Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

Abstract

Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free.

Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review

“…For the perioperative outcomes, 11 studies [ 21 – 28 , 30 , 32 , 33 ] reported data on operation time, 8 studies [ 21 – 23 , 26 , 29 – 31 , 33 ] reported laser time data, 4 studies [ 21 – 23 , 25 ] reported data on duration of hospital stay, 3 studies [ 21 , 22 , 25 ] reported the drop in hemoglobin, 5 studies [ 21 , 22 , 26 , 29 , 31 ] reported the total energy used in the lithotripsy process, and the remaining 3 studies [ 23 , 26 , 32 ] reported postoperative ureteral stenting rates. The findings suggested that the operation time of the TFL group was shorter than that of the Ho: YAG group [-5.47, 95% CI (-8.86, -2.08), P = 0.002].…”

“…Five studies [ 23 , 26 , 27 , 30 , 32 ] reported eligible data on intraoperative complications. The findings revealed that the total incidence of intraoperative complications in the TFL group was lower than that in the Ho: YAG group by 8.2% vs. 12.7%, but there was no statistical difference [0.58, 95% CI (0.27, 1.26), P = 0.17].…”

“…Eight studies [ 22 , 23 , 26 – 30 , 32 ] examined the overall incidence of postoperative complications. The results showed that there was no statistically significant difference between the two groups in the incidence of postoperative complications [0.95, 95% CI (0.58, 1.55), P = 0.84].…”

Pulsed thulium: YAG laser – what is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in-vitro PEARLS study

“…Currently, the holmium:yttrium-aluminum-garnet (Ho:YAG) and the more recent thulium fiber laser (TFL) are widely used in endourological procedures [6][7][8], with their effectiveness against human urinary stones extensively evaluated [9][10][11][12][13][14].…”