Laser lithotripsy involves thermal risks due to heat generated in the surrounding fluid. The concept of thermal dose, which accounts for both temperature and exposure duration, provides a more nuanced understanding of tissue tolerance than fixed temperature thresholds, considering both the magnitude of the temperature increase and the length of exposure to each specific temperature. The concept of a thermal safety distance defines the spatial extent of potential damage, supporting safe power limits of 10 W in the ureter and 20 W in the kidney. Importantly, the type of laser (holmium:YAG, thulium fiber, or thulium:YAG) does not independently affect the rise in temperature, which is primarily driven by the amount of energy absorbed by water in the surrounding tissue. Temperature-related tissue injury can be mitigated by optimizing the flow of the irrigation fluid and the laser power settings and activation patterns. PATIENT SUMMARY: Laser treatment for stones in the kidney or ureter generates heat, which can harm adjacent tissues. The use of low-power settings and proper fluid flow helps in reducing this risk.
European urology focus. 2025 Jun 04 [Epub ahead of print]
Felipe Pauchard, Mariela Corrales, Davide Perri, Daniele Robesti, Arman Tsaturyan, Bhaskar K Somani, Ioannis Kartalas Goumas, Olivier Traxer, Eugenio Ventimiglia
Progressive Endourological Association for Research and Leading Solutions, Paris, France; European Association of Urology Endourology Section, Arnhem, The Netherlands; Urology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile., Progressive Endourological Association for Research and Leading Solutions, Paris, France; European Association of Urology Endourology Section, Arnhem, The Netherlands; Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France; European Association of Urology Young Academic Urologists Urolithiasis and Endourology Working Party, Arnhem, The Netherlands., Division of Urology, ASST Lariana Sant'Anna Hospital, San Fermo della Battaglia, Italy., European Association of Urology Endourology Section, Arnhem, The Netherlands., Department of Urology, M. Heratsi Yerevan State Medical University, Yerevan, Armenia., European Association of Urology Endourology Section, Arnhem, The Netherlands; Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Progressive Endourological Association for Research and Leading Solutions, Paris, France; European Association of Urology Endourology Section, Arnhem, The Netherlands; Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France., Progressive Endourological Association for Research and Leading Solutions, Paris, France; European Association of Urology Endourology Section, Arnhem, The Netherlands; European Association of Urology Young Academic Urologists Urolithiasis and Endourology Working Party, Arnhem, The Netherlands; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: .