Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial

Ulvik, Øyvind; Æsøy, Mathias Sørstrand; Juliebø‐Jones, Patrick; Gjengstø, Peder; Beisland, Christian

doi:10.1016/j.eururo.2022.02.027

Cited by 110 publications

(84 citation statements)

References 22 publications

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“…Furthermore, the introduction of the Thulium laser in modern endourology seems to further revolutionize the management of kidney stones with superior results regarding stone dusting and postoperative stone-free status. The results of this study are similar to the data in the literature, obtaining over 90% stone-free rates in the second group, the one that uses the Thulium laser and over 85% in the first group, corresponding to the Holmium laser [ 30 , 31 ].…”

Section: Discussionsupporting

confidence: 88%

Second-look flexible ureteroscopy after RIRS – Holmium Moses versus TFL (Soltive)

Geavlete¹,

Mareș²,

Multescu³

et al. 2022

JMedLife

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Retrograde intrarenal surgery (RIRS) is nowadays more and more indicated in pyelocaliceal stones. Holmium and Thulium lasers are the main lasers used. Fragmenting (basketing) or dusting, despite the new technology, still have residual stones (even having 250 microns). This study evaluates second-look flexible ureteroscopy for residual fragments. We analyzed 246 patients (October 2020–March 2022) on which we used Moses Holmium technology (187 cases) in Group 1 and Soltive Laser System (59 cases) in Group 2. The average stone size was 13.1 mm (range 11–29), and the average stone density was 1026 HU (range 870–1752). We used 270 µm for Ho: YAG laser and 150 µm for TFL. For Holmium, we applied energy 0.4J and frequency 80 Hz. For TFL, we applied fine dusting (0.15 J/100 Hz) and dusting (0.5 J/30 Hz). After three months, we practiced the second flexible ureteroscopy. Both groups were compared for completely visual stone-free rates. Stone-free rate at 3 months (second flexible ureteroscopy) was 86.63% (n=162/187) in Group 1 and 96,61% (n=57/59) in Group 2, respectively. The stone-free correlation with the CT preoperative evaluation was 160/187–85.56% for Holmium and 55/59–93.22% for TFL. We found residual stones after the second flexible ureteroscopy in 25 cases after Holmium laser treatment and only in 2 cases after TFL. In all these cases, we finally obtained zero residual stones. The second flexible ureteroscopy could achieve complete residual stone removal and real stone-free status. Despite a slight difference between these two laser technologies, the second look decreases the residual fragments.

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Section: Discussionsupporting

confidence: 88%

Second-look flexible ureteroscopy after RIRS – Holmium Moses versus TFL (Soltive)

Geavlete¹,

Mareș²,

Multescu³

et al. 2022

JMedLife

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“…The technique did not pose any limitation to the procedure. Since we were using the scope as a suction conduit to aspirate, it was quintessential to use the pure dusting technique, hence TFL laser was preferentially used in all these cases, as it has been shown to be more effective and faster in dusting than the holmium laser [ 26 , 27 ]. In our series, patients with DISS had a longer operative time than SUAS, as even though laser lithotripsy was fast, it takes time to inspect each calyx and visually aspirate the dust and debris to ensure complete clearance.…”

Section: Discussionmentioning

confidence: 99%

Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones

Gauhar

Somani

Heng

et al. 2022

JCM

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Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0–28.8) vs. 13.0 (11.8–15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0–100) minutes] as compared to the SUAS group [47.5 (41.5–60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667–1.00) vs. 1.00 (1.00–2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.

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“…Multiple studies have reported a more efficient lithotripsy [ 56 ]. TFL has also show its advantages with respect to Ho:YAG laser in high evidence clinical studies both for shorter operative time [ 57 ] and higher stone free rate and less complications after flexible ureteroscopy [ 58 ]. In our review, two in-vitro studies pointed into the same direction [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

Sánchez-Puy

Bravo‐Balado

Diana

et al. 2022

JCM

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(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.

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Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial

Cited by 110 publications

References 22 publications

Second-look flexible ureteroscopy after RIRS – Holmium Moses versus TFL (Soltive)

Second-look flexible ureteroscopy after RIRS – Holmium Moses versus TFL (Soltive)

Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

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