{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:51:57Z","timestamp":1791870717661,"version":"4.3.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To optimize thulium fiber laser (TFL) settings for effective stone fragmentation although minimizing thermal injury in confined ureteral spaces using a three-dimensional ureter model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A hydrogel-based ureter model was maintained at 37.2 \u00b1 0.5\u00b0C, with a cylindrical BegoStone (10 \u00d7 10 mm, 1.00 \u00b1 0.07 gm) occluding the ureter. Ureteroscopy was performed using a 150 \u00b5m TFL fiber for 3 minutes with room temperature irrigation and differing rates (0, 20, 40 mL\/min) and power settings (6.4 to 20 W). Maximum sustained temperature (MST) and cumulative thermal dose (cumulative equivalent minutes at 43\u00b0C) were assessed against a 120-minute safety threshold. We also evaluated the effects of ureter volume and irrigation temperature. Stone mass treated was calculated by subtracting the mass of residual fragments &gt;3 mm from the initial mass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At 6.4 and 10 W, MSTs were below body temperature, and thermal doses were under 1 minute, indicating minimal thermal risk. At 20 W with 20 mL\/min irrigation, MST exceeded 43\u00b0C within seconds, and thermal doses surpassed 120 minutes. Treatment efficiency was highest at 20 W (1.58 mg\/s), followed by 10 W (1.15 mg\/s) and 6.4 W (0.78 mg\/s). Among 10 W settings, 1.0 J\/10 Hz was more efficient than 2.0 J\/5 Hz and 3.0 J\/3 Hz. Safe settings produced 95.5% fine dust, whereas high-energy pulses 2\u20133 J produced significantly more fragments (1\u20133 mm) compared with settings with pulse energy 0.5\u20131.0 J. Increasing irrigation to 40 mL\/min or using 15\u00b0C irrigation effectively reduced MST and improved efficiency, particularly at 20 W.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our study demonstrates the risk of thermal injury with 20 W TFL treatment. Conversely, 10 W settings at 2.0 J\/5 Hz are safe and effective for fragmentation. Future research will focus on validating these optimal settings for human stone treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/end.2024.0637","type":"journal-article","created":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:39:30Z","timestamp":1746837570000},"page":"698-707","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Optimizing Fragmentation while Minimizing Thermal Injury Risk with the Thulium Fiber Laser in Ureteral Stone Lithotripsy: An In Vitro Study"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5207-937X","authenticated-orcid":false,"given":"Arpit","family":"Mishra","sequence":"first","affiliation":[{"name":"Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9875-502X","authenticated-orcid":false,"given":"Ezra J.","family":"Margolin","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron W.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Medairos","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodi","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn M.","family":"Preminger","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Zhong","sequence":"additional","affiliation":[{"name":"Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Lipkin","sequence":"additional","affiliation":[{"name":"Division of Urology, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16218"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-022-03966-9"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00240-024-01585-0"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00240-023-01501-y"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000003050"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2020.0581"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15079"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.euros.2022.05.017"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2021.0842"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16015"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11175048"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/CU9.0000000000000019"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2022.0039"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11060764"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(84)90379-1"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.3109\/02656736.2010.534527"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2018.0395"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2019.0499"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010149"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000000300"},{"issue":"9","key":"e_1_3_6_22_2","first-page":"1542","article-title":"Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones","volume":"125","author":"Liu D-Y","year":"2012","unstructured":"Liu D-Y, , He H-C, , Wang J, et al. 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