Thulium fiber laser versus holmium

Abstract

Introduction: We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones. Methods: The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate. Results: A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%). Conclusions: The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.

Successful treatment of renal staghorn stones with flexible ureteroscopy and Thulium Fiber Laser (TFL) lithotripsy: a prospective study.

“…Majdalany et al assessed e ciency measures for Ho: YAG with Moses technology and found that for a mean stone volume of 290 mm3, mean laser e cacy was 38.2 J/mm3 and the mean ablation speed was 0.9 mm3/s [24]. In a RCT comparing Ho: YAG and TFL during mini-PCNL, the authors noted shorter stone fragmentation time and shorter operative time in favour of TFL [25].…”

Thulium oder Holmium-Laser oder beides: wo geht die Reise hin?

“…Die neuesten Fortschritte in der Miniaturisierung der PCNL ermöglichen wesentlich kleinere Zugänge, wodurch Transfusionsraten, postoperative Schmerzen und Krankenhausaufenthalte verringert werden, während die Steinfreiheitsraten im Vergleich zu der Standard-PCNL aufrechterhalten werden [38]. Da der TFL vielversprechende Ergebnisse bei der URS gezeigt hat, haben einige Arbeitsgruppen seine Wirksamkeit auch bei der Mini-PCNL evaluiert [39,40,41].…”

“…Ein kürzlich veröffentlichter Vergleich zwischen dem TFL und dem Ho:YAG-Laser mit ähnlichen Fragmentierungseinstellungen bei Patienten, die eine Mini-PCNL (16,5-17,5 Fr) erhielten, zeigte kürzere Desintegrationszeiten und eine geringere Operationszeit in der TFL-Gruppe (11 Minuten 19 Sekunden vs. 20 Minuten 45 Sekunden, p<0,001; und 55 Minuten vs. 68 Minuten, p = 0,001). In dieser Serie erwies sich der TFL während der PCNL als sicher, obwohl die Patienten im Vergleich zur Ho:YAG-Laser-Gruppe eine leicht verlängerte Hämaturie aufwiesen [41]. In einer Studie, die diese Modalitäten verglich, war bei der URS eine schlechte Sicht mit höheren Frequenzen korreliert, was jedoch nicht bei der PCNL bestätigt werden konnte [42].…”

Retrograde intrarenal surgery for stones associated with renal anomalies: caliceal diverticulum, horseshoe kidney, medullary sponge kidney, megacalycosis, pelvic kidney, uretero-pelvic junction obstruction

“…with the current development of thulium fibre laser (TFL), the incidence of self-limiting haematuria is higher [17]. Cakiroglu et al [18 & ] also evaluated the efficacy of RIRS and Ho:YAG lithotripsy in the treatment of 30 symptomatic calyceal diverticulum stones.…”