MP65-04 RIRS VERSUS PCNL IN LARGER KIDNEY STONES. COULD SUPERPULSED TFL CHANGE THE GAME?

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-04 RIRS VERSUS PCNL IN LARGER KIDNEY STONES. COULD SUPERPULSED TFL CHANGE THE GAME? Mark Taratkin, Camilla Azilgareeva, Denis Chinenov, Stanislav Ali, Dmitry Korolev, Dmitry Tsarichenko, Mariela Corrales, and Dmitry Enikeev Mark TaratkinMark Taratkin More articles by this author , Camilla AzilgareevaCamilla Azilgareeva More articles by this author , Denis ChinenovDenis Chinenov More articles by this author , Stanislav AliStanislav Ali More articles by this author , Dmitry KorolevDmitry Korolev More articles by this author , Dmitry TsarichenkoDmitry Tsarichenko More articles by this author , Mariela CorralesMariela Corrales More articles by this author , and Dmitry EnikeevDmitry Enikeev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The novel SuperPulsed Thulium-fiber laser (SP TFL) produces higher stone ablation rates, three to four-times more dust, smaller stone fragments, when compared to Ho:YAG laser. The aim of the study was to compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) efficacy and safety with SuperPulsed Thulium-fiber laser (SP TFL) for stones > 20 mm. METHODS: Patients with large kidney stones (>20mm) were recruited to undergo PCNL or RIRS with SP TFL lithotripsy. Both RIRS and PCNL were performed under general anaesthesia with all the patients in the lithotomy position. During the RIRS, the FLEX-X2 (Karl Storz Gmbh Germany) or the LithoVue™ (Boston Scientific, Marlborough, USA) ureteroscopes with a 200 μm laser fiber were used. All PCNL procedures were performed using a 12 Fr nephroscope with MIP set (16.5-17.5 Fr) (Richard Wolf Gmbh, Germany). Lithotripsy was performed with a 400 μm laser fiber using a fragmentation setting only. Both groups were comparable in terms of stone size and density, operation time, laser-on time (LOT), stone-free rate, residual fragments and complication rate. Stone retropulsion and visibility were assessed based on the surgeon's feedback using three-point Likert scales. RESULTS: A total of 14 and 56 patients were included in the RIRS and PCNL groups respectively. The mean stone density was 833.8±298.3 HU in the RIRS group and 882.3±408.5 HU in the PCNL group (p=0.072). The median LOT was 11.7 (10.0-15.5) min for RIRS and 10.0 (6.0-12.1) min for PCNL (p=0.207). The median total energy for stone ablation was 13.8 (11.8-25.0) kJ for RIRS and 12.0 (7.0-20.1) kJ for PCNL (p=0.508). The median ablation speed was 3.9 (3.9-5.7) mm3/sec for RIRS and 5.0 (4.6-11.3) mm3/sec for PCNL (p=0.085). In both groups LOT was positively correlated with total energy (RIRS: r= 0.865 with p<0.001; PCNL: r= 0.834 with p<0.001). We found a significant correlation between retropulsion and the type of surgery performed: with higher retropulsion in the PCNL (r=0.298 with p=0.012). The stone-free rate at 3-months was 85.7 % (12/14 cases) in RIRS and 89.3 % (50/56 cases) in PCNL (p=0.505). The postoperative complication rate was relatively low with only 14.2% (2/14) in RIRS and 14.3% (8/56) in PCNL with only Clavien Grade I-II complications. CONCLUSIONS: TFL is a safe and effective modality for both RIRS and PCNL resulting in minimal retropulsion and good visibility. No discrepancies in procedure duration, complications, or LOT were identified between the different modalities. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1120-e1120 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Taratkin More articles by this author Camilla Azilgareeva More articles by this author Denis Chinenov More articles by this author Stanislav Ali More articles by this author Dmitry Korolev More articles by this author Dmitry Tsarichenko More articles by this author Mariela Corrales More articles by this author Dmitry Enikeev More articles by this author Expand All Advertisement Loading ...