Impact of laser fiber tip cleavage on power output for ureteroscopy and stone treatment.

PURPOSE: Holmium:YAG laser is the most used laser for urolithiasis. Generally, we use metallic scissors to cut the fiber tip to restore its effectiveness. Many cleaving methods have been described to avoid fiber damage and to restore its greatest power to the fiber. There is a lack of information regarding which cleaving method should be used and its effect on the fiber. In order to compare these effects, we studied different cleavage methods in terms of power output and its effects on the fiber. METHODS: New single-use 272-µm fibers were used with a holmium:YAG laser lithotripter. Five kinds of fiber tips were compared: a new intact fiber, cleaved with ceramic scissors, cleaved with metallic scissors, first cleaved then stripped and first stripped then cleaved. The fibers were used against synthetic stones (BegoStone®) similar to calcium oxalate monohydrate, with fragmentation (SP, 5 Hz, 1.5 J) and dusting (LP, 15 Hz, 0.5 J) settings. We measured power output at 0, 1, 5, 10 and 15 min. RESULTS: For fragmentation parameters, there was a statistical difference between the 5 groups at 0 and 1 min of laser use (p < 0.05) and none for time period over 1 min (p = 0.077-0.658). For dusting parameters, there was a statistical difference between the 5 groups at 0 min of laser use (p < 0.05) and none for time period over 0 min (p = 0.064-1). CONCLUSION: Cleaving the fiber tip may restore its effectiveness to the fiber, but only for a limited time, although it may preserve the scopes from damage.

Evaluation of recovery and quality of sexual activity in women during postpartum in relation to the different mode of delivery: a retrospective analysis.

AIM: Aim of the study was to assess the recovery and quality of sexual activity of women during postpartum, in relation to delivery. METHODS: We recruited 200 women at 8 weeks after delivery. For each patient we recorded mode of delivery, age, body mass index (BMI), parity and test Female Sexual Function Index (FSFI) score. RESULTS: Sixty-four women (32%) had spontaneous deliveries without episiotomy, 48 (24%) had it with episiotomy, 88 (44%) had caesarean sections. The analysis of variance (ANOVA) test showed no significant differences among the 3 groups for age, BMI, parity. The test FSFI evidenced 68 cases (34%) of Regular Female Sexual Function (RFSF) and 132 (66%) of Female Sexual Dysfunction (FSD). The ANOVA test showed significant differences among the 3 groups in RFSF (F [2, 14]=8.075, P=0.005), but not in FSD (F [2, 30]=2.646, P=0.087). In RFSF, FSFI score was higher in women who had vaginal delivery with episiotomy compared with the other two groups. Conversely, in FSD (both with or without resumed sexual activity at 8 weeks postpartum) we evidenced that patients who had vaginal delivery with episiotomy showed lower FSFI score than the other two groups, with a decrease in lubrication, orgasm and satisfaction scores. Furthermore, we observed that most of the RFSF patients had a job and breastfed. CONCLUSION: Our results did not evidence a direct and significant correlation between mode of delivery and onset of female postpartum sexual dysfunction, even if FSD patients who underwent episiotomy during delivery markedly showed low FSFI scores.