Dependence of calculus retropulsion on pulse duration during HO: YAG laser lithotripsy

Abstract

Background and Objectives The purpose of this study was to investigate the effect of optical pulse duration on stone retropulsion during Ho:YAG (λ = 2.12 µm) laser lithotripsy. Study Design/Materials and Methods A clinical Ho:YAG laser with pulse durations was employed to fragment calculus phantoms and to evaluate stone phantom retropulsion. At a given pulse energy, optical pulse durations were divided into two discrete conditions: short pulse (τ_p: 120 ∼ 190 µseconds at FWHM) and long pulse (τ_p: 210 ∼ 350 µseconds at FWHM). Plaster of Paris calculus phantoms were ablated at different energy levels using optical fibers of varying diameters (273, 365, and 550 µm in core size). The dynamics of the recoil action of a calculus phantom was monitored using a high‐speed camera; the laser‐induced craters were evaluated with optical coherent tomography (OCT). Bubble formation and collapse were recorded with a fast flash photography setup, and acoustic transients were measured with a hydrophone. Results Shorter pulse durations produced more stone retropulsion than longer pulses at any given pulse energy. Regardless of pulse duration, higher pulse energy and larger fibers resulted in larger ablation volume and retropulsion (PP<0.05). Conclusion Less retropulsion and equivalent fragmentation occurred when Ho:YAG pulse duration increased. Lasers Surg. Med. 38:762–772, 2006.