Thulium Fiber Laser Lithotripsy in COVID Positive Patients

Abstract

Background: Thulium fiber laser technology has been shown to provide more power through a small fiber to enable faster stone fragmentation. In the Covid era, positive patients were postponed for a few weeks before any surgery to ensure their safety. However, with complete ureteric obstruction with large stones, delayed ureteroscopy and stone fragmentation could potentially compromise renal function. We aim to evaluate the Thulium Fiber Laser outcome as an alternative to holmium YAG laser as intracorporeal lithotripter in Covid-19 positive patients. Methods: From March-July 2020, during the peak of the corona outbreak, 11 COVID-19 positive patients were admitted through the emergency department with obstructing ureteric stones underwent urgent JJ stent insertion 2 weeks later from the initial surgery a definitive treatment offered. Results: The average age was 36+-11.7 years, all-male, all fit and healthy despite their Covid-19 status. The average stone size was 11+-3.1 mm with a volume of 395.8+-280 mm3 . The Hounsfield unit measurement was 1033.3+-57.7. Seven underwent short general anesthesia and 4 had spinal anesthesia. The average laser duration was of 593.9+-357.5 seconds, and the average stone ablation speed was 0.66+-0.19 mm3 /Sec. The overall stone- free rate was 90.9%. All 11 patients were discharged safely on the same day with only 1 patient readmitted with steinstrasse and underwent urgent ureteroscopy. None of our patients developed late complications. Conclusion: Using the Thulium laser technology allows for a quick and safe alternative to Holmium for fragmenting ureteric stones with a high stone-free rate.