Which holmium laser lithotripsy to choose?

[eliadam]

Which holmium laser lithotripsy to choose?

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[DoctwoB]

Which holmium laser lithotripsy to choose?

None. Once you go thulium you never go back.

 

[cpants]

Thulium better, but if you are going w/ holmium you can't go wrong with the high watt models from luminis.

 

[DoctwoB]

Thulium better, but if you are going w/ holmium you can't go wrong with the high watt models from luminis.

Yup, and if looking at cheaper, lower wattage systems the big thing I'd look out for is maximum frequency. A lot of the lower power systems that should be able to support dusting settings (say 50hz and 0.2j, for only 10watts) do not support higher frequencies which limits your options in cases where you don't want to pull out a bunch of fragments (small ureter/sheath, etc)

Incidentally, for those on the Thulium bandwagon, have you started adjusting your patient counselling in terms of URS vs. PCNL? I've found the thulium makes quick work of the ~2cm dense stones that I used to steer towards PCNL. Sad, because I like percs, but such is progress. I see a near future where percs are really only for the true staghorns and mini-perc disappears except in cases where retrograde access can't be obtained.

 

[cpants]

Yup, and if looking at cheaper, lower wattage systems the big thing I'd look out for is maximum frequency. A lot of the lower power systems that should be able to support dusting settings (say 50hz and 0.2j, for only 10watts) do not support higher frequencies which limits your options in cases where you don't want to pull out a bunch of fragments (small ureter/sheath, etc)

Incidentally, for those on the Thulium bandwagon, have you started adjusting your patient counselling in terms of URS vs. PCNL? I've found the thulium makes quick work of the ~2cm dense stones that I used to steer towards PCNL. Sad, because I like percs, but such is progress. I see a near future where percs are really only for the true staghorns and mini-perc disappears except in cases where retrograde access can't be obtained.

Agree. I used to do fun percs on lots of 1.5cm stones, but now the high power laser turns them to dust in 20 min, and I just can't justify it unless it's a lower pole stone or something.