PD54-08 HOLMIUM:YAG (HO:YAG) VERSUS THULIUM FIBER LASER (TFL) FOR TREATMENT OF UPPER URINARY TRACT CALCULI IN DUSTING MODE: A CLINICAL COMPARISON OF EFFICIENCY, EFFICACY AND COSTS EFFECTIVENESS

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-08 HOLMIUM:YAG (HO:YAG) VERSUS THULIUM FIBER LASER (TFL) FOR TREATMENT OF UPPER URINARY TRACT CALCULI IN DUSTING MODE: A CLINICAL COMPARISON OF EFFICIENCY, EFFICACY AND COSTS EFFECTIVENESS Ahmed Ghazi, Mahmoud Khalil, Changyong Feng, Scott Quarrier, and Rajat Jain Ahmed GhaziAhmed Ghazi More articles by this author , Mahmoud KhalilMahmoud Khalil More articles by this author , Changyong FengChangyong Feng More articles by this author , Scott QuarrierScott Quarrier More articles by this author , and Rajat JainRajat Jain More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preliminary studies have demonstrated the superiority of TFL compared to Ho:YAG for dusting of urinary calculi. These are mainly based on laboratory studies with emerging clinical reports limited to optimizing TFL dusting settings. We aim to compare the efficiency, effectiveness and costs effectiveness of high power Ho:YAG (100W Empower, Olympus) to TFL (Soltive PLS, Olympus) lasers operated at a fixed dusting protocol. METHODS: A prospective study of 62 patients (31 per group) with 10–30 mm renal calculi was completed. Fixed dusting settings (0.4J X 60Hz) during retrograde intrarenal surgery (RIRS) lithotripsy was used for both lasers. Laser on time (LOT), Ablation efficacy (J/mm3) and Ablation speed (mm3/second) were calculated. Retropulsion, visibility, and bleeding during RIRS were graded by 3 urologists using 5-point Likert scales. Stone-free rate (SFR) was assessed at 1 month with non-contrast CT. Projected cost savings were calculated utilizing the formula [average LOT difference x $100/minute billed to insurance for RIRS minus $178 differential between list price of the 200m TFL ball tip and regular Ho:YAG fiber plus price differential for upgrade to PLS Soltive ($18800/1000) amortized over 1000 procedures=$18.8]. RESULTS: Mean age, BMI, stone number, density, ellipsoid stone volume and STONE score was not significantly different among both groups (Table 1). TFL lithotripsy had significantly shorter LOTs (380.6 vs 533.6 seconds, p=0.015) and higher SFRs (68% vs 34.8%, p=0.03). Both ablation efficacy (21.2 vs 12.5 J/mm3, p=0.02) and speed (4.1 vs 1.2 mm3/second, p=0.003) were significantly higher with TFL. TFL was 2.6 min faster for all stones (3.4 min for stones <15mm vs 1.7min for stones >15mm) with an overall projected $69.2 saving per case [$266- ($178+ $18.8) (Table 1). TFL was superior in terms of retropulsion (1.6 vs 2.8), visibility (1.8 vs 3.3) and bleeding (1.1 vs 1.9) gradings. CONCLUSIONS: This clinical study demonstrates TFL as a more effective, efficient and cost effective laser during RIRS lithotripsy when operated in dusting mode, producing higher stone ablation rates and speed with improved stone free rates than Ho:YAG laser. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e925-e926 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ghazi More articles by this author Mahmoud Khalil More articles by this author Changyong Feng More articles by this author Scott Quarrier More articles by this author Rajat Jain More articles by this author Expand All Advertisement Loading ...