nach oben

Erschienen in:

07.07.2023 | Original Article

A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm³)

verfasst von: Abhishek Singh, Chandra Mohan Vaddi, Soundarya Ganesan, Rohan Batra, Paidakula Ramakrishna, Siddalinga Swamy, Hemnath Anandan, Manas Babu, Rakesh Panda, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai

Erschienen in: World Journal of Urology | Ausgabe 8/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Our objective was to analyse the clinical efficiency of TFL in large volume stones during retrograde intrarenal surgery.

Materials and methods

Patients with large volume renal stones (> 1000 mm³) operated at two different centres, from May 2020 to April 2021, were enrolled in this study. Retrograde intrarenal surgery was performed using 60W Superpulse thulium fibre laser™ (IPG Photonics, Russia). Demographic data, stone parameters, laser time, and total operating time were recorded, and laser efficacy (J/mm³) and ablation speed (mm³/s) were calculated. NCCT KUB was done at 3 months postoperatively to calculate stone-free rate.

Results

A total of 76 patients were included and analysed in the study. Mean stone volume was 1753.12 ± 1245.81 (1169.27–2193.25) mm³, mean stone density was 1104.46 ± 313.09 (875.00–1317.00) HU, mean laser time was 537.79 ± 689.89 (21.00–1080.00) sec, mean operating time was 43.38 ± 12.96 (35.00–51.25) min, mean laser efficacy was 20.30 ± 15.5 (8.88–25.57) J/mm³, and mean ablation speed was 1.32 ± 0.7 (0.82–1.64) mm³/sec. A strong positive correlation was found between the stone volume and ablation speed (r = 0.659, p = 0.000), and a moderate negative correlation was found between the stone volume and laser efficacy (J/mm³) (r = − 0.392, p = 0.000). With increasing volume of the stone, J/mm³ decreased significantly and ablation speed increased significantly (p < 0.001). Complications occurred in 21.05% (16/76) patients, most of which were Clavien grades 1–2. Overall SFR is 96.05%.

Conclusion

Laser efficiency increases at higher stone volumes (> 1000 mm³), as less energy is required to ablate every mm³ of stone.

Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2018) EAU guidelines on urolithiasis 2018. European association of urology guidelines

Sabnis RB, Jagtap J, Mishra S, Desai M (2012) Treating renal calculi 1–2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int Br J Urol 110(8):E346. https://doi.org/10.1111/j.1464-410X.2012.11089.xCrossRef

Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R (2012) A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol 26(1):52–57. https://doi.org/10.1089/end.2011.0235CrossRefPubMed

Goldberg H, Golomb D, Shtabholtz Y, Tapiero S, Creiderman G, Shariv A, Lifhshitz D (2017) The “old” 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World J Urol 35(12):1947–1954. https://doi.org/10.1007/s00345-017-2075-8CrossRefPubMed

Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15(9):563–573. https://doi.org/10.1038/s41585-018-0035-8CrossRefPubMed

Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser—a systematic review. Transl Androl Urol 8(Suppl 4):S398. https://doi.org/10.21037/tau.2019.08.01CrossRefPubMedPubMedCentral

Lekarev V, Dymov A, Vinarov A, Sorokin N, Minaev V, Minaev N, Tsypina S, Yusupov V (2020) Mechanism of lithotripsy by superpulse thulium fiber laser and its clinical efficiency. Appl Sci 10(21):7480. https://doi.org/10.3390/app10217480CrossRef

Corrales M, Traxer O (2022) Retrograde intrarenal surgery: laser showdown (Ho: YAG vs thulium fiber laser). Curr Opin Urol 32(2):179–184. https://doi.org/10.1097/MOU.0000000000000971CrossRefPubMed

Enikeev D, Taratkin M, Klimov R, Alyaev Y, Rapoport L, Gazimiev M, Traxer O (2020) Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy. World J Urol 38(12):3069–3074. https://doi.org/10.1007/s00345-020-03134-xCrossRefPubMed

10.

Rice P, Somani BK (2021) A systematic review of thulium fiber laser: applications and advantages of laser technology in the field of urology. Res Rep Urol 13:519. https://doi.org/10.2147/RRU.S233979CrossRefPubMedPubMedCentral

11.

Ergakov D, Martov AG, Guseynov M (2018) The comparative clinical study of Ho: YAG and superpulse Tm fiber laser lithotripters. Eur Urol Suppl 17(2):e1391. https://doi.org/10.1016/S1569-9056(18)31816-5CrossRef

12.

Danilovic A, Cavalanti A, Rocha BA, Traxer O, Torricelli FC, Marchini GS, Mazzucchi E, Srougi M (2018) Assessment of residual stone fragments after retrograde intrarenal surgery. J Endourol 32(12):1108–1113. https://doi.org/10.1089/end.2018.0529CrossRefPubMed

13.

Ghani KR, Wolf JS (2015) What is the stone-free rate following flexible ureteroscopy for kidney stones? Nat Rev Urol 12(5):281–288. https://doi.org/10.1038/nrurol.2015.74CrossRefPubMed

14.

Ventimiglia E, Pauchard F, Gorgen ARH, Panthier F, Doizi S, Traxer O (2021) How do we assess the efficacy of Ho: YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm3 and laser activity concepts. World J Urol 39(3):891–896. https://doi.org/10.1007/s00345-020-03241-9CrossRefPubMed

15.

Majdalany SE, Levin BA, Ghani KR (2021) The efficiency of Moses technology holmium laser for treating renal stones during flexible ureteroscopy: relationship between stone volume, time, and energy. J Endourol 35(3):14. https://doi.org/10.1089/end.2021.0592CrossRef

16.

Corrales M, Traxer O (2021) Initial clinical experience with the new thulium fiber laser: First 50 cases. World J Urol 39(10):3945–3950. https://doi.org/10.1007/s00345-021-03616-6CrossRefPubMed

17.

Enikeev D, Grigoryan V, Fokin I, Morozov A, Taratkin M, Klimov R, Glybochko P (2021) Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: a single- center experience. Int J Urol 28(3):261–265. https://doi.org/10.1111/iju.14443CrossRefPubMed

18.

Traxer O, Corrales M (2021) Managing urolithiasis with thulium fiber laser: updated real-life results—asystematicreview. J Clin Med 10(15):3390. https://doi.org/10.3390/jcm10153390CrossRefPubMedPubMedCentral

19.

El-Nahas AR, Almousawi S, Alqattan Y, Alqadri IM, Al-Shaiji TF, Al-Terki A (2019) Dusting versus fragmentation for renal stones during flexible ureteroscopy. Arab J Urol 17(2):138–142. https://doi.org/10.1080/2090598X.2019.1601002CrossRefPubMedPubMedCentral

20.

Humphreys MR, Shah OD, Monga M, Chang YH, Krambeck AE, Sur RL, Chew BH (2018) Dusting versus basketing during ureteroscopy–which technique is more efficacious? A prospective multicenter trial from the EDGE research consortium. J Urol 199(5):1272–1276. https://doi.org/10.1016/j.juro.2017.11.126CrossRefPubMed

Titel: A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm3)
verfasst von: Abhishek Singh
Chandra Mohan Vaddi
Soundarya Ganesan
Rohan Batra
Paidakula Ramakrishna
Siddalinga Swamy
Hemnath Anandan
Manas Babu
Rakesh Panda
Arvind Ganpule
Ravindra Sabnis
Mahesh Desai
Publikationsdatum: 07.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 8/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04476-y

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm³)