MP26-16 THULIUM FIBER LASER VERSUS HOLMIUM:YAG LASER LITHOTRIPSY FOR UROLITHIASIS: META-ANALYSIS OF CLINICAL STUDIES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP26-16 THULIUM FIBER LASER VERSUS HOLMIUM:YAG LASER LITHOTRIPSY FOR UROLITHIASIS: META-ANALYSIS OF CLINICAL STUDIES Michael Chua, Adam Bobrowski, Ihtisham Ahmad, Jin Kyu Kim, Jan Michael Silangcruz, Mandy Rickard, Armando Lorenzo, and Jayson Lee Michael ChuaMichael Chua More articles by this author , Adam BobrowskiAdam Bobrowski More articles by this author , Ihtisham AhmadIhtisham Ahmad More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Jan Michael SilangcruzJan Michael Silangcruz More articles by this author , Mandy RickardMandy Rickard More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Jayson LeeJayson Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thulium fiber laser (TFL) is a new laser technology capable of pulsed laser emission, suitable for lithotripsy via photothermal and photomechanical mechanisms with 4-5x higher peak water absorption coefficient in water compared to the Ho:YAG laser. This meta-analysis aimed to compare and assess the clinical outcomes between Thulium fiber laser (TFL) and Holmium: YAG (Ho:YAG) laser lithotripsy. METHODS: A systematic literature search was performed in May 2022, grey literature search in July 2022. Comparative clinical studies were evaluated according to Cochrane recommendations. Assessed outcomes include stone-free rate (SFR), complication rate, operative time (OT), laser utilization time (LUT), ablation rate (stone volume/ laser time), ablation efficiency (energy use per stone volume), total energy usage, degree of retropulsion, and hospital stay. Risk ratios (RR) and standardized mean difference (SMD) were extrapolated. Subgroup analyses, heterogeneity, publication bias, and GRADE assessment were performed. PROSPERO registration: CRD42022300788 RESULTS: Fifteen studies with 1,698 cases were included in this review. The outcome of SFR showed no significant between-group difference (RR=1.09, 95%CI 0.99, 1.20). However, subgroup analysis of TFL versus Ho:YAG with no pulse modulation showed SFR favoring TFL (RR=1.11, 95%CI 1.01, 1.23). The composite postoperative complication rate was comparable between the two intervention groups (RR0.97, 95%CI 0.66, 1.43). OT, LUT and ablation rate were significantly better for TFL than Ho:YAG (SMD-1.19, 95%CI -1.85, -0.52; SMD-1.67, 95%CI -2.62, -0.72; SMD 0.59, 95%CI 0.15, 1.03; respectively). The degree of retropulsion was significantly lower for TFL than Ho:YAG without pulse modulation(SMD-1.23, 95%CI -1.74, -0.71). Ablation efficiency, total energy usage, and hospital stay were all comparable. Based on GRADE criteria, the evidence certainty was determined to be very low. CONCLUSIONS: Overall, there was no between-group difference for SFR. However, compared to Ho:YAG with no pulse modulation, TFL renders a better SFR. Shorter operative and laser utilization times, a lesser degree of retropulsion, and a better ablation rate were noted in favor of the TFL. No overall between-group difference was noted for composite postoperative complication rate, ablation efficiency, total energy usage, and hospital stay. Currently, available clinical evidence is assessed to be of very low certainty. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e359 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Chua More articles by this author Adam Bobrowski More articles by this author Ihtisham Ahmad More articles by this author Jin Kyu Kim More articles by this author Jan Michael Silangcruz More articles by this author Mandy Rickard More articles by this author Armando Lorenzo More articles by this author Jayson Lee More articles by this author Expand All Advertisement PDF downloadLoading ...