(UroToday.com) Dr. Thomas Chi of the University of California, San Francisco gave a talk on the actual technologies available currently to fragment stones. Dr. Chi opened by talking about the “very scary” Electrohydraulic Lithotripsy (EHL) from around the 1980s, a first-generation lithotripsy method that utilized a shock to explode stones. Thanks to the efforts of many pioneers like the late Dr. Demetrius Bagley, the field of urology now has the capability to use lasers. The use of lasers like the holmium has allowed for stones to be broken down into much smaller pieces while boasting little tissue penetration, meaning it is safer for patients. To illustrate the function of lasers and how their use has varied over time, Dr. Chi discussed the use of Cavitation bubbles (bubbles in fluid are used to burst stones). This along with frequency vs energy settings in lasers has paved the way to change energy delivery in urology.
Pulse Modulation Technology is a technique that focuses on the change of delivery for energy. Pulse modulation lasers can change the shape of the bubble and how they explode. This results in increased efficiency, less retropulsion, and optimized energy transmission leading to faster work and higher stone free rates. The image below is a screenshot from a video Dr. Chi posted where he shows the benefit of this type of energy delivery has on fragmenting stones, finer dust, and more stable fragmentation.
Another advantage to this technique is that it uses smaller laser fibers. These fibers offer increased flexibility and better manipulation during ureteroscopy. This easy-to-use laser can easily bend with the ureteroscope, allowing for better intervention in difficult to reach regions in the kidney.
Dr. Chi continued this lecture by discussing how imperative it is to use a Combination Lithotrite during a common PCNL. Referring to the work done by Tim Large and Amy Krambeck’s team, utilizing this sort of technology allows for faster, high stone fragmenting rates compared to any other PCNL available technology.
As the lecture came to an end, Dr. Chi brought up some interesting ideas regarding new treatments on the horizon. Burst Wave lithotripsy from the University of Washington is a noninvasive treatment technique that utilizes an ultrasound probe to fragment stones.
Over the years, the technology of energy manipulation and innovative lasers have improved greatly, proving to be a massive game changer in the field of urology. Dr. Chi suggests that there could be a paradigm shift for minimally invasive surgeries. Thus, urologists should be open to new ways and methods that allow for better and more efficient treatment.
Presented by: Thomas Chi, MD, Professor and Associate Chair Kutzmann Endowed Professor for Clinical Urology, University of California, San Francisco
Written by: Seyed Amiryaghoub M. Lavasani, B.A., University of California Irvine, @amirlavasani_ on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.