Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones : Results from a multicenter study
Chai, Chu Ann (University of Malaya)
Somani, Bhaskar K. (University Hospitals Southampton)
Yuen, S.K.K. (The Chinese University of Hong Kong)
Ragoori, D. (Asian Institute of Nephrology & Urology)
Gadzhiev, Nariman K. (Saint-Petersburg State University Hospital)
Tanidir, Yiloren (Marmara University)
Emiliani, Esteban (Institut de Recerca Sant Pau)
Hamri, S.B. (King Saud Bin Abdulaziz University)
Lakmichi, M.A. (University Hospital Mohammed the VIth of Marrakesh)
Chandramohan, V. (Preeti Urology and Kidney Hospital)
Naselli, A. (IRCCS San Giuseppe Hospital)
Soebhali, B. (Muliawarman University)
Gokce, M.I. (Ankara University School of Medicine)
Tursunkulov, Azimdjon N. (AkfaMedline Hospital)
Chillón, F.R.d.F. (Clínica Universidad de Navarra)
Chew, Ben Hall (University of British Columbia)
Traxer, O. (Università Politecnica delle Marche)
Castellani, Daniele (Sorbonne University)
Gauhar, Vineet (Ng Teng Fong General Hospital)
Inoue, Takaaki
Universitat Autònoma de Barcelona

Data:	2024
Resum:	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. 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). 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Endoscopy ; Laser ; Ureteroscopy ; Urinary tract stones ; Urolithiasis
Publicat a:	Investigative and Clinical Urology, Vol. 65 Núm. 5 (september 2024) , p. 451-458, ISSN 2466-054X

DOI: 10.4111/icu.20240185
PMID: 39249917

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