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Risk assessment of holmium laser induced ureteral stricture: in-vivo experiments using a pig model

cell-biology
nephrology
surgery-and-surgical-specialties
urology
histology

Abstract

Abstract
Purpose: To systematically evaluate the safety and potential risks of holmium laser application during ureteroscopy, and deeply explore the detailed trauma and repair processes of the ureter and kidneys following holmium laser use, this study was designed.
Methods: 12 piglets were selected for this experiment. After proper anesthesia and disinfection procedures, a series of carefully designed experiments were carried out. The key variables manipulated included the power of the holmium laser, the flow rates of the lavage fluid, the temperatures of the lavage fluid, and the damage range of the holmium laser. Subsequently, microscopic images were taken, tissue samples were collected and subjected to comprehensive analysis using both Masson staining and immunohistochemical staining techniques. Statistical analyses were performed using the t-test and ANOVA to ensure results reliability.
Results: The results demonstrated that when the lavage fluid flow rate was 15ml/min, even with a holmium laser power of 30W, the lavage fluid temperature rise was about 13℃, remaining relatively safe. At 7.5ml/min, 30W caused a significant increase over 20°C, while 20W led to around 12°C. In the no-flow group, 10W raised the temperature by approximately 5°C. For the ureter, different lavage fluid temperatures induced varying degrees of collagen proliferation during repair. In the kidneys, inflammation decreased and fibrosis increased over time. Notably, when the holmium laser injured 3/4 circle or more of the ureteral wall, ureteral stenosis occurred.
Conclusion: Reasonable control of holmium laser power and perfusion flow rate can prevent water temperature from exceeding the safe range during ureteroscopy. Short-term high temperature isn't the cause of ureteral stricture. During thermal injury repair, collagen tissue proliferates, inflammation decreases, and fibrosis increases. When holmium laser-induced ureteral injury involves 3/4 circle or more of the muscle layer, it causes visible ureteral stenosis.
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