The optimal settings of holmium YAG laser in treatment of pediatric urolithiasis.
İçerik yapay zeka ile optimize edilmiştir
Pediatric Urolithiasis and the Role of Ho:YAG Laser
This study presents a comprehensive clinical experience regarding the application of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatric patients. The primary objective is to evaluate the efficacy of laser technology in pediatric urolithiasis treatment and to define the optimal laser settings for various surgical interventions.
Study Population and Surgical Methodology
The research involved a total of 116 children who underwent specialized urolithiasis treatments. The surgical procedures included percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), and retrograde intrarenal surgery (RIRS). The patient demographics and follow-up details are as follows:
- Age Range: 1–18 years (Mean age: 8.4 ± 5.2 years).
- Follow-up Duration: 9–45 months (Mean: 26 ± 8.8 months).
- Fiber Sizes: 200, 272, and 365-μm fibers were utilized during operations.
- Stone Size: No significant difference was observed between the mean stone sizes of PNL and RIRS patient groups (p = 0.816).
Optimal Laser Settings for Pediatric Stone Fragmentation
Achieving successful stone fragmentation requires precise adjustments of energy and frequency based on the surgical technique used. The following table summarizes the optimized settings identified during the study:
| Procedure Type | Energy Setting (J) | Frequency (Hz) |
|---|---|---|
| Mini-URS | 0.5 - 1 J | > 8 Hz |
| RIRS | 0.5 - 0.8 J | 10 - 20 Hz |
| PNL | 0.8 - 2 J | 5 - 15 Hz |
Clinical Outcomes and Safety Profile
The analysis of surgical success revealed that there was no significant difference between the stone-free rates of PNL and RIRS procedures (p = 0.150). This indicates that both methods are highly effective when the correct laser parameters are applied.
In terms of postoperative safety, only four complications were recorded (Clavien II). these cases involved febrile urinary infections distributed across the treatment groups:
- Two patients in the mini-URS group.
- One patient in the PNL group.
- One patient in the RIRS group.
Conclusion: Efficiency of Ho:YAG Laser in Children
The results confirm that the Ho:YAG laser is an effective and reliable tool for treating stones in the pediatric population. For optimal results, it is recommended to use low-energy high-frequency settings for URS and RIRS, whereas high-energy settings are more appropriate for PNL procedures. These findings provide a strategic framework for surgeons to enhance the safety and success of pediatric urological interventions.
