Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study
- Author:
Chu Ann CHAI
1
;
Takaaki INOUE
;
Bhaskar Kumar SOMANI
;
Steffi Kar Kei YUEN
;
Deepak RAGOORI
;
Nariman GADZHIEV
;
Yiloren TANIDIR
;
Esteban EMILIANI
;
Saeed Bin HAMRI
;
Mohamed Amine LAKMICHI
;
Vaddi CHANDRAMOHAN
;
Angelo NASELLI
;
Boyke SOEBHALI
;
Mehmet Ilker GOKCE
;
Azimdjon N. TURSUNKULOV
;
Fernando Ramón de Fata CHILLÓN
;
Ben Hall CHEW
;
Olivier TRAXER
;
Daniele CASTELLANI
;
Vineet GAUHAR
Author Information
- Publication Type:Original Article
- From: Investigative and Clinical Urology 2024;65(5):451-458
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there’s no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice.
Materials and Methods:Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR).
Results:A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds.
Conclusions:Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.
