Ureteroscopy with Holmium: YAG Laser—A Initial Study in the Urology Department of the Pr Bocar Sidy Sall University Hospital of Kati

Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.

Primary prostate Burkitt's lymphoma resected with holmium laser enucleation of the prostate:A rare case report

BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.

A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the“ureter”during the ureteroscopic holmium laser lithotripsy in vitro.Methods:An in vitro lithotripsy was performed using a modified catheter(5 Fr)as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet.Different laser power settings(10 W,20 W,and 30 W)with various firing times(3 s,5 s,and 10 s)and rates of irrigation(15 mL/min,20 mL/min,and 30 mL/min)were applied in the experiment.Temperature changes in the“ureter”were recorded with a thermometer during and after the lithotripsy.Results:During the lithotripsy,the local highest mean temperature was 60.3℃ and the lowest mean temperature was 26.7℃.When the power was set to 10 w,the temperature was maintained below 43℃ regardless of laser firing time or irrigation flow.Regardless of the power or firing time selected,the temperature was below 43℃ at the rate of 30 mL/min.There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing(3 s,5 s,or 10 s)compared to with not drainage(p<0.05)except for two conditions of 0.5 J×20 Hz,30 mL/min,firing 5 s,and 1.0 J×10 Hz,30 mL/min,firing 5 s.Conclusion:Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect,especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts

Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.

High-Power Single-Spatial-Mode GaSb Tapered Laser around 2.0 μm with Very Small Lateral Beam Divergence

We report high-power single-spatial-mode type-I GaSb-based tapered lasers fabricated on the InGaSb/AlGaAsSb material system. A straight ridge and three different tapered waveguide structures with varying flare angles are fabricated to optimize the output power and spatial-mode performance. The best devices exhibit single-spatial-mode operation with room-temperature output power up to 350？mW in continuous-wave mode at an emission wavelength around 2.0？μm with a very small far-field lateral divergence angle, which is beyond state of the art in terms of single-spatial-mode output power.

A new method for measuring the pulse-front distortion of arbitrary shapes in high-power ultrashort laser systems

We present a new method that can be used to calculate pulse-front distortion by measuring the spectral interference of two point-diffraction fields in their overlapped district. We demonstrate, for the first time, the measurement of the pulse-front distortion of the pulse from a complex multi-pass amplification system, which exists in almost all high-power laser systems, and obtain the irregular pulse-front distribution. The method presented does not need any reference light or assumption about the pulse-front distribution, and has an accuracy of several femtoseconds.

High-Power Passively Q-Switched Nd:YAG Laser at 1112 nm with a Cr^(4+):YAG Saturable Absorber

A high-power passively Q-switched Nd：YAG laser operating at lll2nm with Cr4＋：yAO as a saturable absorber is demonstrated. Under 808 nm diode-direct pumping, the maximum average output power of 2.73 W is achieved at the pump power of 16.65 W, corresponding to an optical-to-optical conversion efficiency of 16.4%. At the same time, the pulse width, pulse repetition rate, single pulse energy and peak power are 27.2ns, 9 kHz, 303.3#3 and 11.2kW, respectively. As far as we know, the result gives the highest average output power at 1112nm generated by an 808 nm diode-end-pumped Nd：YAG laser.

Elucidation of Metallic Plume and Spatter Characteristics Based on SVM During High-Power Disk Laser Welding

During deep penetration laser welding,there exist plume（weak plasma） and spatters,which are the results of weld material ejection due to strong laser heating.The characteristics of plume and spatters are related to welding stability and quality.Characteristics of metallic plume and spatters were investigated during high-power disk laser bead-on-plate welding of Type 304 austenitic stainless steel plates at a continuous wave laser power of 10 kW.An ultraviolet and visible sensitive high-speed camera was used to capture the metallic plume and spatter images.Plume area,laser beam path through the plume,swing angle,distance between laser beam focus and plume image centroid,abscissa of plume centroid and spatter numbers are defined as eigenvalues,and the weld bead width was used as a characteristic parameter that reflected welding stability.Welding status was distinguished by SVM（support vector machine） after data normalization and characteristic analysis.Also,PCA（principal components analysis） feature extraction was used to reduce the dimensions of feature space,and PSO（particle swarm optimization） was used to optimize the parameters of SVM.Finally a classification model based on SVM was established to estimate the weld bead width and welding stability.Experimental results show that the established algorithm based on SVM could effectively distinguish the variation of weld bead width,thus providing an experimental example of monitoring high-power disk laser welding quality.

Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.

High-Power Continuous-Wave and Acousto-Optical Q-Switched Ho:(Sc_(0.5)Y_(0.5))_2SiO_5 Laser Pumped by Laser Diode

We experimentally investigate the continuous-wave(cw)and acousto-optical(AO)Q-switched performance of a diode-pumped Ho:(Sc_(0.5)Y_(0.5))_2SiO_5(Ho:SYSO)laser.A fiber-coupled laser diode at 1.91m is employed as the pump source.The cw Ho:SYSO laser produces 13.0 W output power at 2097.9 nm and 56.0%slope efficiency with respect to the absorbed pump power.In the AO Q-switched regime,at a pulse repetition frequency of 5 kHz,the Ho:SYSO laser yields 2.1 mJ pulse energy and 21 ns pulse width,resulting in a calculated peak power of 100 k W.In addition,at the maximum output level,the beam quality factor of the Q-switched Ho:SYSO laser is measured to be about 1.6.

Formation of choroidal neovascularization under macular fovea after high-power laser irradiation: a case report

Dear Editor,I am Dr.Shan-Shan Li,from Northern Jiangsu People’s Hospital,Yangzhou,China.I write to present the case of formation of choroidal neovascularization(CNV)under the fovea after high-power laser irradiation.Currently,there is an increasing availability and accessibility to laser instruments,but improper use of these tools can lead to macular damage and irreversible visual impairment.

An accurate and stable method of array element tiling for high-power laser facilities

Due to laser-induced damage, the aperture of optics is one of the main factors limiting the output capability of highpower laser facilities. Because of the general difficulty in achieving large-aperture optics, an alternative solution is to tile some small-aperture ones together. We propose an accurate, stable, and automatic method of array element tiling and verify it on a double-pass 1 × 2 tiled-grating compressor in the XG-III laser facility. The test results show the accuracy and stability of the method. This research provides an efficient way to obtain large-aperture optics for high-power laser facilities.

High-Power Dual-End-Pumped Actively Q-Switched Ho:YAG Ceramic Laser

We present a high-power Ho：YAG ceramic laser pumped at 1908nm. Using a dual-end-pumped structure, the maximum continuous-wave output power of 48 W is obtained, corresponding to a slope efficiency of 70.4% with respect to the absorbed pump power. At actively Q-switched mode, the maximum average output power of 46 W and the minimum pulse width of 21 ns are achieved at a pulse repetition frequency of 20 kHz, corresponding to a peak power of approximately 109.5kW. In addition, the beam-quality M2 factor is found to be 1.4 at the maximum output power.

High-Power Continuous-Wave Nd:GdVO4 Solid-State Laser Dual-End-Pumped at 880 nm

A high-power cw all-solid-state Nd：GdVO4 laser operating at 88Onto is reported. The laser consists of a low doped level Nd：GdV04 crystal dual-end-pumped by two high-power diode lasers and a compact negative confocM unstable-stable hybrid resonator. At an incident pump power of 820 W, a maximum cw output of 240 W at 1064nm is obtained. The optical-to-optical efficiency and Mope efficiency are 40.7% and 53.2%, respectively. The M2 factors in the unstable direction and in the stable direction are 4.38 and 5.44, respectively.

High-Power and High-Efficiency Operation of Terahertz Quantum Cascade Lasers at 3.3 THz

A high-power and high-effciency GaAs/A1GaAs-based terahertz （THz） quantum cascade laser structure emitting at 3.3 THz is presented. The structure is based on a hybrid bound-to-continuum transition and resonant-phonon extraction active region combined with a semi-insulating surface-plasmon waveguide. By optimizing material structure and device processing, the peak optical output power of 758mW with a threshold current density of 120 A/cm2 and a wall-plug effciency of 0.92% at 10K and 404mW at 77K are obtained in pulsed operation. The maximum operating temperature is as high as llS K. In the cw mode, a record optical output power of 160roW with a threshold current density of 178A/cm2 and a wall-plug efficiency of 1.32% is achieved at 1OK.

Coagulation of a giant hemangioma in glans penis with holmium laser

A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.

Treatment of Special Renal Colic with Ureteroscope and Holmium YAG Laser

Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were relieved in a short period of time and the original ureter diseases causing renal colic were cured. Conclusion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and effective manner.

Ureteroscopic Holmium:YAG Laser Lithotripsy for Managing Ureteral Calculi (A Report of 168 Cases)

Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Effect of the high-power electromagnetic pulses on the reactivity of the coal-water slurry in hot environment

An effect of the high-power electromagnetic pulses onto the droplet of coal-water slurry inside the furnace was investigated.In contrary to the previously investigated laser-induced fuel atomization that occurs at the room temperature,the pre-heated(to 400 K)slurry becomes dry enough to prevent the explosion-like steam formation.Thus,fuel does not atomize and the ignition does not accelerate.Furthermore,the absorption of several laser pulses leads to evident sintering of irradiated surface with following increase of the ignition delay time for up to 24%.Variation of the pulse energy in range 48-118 mJ(corresponding intensity up to 2.4 J·cm^-2)leads to certain variation of the increase of ignition delay.The strong pulsed overheating of the coal water slurry which does not initiate the fine atomization of the fuel generally makes its ignition longer.

Comparison of the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus

Objective:To study the differences in the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus.Methods: A total of 78 patients with complex renal calculus who accepted surgical treatment in our hospital between May 2011 and January 2016 were collected, the operation methods and test results were reviewed, and then they were divided into the observation group (n=34) who accepted ultrasonic pneumatic treatment and the control group (n=44) who accepted holmium laser treatment.Ⅰstage stone clearance rate of two groups of patients were recorded;serum was collected, sarcosine oxidase method was used to detect serum renal function indexes, and ELISA method was used to detect the levels of inflammatory factors and stress hormones.Results: The mean lithotomy time of observation group was shorter than that of control group;differences inⅠstage stone clearance rate were not statistically significant between two groups of patients. 3 d after operation, serum renal function indexes Scr, BUN and CysC levels of observation group were lower than those of control group;serum inflammatory factors PCT, IL-1β, IL-22 and IL-13 levels of observation group were lower than those of control group while IL-4 level was higher than that of control group;serum stress hormones AngⅠ, AngⅡ, Adr and NE levels of observation group were lower than those of control group.Conclusion:Both ultrasonic pneumatic and holmium laser technology can effectively remove complex renal calculus and ultrasonic pneumatic technology has the advantages of quicker operation and less injury.