Ex vivo comparison of four lithotripters commonly used in the ureter: What does it take to perforate?

Robert W. Santa-Cruz, Raymond J. Leveillee, Arnon Krongrad

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

We hoped to determine the number of pulses and energy needed to create acute ureteral perforations with four different lithotripters in a reproducible ex vivo model. A simple model was constructed to control variables in the testing such as wall thickness, intraluminal pressure, distance between the probe tip and ureter, and power delivered to tissue. Segments of domestic pig ureter were prepared and fixed in position in a normal saline (NS) bath at room temperature. We then attempted perforation with the holmium:YAG (Hot) laser, coumarin pulsed-dye laser (CdL), electrohydraulic lithotripter (EHL), and pneumatic impactor (PI) by placing the instrument probes at right angles to the ureteral wall. The ureter was filled with a methylene blue-stained solution of NS at 90 cm H2O pressure via a urodynamics catheter, and perforation was recorded on initial extravasation of dye. The endpoints measured were time to perforation and total energy required. At 0.5 mm of separation between the wall and probe, the HoL perforated the ureter in an average of 2 seconds and 0.01 kJ delivered at 5 W (10 Hz and 0.5 J/pulse). The EHL perforated at an average of 24.44 ± 8.77 seconds and a total energy of 0.01 ± 0 kJ. The CdL was able to perforate but at much longer intervals (257.51 ± 99.08 seconds) and higher energy levels (12.88 ± 4.95 kJ) on average than either the EHL or HoL. Lastly, the PI was unable to perforate the ureter in more than 6 continuous minutes of application. In addition, we found that at 2-mm separation between the HoL probe tip and the ureteral wall, acute perforation was not possible even at very high power settings. We conclude that although each endoscopic lithotripter has advantages as well as disadvantages, in this ex vivo model, it was clear that the HoL and EHL can easily perforate the ureter and must be used with vigilance. It was found that at 2 mm of separation between the probe and target, the HoL, was unable to perforate acutely. The CdL and PI were associated with a much higher safety index, and the PI was unable to produce ureteral perforation.

Original languageEnglish
Pages (from-to)417-422
Number of pages6
JournalJournal of Endourology
Volume12
Issue number5
StatePublished - Oct 1 1998
Externally publishedYes

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Ureter
Dye Lasers
Pressure
Sus scrofa
Urodynamics
Methylene Blue
Solid-State Lasers
Baths
Sodium Chloride
Coloring Agents
Catheters
Safety
Temperature
coumarin

ASJC Scopus subject areas

  • Urology

Cite this

Ex vivo comparison of four lithotripters commonly used in the ureter : What does it take to perforate? / Santa-Cruz, Robert W.; Leveillee, Raymond J.; Krongrad, Arnon.

In: Journal of Endourology, Vol. 12, No. 5, 01.10.1998, p. 417-422.

Research output: Contribution to journalArticle

Santa-Cruz, RW, Leveillee, RJ & Krongrad, A 1998, 'Ex vivo comparison of four lithotripters commonly used in the ureter: What does it take to perforate?', Journal of Endourology, vol. 12, no. 5, pp. 417-422.
Santa-Cruz, Robert W. ; Leveillee, Raymond J. ; Krongrad, Arnon. / Ex vivo comparison of four lithotripters commonly used in the ureter : What does it take to perforate?. In: Journal of Endourology. 1998 ; Vol. 12, No. 5. pp. 417-422.
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