Chicago—A new tool for kidney stone ablation demonstrates strong potential to dust and fragment stones more quickly and efficiently than devices currently available in the United States. However, clinical studies must be performed before this technology can be used during lithotripsy nationally.
Ben H. Chew, MD, MSc, associate professor of urologic sciences at the University of British Columbia, Vancouver, presented a study of the Super Pulse Thulium Fiber (SPTF) laser during a moderated poster session at the 2019 AUA annual meeting in Chicago. The study compared the SPTF laser’s ability to dust and fragment Begostones to that of a commercially available 120W Holmium:YAG laser, the current lithotrite of choice.
“The SPTF is much smaller and uses less power than the Ho:YAG laser. We basically wanted to show the best foot forward for each of them to compare their efficacy,” Dr. Chew told Urology Times.
The results of the study—performed with Bodo E. Knudsen, MD, of The Ohio State University Wexner Medical Center, Columbus, and Wilson Molina, MD, of the University of Kansas Medical Center, Kansas City—show greater potential to control stone fragmentation than lithotrites that are currently used for patient care.
Advancements to the Holmium:YAG laser have supercharged this technology for clinical use, but downsides remain, including high amperage power requirements, upper limits of pulse frequency, and limitations regarding fiber size. The SPTF laser uses Thulium Fiber—not to be mistaken with Thulium:YAG—that offers low-pulse energy settings and pulse frequencies over 600 Hz.
The authors tested the SPTF and a 120W Holmium:YAG laser in ablating standard, homogenous 5-mm3 BegoStones until remaining particles were smaller than 1 mm. To test fragmentation and dusting, resulting particle sizes were measured after delivering a total of 0.5 kJ and 2 kJ, respectively.
The results were striking. At both fragmentation and dusting settings, the SPTF was significantly faster and more efficient at ablating the entire BegoStone into fragments less than 1 mm in size.