Current status of thulium fibre laser lithotripsy: an up‐to‐date review

Abstract

To perform an up-to-date review to scope the current status of the thulium fibre laser (TFL) in the setting of stone lithotripsy and provide a guide for the clinical urologist. MethodsA review of world literature was performed to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared. ResultsTo date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of miniaturised percutaneous nephrolithotomy (mini-PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, the range of settings has been 0.1-4 J 9 7-300 Hz for both URS and mini-PCNL. Stones ranging from 0.4-3.2 and 1.5-3 cm have been treated with URS and mini-PCNL, respectively. The final stone-free rate for TFL has ranged from 66.6% to 100% and 85-100% for URS and mini-PCNL, respectively. The average length of stay ranged from 0.5 to 2.4 days in the URS group, but no studies have been reported this for mini-PCNL. Operative times in all the studies (both URS and mini PCNL) were <60 min. ConclusionInitial clinical studies reveal that TFL appears to be efficacious in the setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position, as well as determine the optimal settings for use in clinical practice.

Case of the Month from UCSD, San Diego, USA: Treatment of giant dystrophic prostatic calcification using MOSES holmium laser

“…In addition, the second energy pulse then reaches the targeted calculus with less energy attenuation in the vaporised water. Through this biphasic energy delivery, MOSES technology has been demonstrated to reduce operative time by increasing lithotripsy efficiency [5]. We demonstrate and describe that MOSES holmium laser lithotripsy may also be an effective and safe treatment for giant prostatic calculi, applying the sample principles commonly applied in management of nephrolithiasis.…”

“…For nearly three decades, holmium laser technology has been a tool commonly utilised in urological calculus procedures. While effective for lithotripsy and ablation, holmium laser technology can suffer from energy dissipation through the urine environment and cause challenges with efficiency due to calculus migration [5]. The MOSES technology delivers a two-phase energy pulse, where the first is delivered to the urine environment between the laser tip and the calculus and the second delivered directly to the calculus.…”

Endourological management of encrusted ureteral stents: An up-to-date guide and treatment algorithm on behalf of the European Association of Urology Young Academic Urology Urolithiasis Group

“…Its ability to treat larger stones and maintain good visibility can be transferred to SE cases. It also causes reduced bleeding to surrounding tissue and achieves shorter operative times [ 34 , 35 ]. It is also possible that a percutaneous nephrostomy (PCN) tube becomes encrusted, which can be approached using the same rationale as for a ureteral stent.…”

Comparing Pediatric Ureteroscopy Outcomes with SuperPulsed Thulium Fiber Laser and Low-Power Holmium:YAG Laser

“…These technical advantages of the TFL have led to its early adoption with series in adults validating its safety and efficacy in stone lithotripsy. 3 To date, no study has been performed evaluating the safety and efficacy of the TFL in a pediatric cohort.…”