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Minerva Urologica e Nefrologica 2018 December;70(6):624-9

DOI: 10.23736/S0393-2249.18.03050-3


language: English

Resistance of different guidewires to laser injury: an in-vitro experiment

Nuno MORAIS 1 , Marco TERRIBILE 2, Paulo MOTA 1, 3, Antonio CICIONE 4, Sílvia DIONÍSIO 3, Emanuel CARVALHO-DIAS 1, 3, Agostinho CORDEIRO 1, João N. TORRES 1, Carlos OLIVEIRA 1, Estêvão LIMA 1, 3

1 Department of Urology, Hospital of Braga, Braga, Portugal; 2 Department of Urology, University of Campania Luigi Vanvitelli, Naples, Italy; 3 Department of Life and Health Sciences, School of Medicine, University of Minho, Braga, Portugal; 4 Department of Urology, Magna Graecia University, Catanzaro, Italy

BACKGROUND: In urology, lasers are used in a variety of endoscopic procedures such as ureteroscopy and retrograde renal surgery for stone fragmentation of urinary calculi and ablation of urothelial tumors. To perform these procedures, guidewires are used as a preliminary safe-mainstay for referencing the urinary tract. This study aims to determine the effect of two different lasers: holmium:YAG (Ho:YAG) and thulium:YAG (Tm:YAG) lasers on metal guidewires with PTFE coating (PTFE), nitinol guidewires with hydrophilic coating (Hydrophilic) and nitinol guidewires with hydrophilic listed coating (Zebra).
METHODS: Different combinations of frequency (5, 10 and 12 Hz) and energy per pulse (0.5, 1.5, and 2.6 J) of Ho:YAG laser were applied on the three kinds of guidewires in two experiments (50 J vs. 100 J of total energy). For the Tm:YAG laser three power levels (5, 35, and 70 W) with a total energy of 100 J were applied to the guidewires. The degree of damage (0 to 5) of the guidewire was assessed after each laser application.
RESULTS: A higher degree of injury of guidewires was related to higher values of total energy used for the Ho:YAG laser (P=0.036), and to higher values of power applied with the Tm:YAG (P=0.051). The most resistant guidewire to Ho:YAG laser energy was Zebra, followed by PTFE and Hydrophilic (P<0.001). With the Tm:YAG laser, PTFE guidewire appears to be the most resistant and the Hydrophilic the most fragile, although without reaching the statistical significance (P=0.223).
CONCLUSIONS: Both lasers revealed a harmful effect on the three tested guidewires. There was an association between the degree of injury and the amount of Ho:YAG laser energy and Tm:YAG laser power. The guidewire Zebra proved to be the safest when using Ho:YAG laser and the PTFE guidewire the most resistant to laser Tm:YAG. Further studies are necessary to confirm these results.

KEY WORDS: Solid-state lasers - Endoscopy - Ureteroscopy - In-vitro techniques - Laser lithotripsy

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