title: Influence of saline on temperature profile of laser lithotripsy activation.
abstract: OBJECTIVE
  We established an ex vivo model to evaluate the temperature profile of the ureter during laser lithotripsy, the influence of irrigation on temperature, and thermal spread during lithotripsy with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser.
  
  
  METHODS
  Two ex vivo models of Ovis aries urinary tract and human calcium oxalate calculi were used. The Open Ureteral Model was opened longitudinally to measure the thermal profile of the urothelium. On the Clinical Model, anterograde ureteroscopy was performed in an intact urinary system. Temperatures were measured on the external portion of the ureter and the urothelium during lithotripsy and intentional perforation. The lithotripsy group (n=20) was divided into irrigated (n=10) and nonirrigated (n=10), which were compared for thermal spread length and values during laser activation. The intentional perforation group (n=10) was evaluated under saline flow. The Ho:YAG laser with a 365 μm laser fiber and power at 10W was used (1J/Pulse at 10 Hz). Infrared Fluke Ti55 Thermal Imager was used for evaluation. Maximum temperature values were recorded and compared.
  
  
  RESULTS
  On the Clinical Model, the external ureteral wall obtained a temperature of 37.4°C±2.5° and 49.5°C±2.3° (P=0.003) and in the Open Ureteral Model, 49.7°C and 112.4°C with and without irrigation, respectively (P<0.05). The thermal spread along the external ureter wall was not statically significant with or without irrigation (P=0.065). During intentional perforation, differences in temperatures were found between groups (opened with and without irrigation): 81.8°±8.8° and 145.0°±15.0°, respectively (P<0.005).
  
  
  CONCLUSIONS
  There is an increase in the external ureteral temperature during laser activation, but ureteral thermal values decreased when saline flow was applied. Ureter thermal spread showed no difference between irrigated and nonirrigated subgroups. This is the first laser lithotripsy thermography study establishing the framework to evaluate the temperature profile in the future.
authors.affiliation: Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado , School of Medicine, Denver, Colorado.
authors.forename: Wilson R
authors.initials: WR
authors.lastname: Molina
authors.forename: Igor N
authors.initials: IN
authors.lastname: Silva
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Donalisio da Silva
authors.forename: Diedra
authors.initials: D
authors.lastname: Gustafson
authors.forename: David
authors.initials: D
authors.lastname: Sehrt
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Kim
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D006801:Humans; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser / Q000295:instrumentation* / Q000379:methods; D008962:Models, Theoretical; D012756:Sheep; D012965:Sodium Chloride / Q000008:administration & dosage*; D013696:Temperature; D014513:Ureter / Q000187:drug effects*; D018666:Ureteroscopy / Q000295:instrumentation / Q000379:methods; D014545:Urinary Calculi / Q000628:therapy*
chemical_list: D012965:Sodium Chloride