Elsevier

Urology

Volume 79, Issue 2, February 2012, Pages 293-297
Urology

Endourology and Stones
High- vs Low-power Holmium Laser Lithotripsy: A Prospective, Randomized Study in Patients Undergoing Multitract Minipercutaneous Nephrolithotomy

https://doi.org/10.1016/j.urology.2011.08.036Get rights and content

Objective

To determine the efficacy and safety of high-power holmium: yttrium aluminum-garnet (Ho:YAG) laser lithotripsy for multitract modified minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of patients with large staghorn renal calculi.

Methods

A randomized, prospective study was conducted. Two-hundred seventy-three consecutive patients (291 renal units) with large staghorn renal calculi were randomized to undergo multitract MPCNL with 30-W low-power or 70-W high-power Ho:YAG laser lithotripsy. Both groups were compared in terms of perioperative findings and postoperative outcomes, including procedure time, stone-free rate, length of hospital stay, transfusion rates, renal function recovery, and other complications.

Results

The average patient age was 49.2 years (range 22-73) and mean stone size was 5.54 ± 0.7 cm. The 2 groups had some comparable perioperative findings and outcome, including tracts required per operated renal unit (n), blood loss, postoperative fever, postoperative hospital stay, stone-free rate, and improvement of operated renal function. The operation time in the high-power group was significantly shorter than that in the low-power group (129.20 ± 17.2 vs 105.18 ± 14.2, P <.01).

Conclusion

A combination of multitract MPCNL and high-power Ho:YAG laser lithotripsy can greatly decrease the operative time without increasing the intraoperative complications or delaying postoperative renal function recovery when compared with low-power Ho:YAG laser lithotripsy.

Section snippets

Patients

From January 2008 to September 2010, 273 consecutive patients with large staghorn kidney stones (diameter ≥4 cm, based on kidney-ureter-bladder [KUB] films) in our hospital, irrespective of the number of stones and amount of hydronephrosis, were randomly enrolled to undertake multitract MPCNLs with a pulsed Ho:YAG laser (VersaPulse 100 PowerSuite, Coherent Medical Group, Santa Clara, CA). Exclusion criteria were general contraindications of surgery, uncorrectable coagulation disorders,

Results

Two-hundred ninety-one renal units in 273 patients were successfully treated with single-session PCNLs. The average patient age was 49.2 years (range 22-73). The stone size was defined as the maximal diameter measured on the preoperative X-ray film, and the average stone size was 5.54 ± 0.7 cm. The 2 groups had comparable demographic data and baseline characteristics (Table 1).

Of the 291 treated renal units, 762 tracts were established and the number of tracts required per renal unit was 2-4.

Comment

The treatment of large, complete staghorn calculi usually requires a sandwich combination of PCNL and shockwave lithotripsy or sometimes open surgery.11 Complete removal of the stone is an important goal to prevent further stone growth and any associated infection, and to preserve renal function.12 The goal to a complete removal of the renal staghorn calculi has encouraged multiple tracts carried out in a single session of PCNL.1, 2 Despite the fact that standard PCNL is a well-recognized,

Conclusions

A combination of multitract MPCNL and high-power Ho:YAG laser lithotripsy can greatly decrease the operative time without increasing the intraoperative complications or delaying postoperative renal function recovery when compared with low-power Ho:YAG laser lithotripsy.

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Shushang Chen and Lingfeng Zhu contributed equally to this work.

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