser Surgery,Laser Tissue Ablation,Nonablative Laser Treatment,Pulsed Laser Tissue Ablation,Ablation, Laser,Ablation, Laser Tissue,Knife, Laser,Knifes, Laser,Knive, Laser,Knives, Laser,Laser Knifes,Laser Knive,Laser Scalpels,Laser Surgeries,Laser Therapies,Laser Treatment, Nonablative,Laser Treatments, Nonablative,Laser Vaporization,Nonablative Laser Treatments,Scalpel, Laser,Scalpels, Laser,Surgeries, Laser,Therapies, Laser,Therapy, Laser,Tissue Ablation, Laser

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