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Instructional Course

Instructional Course - Available with the Platinum and Silver packages or Individual Course Ticket

010IC - Dust or Bust: A Beginners Guide to Modern Day Laser Lithotripsy Strategies for Ureteroscopy

Friday, May 13, 2022

10:00 AM – 12:00 PM

Location: Room 210

Instructional Course Director(s)

Khurshid R. Ghani, Dr.

Professor of Urology
University of Michigan

Instructional Course Faculty(s)

WR

William Woodruff Roberts, III, MD

Professor of Urology and Biomedical Engineering
University of Michigan
JT

Joel M.H. Teichman, MD

University of British Columbia
MB

Matthew Bultitude, MD

Guy's and St. Thomas' Hospital, London

Learning Objectives:

Identify suitable patient characteristics for treatment with ureteroscopic laser lithotripsy using dusting technique
Specify different laser fiber selection and settings (frequency, pulse energy), including use of altered pulse duration and modulation, for fragmenting varying stone sizes and composition.
Describe laser lithotripsy surgical strategies and techniques such as chipping, dancing, pop-corning and pop-dusting.
Appraise evidence on heat generation and intrarenal pressure for safety.
Appraise the evidence on ureteroscopic stone treatment results and recurrence rates after stone surgery.

Modern day holmium lasers are able to fragment stones using settings that incorporate high frequency, low pulse energy, and variable pulse duration and modulation. This course teaches the practicing urologist the rationale behind the selection of the various parameters now available in next-generation holmium and thulium laser systems for ureteroscopic laser lithotripsy.

Various strategies for laser fiber selection and management, as well as techniques for a dusting and fragmentation approach to endoscopic laser stone surgery, will be taught via video-based case discussion. Participants will be able to identify patients with upper urinary tract stones suitable for fragmentation or dusting techniques. The evidence base on stone clearance after laser lithotripsy will also be discussed, including literature on recurrence rates and retreatment. Standardized algorithms, along with tips and tricks, will open the door for advanced laser strategies in this rapidly evolving field.