Mark A Assmus1, Matthew S Lee2, Mayandi Sivaguru3,4, Deepak K Agarwal5, Tim Large5, Bruce W Fouke3,4, Amy E Krambeck2. 1. Department of Urology, Northwestern University, Chicago, USA. mark.assmus@nm.org. 2. Department of Urology, Northwestern University, Chicago, USA. 3. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana-Champaign, Champaign, USA. 4. Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana-Champaign, Champaign, USA. 5. Department of Urology, Indiana University, Indianapolis, IN, USA.
Abstract
PURPOSE: We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550 μm standard fibers versus 550 μm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level. METHODS: We prospectively collected outcomes for 50 standardized HoLEP cases using 550 μm Moses fiber with 2.0 BPH mode compared to our historical cohort of 50 patients using 550 μm standard fibers on regular mode. Macroscopic degradation length was the difference in length of exposed fiber at the start and end of each case. Five consecutive 550 μm standard fibers, five 550 μm Moses fibers and their respective controls underwent novel utilization of three objective corroborating imaging techniques: Brightfield high resolution microscopy, high resolution 3-D microCT and Confocal Reflection Surface Analysis. Mann-Whitney U, 2-tailed T tests and Chi-squared tests were used. RESULTS: Standard fibers demonstrated greater degradation than the Moses fibers with 2.0 BPH mode [2.9 cm (IQR 1.7-4.3 cm) vs 0.2 cm (IQR 0.1-0.4 cm), p < 0.01]. This difference remained significant when comparing degradation per energy used, per minute enucleation and per gram enucleated (all p < 0.05). None of the cases with Moses fiber and 2.0 BPH mode required intraoperative interruption to re-strip the fiber. Objective fiber degradation by three microscopic techniques confirmed more damage to the standard fibers with regular mode. CONCLUSION: Overall, use of the 550 μm Moses fiber with 2.0 BPH mode resulted in less fiber degradation compared to a standard 550 μm fiber with regular mode as confirmed using 4 corroborating macroscopic and microscopic techniques.
PURPOSE: We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550 μm standard fibers versus 550 μm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level. METHODS: We prospectively collected outcomes for 50 standardized HoLEP cases using 550 μm Moses fiber with 2.0 BPH mode compared to our historical cohort of 50 patients using 550 μm standard fibers on regular mode. Macroscopic degradation length was the difference in length of exposed fiber at the start and end of each case. Five consecutive 550 μm standard fibers, five 550 μm Moses fibers and their respective controls underwent novel utilization of three objective corroborating imaging techniques: Brightfield high resolution microscopy, high resolution 3-D microCT and Confocal Reflection Surface Analysis. Mann-Whitney U, 2-tailed T tests and Chi-squared tests were used. RESULTS: Standard fibers demonstrated greater degradation than the Moses fibers with 2.0 BPH mode [2.9 cm (IQR 1.7-4.3 cm) vs 0.2 cm (IQR 0.1-0.4 cm), p < 0.01]. This difference remained significant when comparing degradation per energy used, per minute enucleation and per gram enucleated (all p < 0.05). None of the cases with Moses fiber and 2.0 BPH mode required intraoperative interruption to re-strip the fiber. Objective fiber degradation by three microscopic techniques confirmed more damage to the standard fibers with regular mode. CONCLUSION: Overall, use of the 550 μm Moses fiber with 2.0 BPH mode resulted in less fiber degradation compared to a standard 550 μm fiber with regular mode as confirmed using 4 corroborating macroscopic and microscopic techniques.
Authors: Amihay Nevo; Kassem S Faraj; Scott M Cheney; Jonathan P Moore; Karen L Stern; Michael Borofsky; Ehud Gnessin; Mitchell R Humphreys Journal: BJU Int Date: 2020-11-01 Impact factor: 5.588
Authors: Edward J Choi; Perry Xu; David Barham; Farouk M El-Khatib; Faysal A Yafi; Parviz K Kavoussi Journal: J Urol Date: 2021-10-25 Impact factor: 7.450
Authors: Tim Large; Charles Upshur Nottingham; John Ethan Brinkman; Deepak Kumar Agarwal; Andrea Ferrero; Michael W Sourial; Karen Lynne Stern; Marcelino E Rivera; Bodo E Knudsen; Mitchell R Humphreys; Amy Krambeck Journal: J Endourol Date: 2021-04-11 Impact factor: 2.942