064IC - Dust or Bust: A Guide to Modern Day Laser Lithotripsy Strategies for Ureteroscopy

Sunday, April 30, 2023

1:30 PM – 3:30 PM CST

Location: S104

Instructional Course Director(s)

Khurshid Ghani, MD

University of Michigan

Instructional Course Faculty(s)

Matthew Bultitude, MD

Guy's and St. Thomas' Hospital, London
William Roberts, III, MD (he/him/his)

Professor of Urology and Biomedical Engineering
University of Michigan
Karen Stern, MD

Associate Professor
Mayo Clinic Arizona

Course Description: Modern-day lasers can fragment stones using settings that incorporate a variety of selection parameters: frequency, pulse energy, pulse duration and pulse modulation. The options of lasers have increased from low-power to high-power holmium systems and now the super pulse thulium fiber laser. This course teaches the practicing urologist the rationale behind the selection of which laser and why for laser lithotripsy, and the various parameters to choose for safe and efficient ureteroscopic laser lithotripsy.

Various strategies 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. They will understand differences between the holmium and thulium laser wavelengths and advantages to each system. The evidence base on stone clearance and quality of life after laser lithotripsy will be discussed, including literature on recurrence rates and re-treatment. Standardized algorithms, along with tips and tricks, will open the door for advanced laser strategies in this rapidly evolving field.

Learning Objectives:

Identify suitable patient characteristics for treatment with ureteroscopic laser lithotripsy using dusting technique.
Specify different laser settings (frequency, energy, duration and modulation) for fragmenting varying stone sizes and compositions.
Describe the laser characteristics and properties that will allow for appropriate selection of thulium versus holmium laser for lithotripsy.
Describe laser lithotripsy surgical strategies and techniques such as chipping, dancing, popcorning and pop-dusting.
Appraise the evidence on heat generation and intrarenal pressure for safety during ureteroscopy and laser lithotripsy.
Appraise the evidence on ureteroscopic stone treatment results, recurrence rates and quality of life after ureteroscopic stone surgery.