LAUSR

OBJECTIVES To better understand the impact of laser fiber-tip configuration on lithotripsy performance, we undertook an in vitro study comparing three fiber-tip configurations: 1) new (single-use), 2) cleaved (re-usable) and 3) coated (cut with scissors). METHODS Lithotripsy was performed using a Ho:YAG laser utilizing fragmentation (1Jx10Hz) and dusting (0.5Jx20Hz) settings. BegoStones were fragmented with a laser fiber advancing at a speed of 1 mm/s (220 seconds of activation). Three fiber-tip configurations were tested: new single-use standard (242 μm core) and cleaved (272 μm core), compared to the same fiber-tip coated/cut flush with scissors, respectively. Study outcome was difference in stone mass before and after each experiment. Power output was measured using a power meter. RESULTS Fragmentation for new or cleaved fibers was greater than the coated/cut flush fiber-tip (p<0.05). For 1Jx10Hz and 0.5Jx20Hz settings, fragmentation was 59% and 75% higher with new fiber-tip compared to the coated/cut flush fiber-tip, respectively. For 1Jx10Hz and 0.5Jx20Hz settings, fragmentation was 51% and 45% higher with cleaved fiber-tip compared to the coated/cut flush fiber-tip, respectively. Power output at the end of laser activation was higher for new and cleaved fiber-tips. CONCLUSION New and cleaved laser fibers demonstrated superior lithotripsy performance compared to fibers that were coated/cut flush with scissors. Cutting single-use laser fibers risks damaging the fiber-tip which can disperse the energy and reduce lithotripsy efficiency.