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• W2940623632 abstract "You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD04)1 Apr 2019PD04-02 THERMAL DOSE DURING HOLMIUM LASER LITHOTRIPSY: IN VITRO URETERAL MODEL Ali H Aldoukhi*, Kristian M Black, Timothy L Hall, Khurshid R Ghani, Adam D Maxwell, Brian MacConaghy, and William W Roberts Ali H Aldoukhi*Ali H Aldoukhi* More articles by this author , Kristian M BlackKristian M Black More articles by this author , Timothy L HallTimothy L Hall More articles by this author , Khurshid R GhaniKhurshid R Ghani More articles by this author , Adam D MaxwellAdam D Maxwell More articles by this author , Brian MacConaghyBrian MacConaghy More articles by this author , and William W RobertsWilliam W Roberts More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555050.05233.6aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: High-power laser settings are commonly employed for stone dusting techniques. Previous in vitro and in vivo studies have demonstrated that a toxic thermal dose can result from treatment within a renal calyx. The risk of thermal damage with laser lithotripsy within the ureter is hypothesized to be even greater than in a renal calyx given the smaller volume of fluid adjacent to the laser fiber. The aim of this study was to experimentally measure temperature and calculate thermal dose for a range of laser power and irrigation parameters in a simulated ureteral model. METHODS: The experimental system consisted of a rounded glass tube (inner diameter 6 mm/length 130 mm) simulating a ureter that ends with a 19 mm sphere simulating a renal pelvis. A 242 μm laser fiber (Flexiva, Boston Scientific) was inserted through a ureteroscope (Lithovue, Boston Scientific) and positioned 60 mm away from the simulated pelvis wall. Real time temperature was recorded using two wire thermocouples; one at the level of the ureteroscope and another in the simulated pelvis. The model was placed in a water bath maintained at 37°C. Irrigation with room temperature fluid was provided at 25,12, or 6 mL/min. Laser energy was applied (pulse 120; Lumenis) for 60 seconds. Thermal dose for each trial was calculated based on Dewey and Sapareto t43 equivalence calculations. Thermal toxicity (cell death) was considered attained when t43= 120 minutes, the equivalent of maintain 43°C for 120 minutes. The probability of exceeding t43 = 120 equivalent minutes was determined for strategically selected power levels and irrigant flow rates in order to map the safety margin. Each experiment was repeated 5 times. RESULTS: Thermal dose within the ureter for each parameter pair (power, irrigation rate) is represented by a circle in Figure 1. The percentage of trials that exceeded t43= 120 minutes is indicated on each circle. Temperature in the renal pelvis was not elevated by laser lithotripsy in the ureter. CONCLUSIONS: We have defined a thermal safety threshold between safe and unsafe laser/irrigation parameter set pairs. Further studies are needed to map out the safety thresholds for other locations within the urinary tract. This methodology will also provide a framework in which to assess effectiveness of various strategies to control and mitigate thermal dose. Source of Funding: Research grant from Boston Scientific Ann Arbor, MI; Seattle, WA; Ann Arbor, MI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e73-e74 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali H Aldoukhi* More articles by this author Kristian M Black More articles by this author Timothy L Hall More articles by this author Khurshid R Ghani More articles by this author Adam D Maxwell More articles by this author Brian MacConaghy More articles by this author William W Roberts More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2940623632 title "PD04-02 THERMAL DOSE DURING HOLMIUM LASER LITHOTRIPSY: IN VITRO URETERAL MODEL" @default.
• W2940623632 doi "https://doi.org/10.1097/01.ju.0000555050.05233.6a" @default.
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