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Zhong P, Luo R, Liao L. Thulium fiber laser versus holmium:yttrium aluminum garnet for lithotripsy. World J Urol 2024; 42:204. [PMID: 38554252 DOI: 10.1007/s00345-024-04931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Affiliation(s)
- Ping Zhong
- Second Clinical Medical College, Shandong University, Jinan, China
- Department of Urology, China Rehabilitation Research Center, 10 Jiaomen Beilu, Fengtai, Beijing, 100068, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Runtian Luo
- Department of Urology, China Rehabilitation Research Center, 10 Jiaomen Beilu, Fengtai, Beijing, 100068, China
- China Rehabilitation Science Institute, Beijing, China
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Second Clinical Medical College, Shandong University, Jinan, China.
- Department of Urology, China Rehabilitation Research Center, 10 Jiaomen Beilu, Fengtai, Beijing, 100068, China.
- China Rehabilitation Science Institute, Beijing, China.
- University of Health and Rehabilitation Sciences, Qingdao, China.
- School of Rehabilitation, Capital Medical University, Beijing, China.
- Wenzhou Medical University, Wenzhou, China.
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Ortner G, Somani BK, Güven S, Kitzbichler G, Traxer O, Giusti G, Proietti S, Liatsikos E, Kallidonis P, Krambeck A, Goumas IK, Duvdevani M, Kamphuis GM, Ferretti S, Dragos L, Ghani K, Miernik A, Juliebø-Jones P, Jung H, Tailly T, Pietropaolo A, Hamri SB, Papatsoris A, Sarica K, Scoffone CM, Cracco CM, Keller EX, Durutovic O, Pereira S, Herrmann TRW, Nagele U, Gözen AS, Tokas T. Experts' recommendations in laser use for the treatment of urolithiasis: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2024; 42:33. [PMID: 38217743 DOI: 10.1007/s00345-023-04726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. METHODS After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. CONCLUSIONS Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kitzbichler
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Olivier Traxer
- Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Guido Giusti
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | | - Mordechai Duvdevani
- Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefania Ferretti
- Department of Urology, Hospital, University of Modena, Modena, Italy
| | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Helene Jung
- Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Saeed Bin Hamri
- Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia
| | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kemal Sarica
- Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey
| | | | | | | | - Otas Durutovic
- Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sergio Pereira
- Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
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Taratkin M, Azilgareeva C, Petov V, Morozov A, Ali S, Babaevskaya D, De Coninck V, Korolev D, Akopyan G, Scoffone CM, Chinenov D, Androsov A, Fajkovic H, Lifshitz D, Traxer O, Enikeev D. Thulium fiber laser vs Ho:YAG in RIRS: a prospective randomized clinical trial assessing the efficacy of lasers and different fiber diameters (150 µm and 200 µm). World J Urol 2023; 41:3705-3711. [PMID: 37855897 PMCID: PMC10693522 DOI: 10.1007/s00345-023-04651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION The aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium-aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm). METHODS A prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber. RESULTS Ninety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2-14.6) min, in 150-μm SP TFL-11.4 (7.7-14.9) min (p = 0.390), in Ho:YAG-14.1 (10.8-18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8-15.2) kJ; 150-μm SP TFL - 10.8 (7.3-13.5) kJ (p = 0.626) and in Ho:YAG-15.2 (11.1-25.3) kJ (p = 0.005). CONCLUSIONS Irrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Camilla Azilgareeva
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Stanislav Ali
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Diana Babaevskaya
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Dmitry Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Gagik Akopyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Denis Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - David Lifshitz
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Olivier Traxer
- GRC #20 Lithiase Urinaire, Sorbonne University, Hôpital Tenon, Paris, France
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel.
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Liang H, Liang L, Lin Y, Yu Y, Xu X, Liang Z, Sheng J, Shen B. Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases. BMC Urol 2023; 23:175. [PMID: 37915008 PMCID: PMC10621309 DOI: 10.1186/s12894-023-01347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION During the last decades, the advent of flexible ureteroscopic lithotripsy has revolutionized the management of upper urinary tract stones. We designed a patented tip-bendable ureteral access sheath to facilitate stone clearance. Our current study reported our initial experience of 224 cases. MATERIALS AND METHODS The study is a descriptive, retrospective analysis. The initial 224 cases, operated consecutively by one surgeon during 16 months, were reviewed. The novel tip-bendable ureteral access sheath was applied in the procedure. Demographics, laboratory tests, and peri- and postoperative findings (operation duration, stone-free rate (SFR), utilization of flexible instruments and complications) were analyzed. RESUTLS The median age of the patients was 56 years and the mean stones size was 2.3 ± 1.3 cm. There were 63 cases of upper ureteral stone, 93cases of renal stone and 68 cases of ureteral-renal stones. The mean operative time was 69.2 ± 65.2 min. The immediate stone-free rate was 76.8% and the 1 month post-operative stone-free rate was 97.3%. Most cases(95.5%)were success in single session. Two patient experienced post-operative fever. There was no unplanned readmission. The frequency of post-operative complications was estimated at 0.89% (Clavien I). CONCLUSION Flexible ureteroscopic lithotripsy with tip-bendable ureteral access sheath is a safe and effective procedure, which can achieve excellent stone clearance.
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Affiliation(s)
- Hui Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China.
| | - Lijian Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Yiwei Lin
- Department of Urology, the 1st Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yin Yu
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Xiaoling Xu
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Zihao Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Jinmin Sheng
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang Province, China
| | - Baihua Shen
- Department of Urology, the 1st Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Solano C, Corrales M, Panthier F, Candela L, Doizi S, Traxer O. Navigating urolithiasis treatment: assessing the practicality and performance of thulium fiber laser, holmium YAG, and thulium YAG in real-world scenarios. World J Urol 2023; 41:2627-2636. [PMID: 37468656 DOI: 10.1007/s00345-023-04487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The management of urolithiasis has undergone significant advancements with the introduction of pulsed lasers, particularly the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently considered the gold standard in endourology. However, the Ho:YAG laser has certain limitations, such as the inability to support small laser fibers (150 μm) and the requirement of a heavy water cooling system, making it challenging to transfer between operating rooms. These limitations have led to the emergence of new laser technologies, including the thulium fiber laser (TFL) and the thulium:yttrium-aluminum-garnet laser (Tm:YAG), as potential alternatives to the Ho:YAG laser. METHODS In this review, we aimed to evaluate the effectiveness and safety of TFL, Ho:YAG, and Tm:YAG lasers in real-life scenarios by comparing clinical trial data with laboratory findings. A literature review was conducted, and relevant in vitro studies and clinical trials until March 2023 were analyzed. RESULTS The findings indicate that TFL has demonstrated high ablation efficiency for stones of any composition, size, and location, superior the capabilities of Ho:YAG lasers. TFL has shown superior dusting and fragmentation abilities, lower retropulsion, and increased patient safety. The laser parameters, such as ablation efficiency, speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes. CONCLUSION Although the number of studies on TFL is limited, the available evidence suggests that TFL represents a significant advancement in laser technology for lithotripsy. However, further research is needed to fully explore the implications and limitations of TFL and Tm:YAG lasers.
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Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Frederic Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Luigi Candela
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steeve Doizi
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
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Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. 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. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
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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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
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