Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR)

Keat, William Ong Lay; Somani, Bhaskar; Pietropaolo, Amelia; Chew, Ben H.; Chai, Chu Ann; Inoue, Takamitsu; Ragoori, Deepak; Biligere, Sarvajit; Galosi, Andrea Benedetto; Pavia, Maria Pia; Milanese, Giulio; Ahn, Thomas; More, Sumit; Sarıca, Kemal; Traxer, Olivier; Teoh, Jeremy Yuen‐Chun; Gauhar, Vineet; Castellani, Daniele

doi:10.1007/s00345-023-04362-7

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…In a comparative study by Ulvik et al, the TFL showed a higher SFR (92% vs. 67%, p = 0.002), lower operative time (49 vs. 57 min, p = 0.008), and lower intraoperative adverse event (5% vs. 22%, p = 0.014), compared to the Ho:YAG laser [25]. In a large multicenter study involving 4208 patients who underwent RIRS, Keat et al showed that overall, the TFL was associated with lesser residual fragments (>2 mm), a finding that was confirmed by a multivariate analysis for stones both more and less than 1000 HU [26]. Since residual fragments require second treatment, this is best avoided.…”

Section: Thulium Fibre Laser (Tfl)mentioning

confidence: 95%

“…Since the approval of the TFL by the FDA and the EMA, numerous studies have been published showing that the TFL outperforms the Ho:YAG laser in terms of dusting quantity and quality, lower retropulsion, and shorter operation time for any kind of stone [21,[23][24][25][26][27]. In a comparative study by Ulvik et al, the TFL showed a higher SFR (92% vs. 67%, p = 0.002), lower operative time (49 vs. 57 min, p = 0.008), and lower intraoperative adverse event (5% vs. 22%, p = 0.014), compared to the Ho:YAG laser [25].…”

Section: Thulium Fibre Laser (Tfl)mentioning

confidence: 99%

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Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

et al. 2023

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The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones <2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon’s expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology.

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Section: Thulium Fibre Laser (Tfl)mentioning

confidence: 95%

Section: Thulium Fibre Laser (Tfl)mentioning

confidence: 99%

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

et al. 2023

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“…1 Extracorporeal shockwave lithotripsy is now supplanted by flexible ureteroscopy using thulium lasers, which are more efficient for reducing stones into a powder easily evacuated in urine. 9 KS are composed of multiple crystalline domains. Established methods for KS component characterization include optical microscopy, 1,10 Fourier transform IR spectroscopy, 1 Raman spectroscopy, 6,11−14 (SEM), 15 and X-ray crystallography.…”

Section: ■ Introductionmentioning

confidence: 99%

“…However, the optimal shockwave profile requires classification of the KS type based on its physiochemical composition . Extracorporeal shockwave lithotripsy is now supplanted by flexible ureteroscopy using thulium lasers, which are more efficient for reducing stones into a powder easily evacuated in urine …”

Section: Introductionmentioning

confidence: 99%

Kidney Stone Classification Using Multimodal Multiphoton Microscopy

Gleeson,

Morizet,

Mahou

et al. 2023

ACS Photonics

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Kidney stones are a common form of nephrolithiasis, affecting up to 15% of the world's population with a high probability of recurrence. These stones exhibit various chemical compositions and crystalline forms associated with different etiologies. Classification of the stones' components is necessary to optimize treatment and suggest lifestyle changes to reduce the risk of recurrence. Current characterization methods usually require extensive sample preparation or are too detailed for the needs of a high-throughput laboratory. In this article, we present a kidney stone component classification scheme based on the multiphoton response of crushed samples that is label-free, requires minimal sample amounts, and simple preparation. We measure two-photon excited fluorescence, which is sensitive to protein content, second-harmonic generation, which is sensitive to crystalline symmetry, and polarization-resolved third-harmonic generation (pTHG), which is sensitive to crystal heterogeneity and birefringence. The combination of these three contrast modes can distinguish different materials, specifically calcium oxalate in monohydrate (COM), dihydrate (COD), or amorphous forms, cystine, and carbonate apatite. In addition, pTHG images have the potential to distinguish between COM and COD fragments and to provide information on the submicron organization of carbonate apatite fragments.

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“…Many studies focus on several variables like demographic factors, 1 stone parameters, 2 and intraoperative technical steps and technology used 3 to predict stone-free rate (SFR) and outcomes of retrograde intrarenal surgery (RIRS) in adults and children alike. Similarly, preoperative computerized tomography (CT) imaging for endourological intervention is ideal for kidney stones and to estimate stone parameters like Hounsfield units (HU), 4 and its ability to influence decision-making for RIRS has been well documented.…”

Section: Introductionmentioning

confidence: 99%

Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group

Gauhar,

Castellani,

Chew

et al. 2023

Therapeutic Advances in Urology

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Background: Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective: To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design: A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018–August 2021). Methods: Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results: A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009–1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017–1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025–1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557–2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094–7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions: CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.

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Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR)

Cited by 9 publications

References 27 publications

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

Kidney Stone Classification Using Multimodal Multiphoton Microscopy

Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group

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