Category: New Technology: Stones

MP5-14 - Comparing dusting efficiency of Holmium laser lithotripsy with and without Moses technology

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

To compare dusting efficiency of holmium yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy with and without Moses technology.


Methods :

All experiments were conducted ex vivo using a Boston Lithovue flexible ureteroscope for direct vision and fiber control, as well as a Lumenis P120H Ho:YAG laser generator with corresponding 200 µm laser fibers. Calcium-oxalate monohydrate (COM) or uric acid (UA) stones were placed into a 4.5 ml glass container. Each stone was submitted to laser lithotripsy for 2’30’’, using Lumenis’ default dusting settings (0.2 J, 80 Hz, short pulse) either with or without Moses technology (“contact” mode) and a constant irrigation pressure of 40 cmH20. The resulting stone dust was separated from larger residual fragments based on the floating ability of stone particles. For this, dust from irrigation overflow was collected during lithotripsy, as well as during an additional irrigation phase of 2’ after lithotripsy. Experiments were repeated five times for each stone composition. Differences between two groups were compared using Mann-Whitney U tests.


Results :

In the Moses and non-Moses group, initial mean stone weight was 180 mg (SD 48 mg) and 188 mg (SD 52 mg) for COM samples (p=0.80), and 280 (SD 79) and 266 mg (SD 87) for UA samples (p=0.95), respectively. For COM stones, there was no significant difference in dust production between both groups (96 mg vs. 87 mg, p=0.53). For UA stones, a trend towards a higher dust production was found in favor of the Moses group (126 mg vs. 99 mg, p=0.08).


Conclusions :

The dusting effect of Ho:YAG laser lithotripsy with Moses technology seems to differ between stone types. Moses may provide more efficient dusting for UA stones. Contrarily, Moses may not offer any advantage for COM stones.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Paul H.L. Chiron

MD, FEBU
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Saint Mandé, Ile-de-France, France

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France