"If you suspect that you have a calcium oxalate monohydrate stone, we found that the most effective settings are 0.4 J and 40 Hz, and maybe as a backup setting, 0.2 J and 100 Hz," says Ojas Shah, MD.
In this video, Ojas Shah, MD, discusses key take-home messages from the study, “Comparative Analyses and Ablation Efficiency of Thulium Fiber Laser by Stone Composition.” Shah is the vice chair and a professor of urology at Columbia University Medical Center in New York, New York.
I think you need to get experience with this technology before you start using it. It would probably be useful to watch some videos or go to some lectures about this technology, because the first thing that you do when you use this technology is you don't know what the right settings are. That's one of the first things that you learn is what is the right setting and what is the safety zone. I think the companies are doing a really good job now to put stop caps, because when the first iteration of this machine came out, people were using settings that can be really effective, but were not necessarily safe. And some complications occurred initially with this type of technology. Now, the companies are putting levels of safety, and putting more effort into education to teach users how to use it to become more effective in their treatment of stones and other types of conditions. So, education is critical before anyone starts to use it.
Our paper gives settings that people could set their machine at to try and treat different types of stone types. If you suspect that you have a calcium oxalate monohydrate stone, we found that the most effective settings are 0.4 J and 40 Hz, and maybe as a backup setting, 0.2 J and 100 Hz. Because nobody actually knows what the stone is made out of. When you look at a stone, you can try and predict what you think it's made out of. Some people have had prior stone compositions or other urinary studies that have shown to imply what your stone is made out of as well, or to guess what the stone composition is. That's the dynamic part of this, you need to adjust your laser settings in the middle of a case, in order to get the maximum efficacy without getting charring of your stone and ending up with a situation where it becomes harder to break the stone than easier.
This transcription has been edited for clarity.