PD34-04 URETEROSCOPIC PERFORMANCE OF THULIUM FIBER LASER (SOLTIVE PREMIUM SUPER PULSED LASER ^TM ) FOR THE TREATMENT OF UROLITHIASIS: RESULTS OF THE FIRST CASE SERIES IN THE UNITED STATES

Abstract

We previously showed that nearly half the patients left with residual fragments (RFs) after URS experience a subsequent stone-related event (SE). We aimed to determine if a stone free state after URS is associated with a fewer SEs than those left with residual fragments.METHODS: After undergoing URS for renal and ureteral calculi between December 2015 and February 2017 167 patients (209 renal units, RUs) were prospectively enrolled. CT was obtained 6-8 weeks post-operatively. Patients were evaluated at subsequent office visits and/or contacted by phone to determine if a stone event attributable to the treated RU occurred. A stone event (SE) was defined as spontaneous stone passage, symptoms requiring emergency department (ED) visit, surgical intervention, or stone growth. Only patients with at least 12 months of follow-up were included for analysis. Kaplan Meier analysis, Chi-squared analysis, log rank test, and logistic regression were used to assess outcomes.RESULTS: Among the study group, 123 patients and 152 RUs met study criteria, including 57% (87 RUs) with residual fragments and 43% (65 RUs) who were rendered stone-free on post URS CT. Median overall follow-up was 29 months . The mean number of RFs per patient was 2.1 AE 1.5 and mean largest fragment size was 3.7 AE 2.0 mm. SE occurred in 47% (41/87) of RUs with RFs and 14% (9/ 65) of those that were stone free (p<0.001). Median time to SE was 33 months for those with RFs (CI 23-43) and 45 months in those who were stone free . The stone event-free survival was 68% in those with RFs and 98% in those stone free at 24 months (p<0.001) (Figure 1). Multivariate regression demonstrated stone-free status as a predictor of a stone event (OR 4.98, p<0.001), although residual fragment size and number were not.CONCLUSIONS: Attaining a stone-free state after URS with basket extraction reduces the rate of SEs in patients undergoing ureteroscopy.

Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review

“…Despite the majority of the initial laboratory and clinical studies were from Russian researchers, many more recent studies were done by researchers all around the world, showing promising results [ 14 ▪▪ , 15 – 18 ]. Still, after evaluating our bibliographic search results, more than 40% of the recent published research on TFL is from Russian origin or has Russian researchers participating in it.…”

“…Settings such as, 1–1.5 J and 15–30 Hz for fragmentation and 0.1–0.3 J and 50–100 Hz for dusting in (micro-) PCNL, 0.1–0.2J with 15–30W for dusting in the kidney, 0.2–0.5J with 10–15W for dusting and fragmentation in the ureter, and 2–5J and 5–10 Hz for bladder stones treatment [ 38 , 41 , 46 ]. However, there are even reports of some authors using up to 500 Hz in the upper tract [ 15 ]. Yet, this is very preliminary data and the optimal laser settings are far from being established, needing future studies on it [ 8 ▪ , 47 ].…”

“…Concerning the safety of this new technology, the clinical and prospective data from several patient cohorts is coherent in deeming the TFL safe to use, in any anatomical location, and regardless of its endoscopic surgical approach [ 15 – 17 , 27 , 38 – 40 , 45 , 46 , 51 , 55 , 57 , 58 ]. One of the safety features of the TFL is its laser fibres higher resistance to extreme bending diameters, even using high power, thereby avoiding their breakage with consequent laser emission inside the fragile flexible scopes [ 50 ▪▪ , 59 ].…”

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

“…The initial clinical experiences have demonstrated that the different laser settings used in the operating room are safe for patients. Many combinations of laser settings have been tested for ureteral, renal, and bladder stone lithotripsies presented in various conference abstracts [ 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and in full-text clinical experiences [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] ( Table 2 ). However, the ideal one has not yet been established.…”

“…Initial clinical experiences have confirmed that the use of a small TFL laser fiber gives a better instrument deflection, and therefore, the urologist is able to treat lower pole calyceal stones [ 21 , 25 ], even with an acute lower pole infundibulopelvic angle [ 21 ].…”