Role of low- <i>versus</i> high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Pietropaolo, Amelia; Mani, Mriganka; Hughes, Thomas; Somani, Bhaskar K.

doi:10.1177/17562872221097345

Cited by 14 publications

(9 citation statements)

References 34 publications

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“…In addition, patients who used HPL had lower operation time, hospital stay, and uoroscopy time than the LPL group. Previous studies comparing HPL and LPL reported similar SFR at both laser powers [5][6][7]. Furthermore, SFR was similar for the rst and postoperative third months at different energies.…”

Section: Discussionsupporting

confidence: 56%

“…Our study reports postoperative complications according to the Clavien-Dindo grading [11] [12]. In the literature comparing HPL and LPL as complications, the complication rates were changing between 4.3-21% vs. 4.7-17.7% for HPL and LPL, respectively (5,6,8); it was 22.9% − 18.2% for HPL and LPL in our study, and no difference was found in terms of complications between the groups. Although serum creatinine measurement is nonspeci c, it indirectly indicates tubular damage, and preoperative and postoperative creatinine values and kidney damage markers were considered [13] [14].…”

Section: Discussionmentioning

confidence: 43%

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Multicentric Evaluation of High and Low Power Lasers on RIRS Success Using Propensity Score Analysis

Erol

Ecer

Kiremit

et al. 2023

Preprint

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Objectives In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists.While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low power laser). Methods This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. Results There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p=0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35±2.27 days vs. 1.42±1.10 days; p<0.001).The operation duration was 88.70±29.72 minutes in Group1 and 66.17±41.02 minutes in Group2 (p<0.001). The fluoroscopy time (FT) was 90.73±4.79 seconds in Group 1 and 50.78±5.64 seconds in Group 2 (p<0.001).Complications according to Clavien Classification, were similar between the groups(p>0.05) (Table 2). Conclusion According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group.Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 43%

Multicentric Evaluation of High and Low Power Lasers on RIRS Success Using Propensity Score Analysis

Erol

Ecer

Kiremit

et al. 2023

Preprint

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“…The complication comparison between MOSES mode and normal mode comprised data from 6 studies (with 779 patients) [ 12 – 14 , 16 – 18 ]. In relation to safety, no significant difference was found in the forest plot (RR = 0.85, 95% CI 0.48–1.53, P = 0.806, Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of the efficacy and safety of holmium laser with the Moses technology and regular mode for stone treatment: a systematic review and meta-analysis

Chi

et al. 2023

BMC Urol

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Background As a new pulse modality of holmium laser in retrograde intrarenal stone surgery, the MOSES technique can reduce the possibility of stone drifting and help to powder kidney stones in vitro and in animal experiments. However, there remains controversy about whether the MOSES mode needs to be used instead of the regular mode in clinical practice. This meta-review was conducted to evaluate the clinical efficacy and safety of MOSES technology for stone disease. Methods PubMed, Embase, Web of Science, Cochrane Library, and CNKI were searched for relevant studies until September 2022, with 1 RCT and 6 nonrandomized studies included. We pulled data on adverse events, success rates and operative time to analyze based on the random effect model. Results We found that using MOSES mode could shorten the operative time (standard mean difference [SMD] − 0.43; 95% confidence interval [CI] − 0.79 to − 0.08; P = 0.016) than regular mode especially in a small sample study or in the Asian area. When the number of women is smaller than the number of men, the reduction of the duration was also significant. Stone-free rates of the two modes had no difference (relative risk [RR] 1.06; 95% CI 0.99–1.12; P = 0.30), and there was no publication bias. In terms of safety, no significant difference in complications was detected between the two approaches (RR 0.85; 95% CI 0.48–1.53; P = 0.81) without significant heterogeneity. Conclusion MOSES mode holmium laser was superior to the regular mode laser in terms of procedure time. There was no large disparity in stone-free rates or complications between the two modes. However, our conclusions should be confirmed in prospective studies with high evidence.

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“…One advantage is that smaller laser fibre sizes that might be used with TFLs, coupled with the new miniaturized technologies and the smaller single-use flexible scopes, might extend the use of RIRS for larger and lower pole stones. Additionally, high-power lasers might widen the horizon of RIRS, since some studies have already demonstrated advantages in terms of shorter operative time, reduced use of ureteral access sheath (UAS), and postoperative stent, which in turn mean a reduction in sepsis-related complication rates [102]. Large comparative studies comparing TFL and Ho:YAG lasers with MOSES technology might shed new light on what the best treatment is in terms of surgical outcomes, emphasizing the outcome measures such as stone-free rate and the imaging used to achieve it, quality of life, costs, and environmental impact [103][104][105].…”

Section: Future Perspectivesmentioning

confidence: 99%

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

et al. 2023

Self Cite

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The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones <2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon’s expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology.

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Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Cited by 14 publications

References 34 publications

Multicentric Evaluation of High and Low Power Lasers on RIRS Success Using Propensity Score Analysis

Multicentric Evaluation of High and Low Power Lasers on RIRS Success Using Propensity Score Analysis

Comparison of the efficacy and safety of holmium laser with the Moses technology and regular mode for stone treatment: a systematic review and meta-analysis

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

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