Comparison of the clinical efficacy of holmium and thulium ureterolithotripsy

Abstract

Introduction. Urolithiasis is one of the most common pathologies in modern urology. This disease is registered in 10% of the population and is manifested by an annual increase. Despite all the effectiveness and safety of Ho:YAG, in recent years, the thulium laser has attracted more and more interest. At the moment, in the modern literature there is not enough information about thulium and holmium ureterolithotripsy. The aim of this study is to compare the effectiveness of thulium and holmium ureterolithotripsy. Material and Methods. Since from October 2018 to October 2019 in City Centre Endoscopic Urology and New Technologies Clinical Hospital of St. Luke; St. Petersburg, 420 patients underwent contact ureterolithotripsy with using of thulium (group Б) or holmium (group А) lasers for calculi localized in the ureter. Results. Patients in group B had an advantage in terms of such indicators as the time of surgery, the time of lithotripsy in the Dusting and Fragmentation modes for ureteral calculi of any localization compared with group A. The SFR level in the two groups was relatively identical. Patients in group B had a lower rate of retropulsion during lithotripsy compared to patients in group A. And also in group B there was no migration of calculus into the renal cavity system. Conclusion. Our data indicate the same level of stone free rate when using both thulium and holmium lasers in the dusting and fragmentation modes. However, there is a higher efficiency during ureterolithotripsy using a thulium laser compared to ureterolithotripsy using a holmium laser, regardless of the lithotripsy mode.

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

“…Furthermore, 30 articles were excluded because they did not meet the inclusion criteria. The final 13 studies [ 21 – 33 ], including 1394 patients, were included in this meta-analysis (Fig. 1 ).…”

“…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].…”

Thulium fibre laser vs holmium: yttrium‐aluminium‐garnet laser lithotripsy for urolithiasis: meta‐analysis of clinical studies

“…A total of 15 comparative studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], with 1698 cases (TFL, 708; Ho:YAG, 990), were included in the meta-analysis; six RCTs [18][19][20][21][22][23], five prospective [24,[27][28][29]31], and four retrospective cohorts [25,26,30,32]. Four studies were conducted in the United States [19,24,25,30], four in India [20,22,27,28], three in Russia [18,21,29], one in Norway [23], one in Italy [31], one in Canada [32] and one from an Asian-European multi-institutional initiative [26]. Most studies reported clinical outcomes from adult cohorts, while two reported on paediatric patients [25,26].…”

“…Most studies reported clinical outcomes from adult cohorts, while two reported on paediatric patients [25,26]. In addition, two studies reported a comparative study of TFL vs Ho:YAG in the mini-percutaneous nephrolithotomy (PCNL) procedure [20,27], three exclusively involved ureteroscopy (URS) [21,28,29], and the remaining studies included flexible URS with retrograde intra-renal surgeries (RIRS). Two studies compared TFL with Ho:YAG with pulse modulation (MOSES) [19,27], while the other studies included Ho:YAG of low-(30-35 W) or high-power (100-120 W) capability with no pulse modulation.…”

“…Most sources of serious risk of bias were secondary to outcome measurement, missing data, and confounders. Table 1 [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] details the ROB2 and ROBINS-I evaluation and consensus among the reviewers.…”