Superpulsed Thulium Fiber Laser Research Articles

Ablation efficiency and laser safety of a novel superpulsed thulium fiber laser: a in vitro study.

To assess the ablation efficiency of the Superpulsed Thulium Fiber Laser (SP-TFL) and investigate the thermal effects of SP-TFL. A SP-TFLwas employed to evaluate ablation efficiency. Fresh ex-vivo pig kidneys and ureters were utilized to evaluate the renal pelvis and ureter temperature changes, different irrigation rates(0, 15, 38mL/min) and a long pulse width were used. The research indicated that as laser output power increased, ablation rates significantly increased. Ablation rates(mg/min) were higher and the energy per ablated mass(J/mg) was lower at lower frequencies(10-50Hz). Under the same frequency and single pulse energy, super short and short pulse widths demonstrated higher ablation rates at higher frequencies (exceeding 100Hz). The temperature of the renal pelvis and ureter decreased with increasing irrigation rates. In the renal pelvis, without irrigation, the temperature quickly reached the critical threshold of 43℃. The irrigation rate was 15ml/min and power was no more than 18W, the renal pelvis temperature did not reach 43℃. When the irrigation rate were 38ml/min, the temperature did not risen to 43℃. In the ureter, without irrigation, the temperature also quickly reached 43℃. The temperature reached 43℃ when the power exceeded to12W with an irrigation rate of 15ml/min. With an irrigation rate of 38ml/min, the temperature reached 43℃ at a laser power of 30W. The SP-TFL demonstrated promising ablation effectiveness especially for lower frequencies and super short and short pulse widths model. Proper irrigation rates, single pulse energy, frequency and pulse width are crucial during lithotripsy.

Treatment of Urolithiasis with Thulium Fiber Laser in Fragmentation Mode Using Optimized Pulse Sequences.

Objectives: The super-pulsed thulium fiber laser (SP TFL) is a new alternative to high-power holmium laser for intracorporeal lithotripsy. The SP TFL has shown advantages in dusting regimes, but benefits in fragmentation regimes are less understood. The second-generation SP TFL introduces an advanced fragmentation pulse (AFP) sequence to maximize SP TFL's efficiency in fragmentation. This study evaluates safety and efficacy of the SP TFL fragmentation mode in ureteroscopy (URS) and mini percutaneous nephrolithotomy (mini-PCNL). Materials and Methods: The study was conducted in two phases. Safety of a new AFP was compared ex vivo to standard SP TFL fragmentation settings by measuring the dimensions of wounds created in porcine kidney after laser exposure for 0.5, 1.0, and 2.0 s. The resulting wounds were evaluated histologically using nitro blue tetrazolium chloride (NBTC) stain. In the clinical phase, the second-generation SP TFL was used to fragment and extract ureteral and renal stones in 40 patients using ureteroscopic and percutaneous approaches. The stone size, volume, density, laser-on-time, and total energy were recorded for each patient. In addition, the chemical composition, ablation rate, and ablation efficiency were assessed for each stone treatment. Results: The ex vivo mucosa damage profiles caused by AFP were similar to those caused by regular pulses. In clinical phase, the median volume and density for ureteral stones were 0.4 cm3 and 1029 Hounsfield units (HU), for renal stones 1.3 cm3 and 1113 HU, respectively. Different stone types were crushed into fragments suitable for extraction. The mean AFP energy was 3 J and the average power for ureteral stones was 10.5 W, whereas for renal stones it was 28.5 J and 31 W, respectively. The overall complication rate was low in both groups. Conclusion: ST PFL with AFP capability facilitates effective fragmentation of ureteral and renal stones of any composition during URS and mini-PCNL with minimal complication rates.

Super pulsed thulium fiber laser outcomes in retrograde intrarenal surgery for ureteral and renal stones: a systematic review and meta-analysis

BackgroundLaser lithotripsy using a thulium fiber laser (TFL) has become an effective treatment option for small renal stones with low complication rates. TFL has a higher absorption coefficient, smaller fibers, and better pulse rate capability.MethodsWe conducted a systematic review and meta-analysis to evaluate the published evidence regarding TFL's lithotripsy performance in retrograde intrarenal surgery (RIRS), for which we primarily assessed the outcomes of stone-free rate, operation time, and complications. We searched different databases from inception to April 2023. We assessed the methodological quality and risk of bias using the Cochrane Risk of Bias tool for randomized trials and the ROBINS-I tool for non-randomized studies. We used a random-effects model for meta-analysis and assessed heterogeneity using the I2 statistic.ResultsTwelve published studies evaluated the efficacy of RIRS using a TFL for treating renal and ureteral stones. The meta-analysis revealed a predicted stone-free rate of 89.37% (95% CI: 83.93% to 93.12%), indicating that, on average, approximately 89.37% of patients achieved a stone-free state after treatment. The substantial heterogeneity among the studies was evident, as shown by a Q-value of 33.1174 and a p-value of 0.0003. The I2 value of 69.80% (95% CI: 25.91% to 92.02%) highlighted the proportion of variability attributed to genuine heterogeneity across the studies. Moreover, the H2 value 3.31 (95% CI: 1.35 to 12.53) indicated significant heterogeneity beyond random chance. The estimated overall effect size (logit-transformed) of 2.1289 was highly statistically significant (z = 8.7648, p < 0.0001) with a confidence interval of 1.6528 to 2.6049. The reported complications varied across studies, encompassing Clavien grade I–II complications in most cases, with a subset experiencing more severe Clavien grade III–V complications. Additionally, other studies noted a range of complications, such as haematuria, fever, transient creatinine elevation, and postoperative issues like bleeding, pain, and sepsis.ConclusionThis meta-analysis suggests that RIRS using TFL is an effective and safe treatment option for renal and ureteral stones, with high stone-free and low complication rates. The included studies exhibited a low risk of bias and were of high quality. However, more extensive randomized controlled trials with extended follow-up periods are needed to investigate this technique's efficacy and safety.

Thulium fiber laser vs Ho:YAG in RIRS: a prospective randomized clinical trial assessing the efficacy of lasers and different fiber diameters (150 µm and 200 µm)

IntroductionThe aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium–aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm).MethodsA prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber.ResultsNinety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2–14.6) min, in 150-μm SP TFL—11.4 (7.7–14.9) min (p = 0.390), in Ho:YAG—14.1 (10.8–18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8–15.2) kJ; 150-μm SP TFL − 10.8 (7.3–13.5) kJ (p = 0.626) and in Ho:YAG—15.2 (11.1–25.3) kJ (p = 0.005).ConclusionsIrrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.

Efficacy and safety of superpulse thulium laser lithotripsy in the intracavitary treatment of urinary calculi

Objective: To evaluate the efficacy and safety of superpulse thulium laser lithotripsy in the intracavitary treatment of urinary calculi. Methods: From May 2021 to July 2022, patients diagnosed with urinary calculi were screened in four medical centers. Those who met the criteria were treated with superpulse thulium fiber laser under endoscope. The patients' perioperative conditions were recorded. The main effective index was stone-free rate (SFR) 4 weeks after operation, the main safety index was the failure rate of the experimental instruments during operation, and the secondary safety index was the incidence rate of perioperative complications. Results: A total of 76 eligible patients completed superpulse thulium fiber laser lithotripsy, with an average age of (52.0±11.1) years, 54 males and 22 females. There were 31 renal stones, 43 ureteral stones and 2 bladder stones. Percutaneous nephrolithotomy was performed in 17 patients. Ureteroscopy lithotripsy/flexible ureteroscopy lithotripsy was performed in 57 patients and transurethral bladder lithotripsy was in 2 patients. The lithotripsy time of all patients was (50.9±31.4) minutes. There was no failure of experimental instruments during the operation. Six patients refused follow-up examination after operation. The incidence of postoperative adverse events was 61.8% (47/76). One patient needed hospitalization due to inguinal hernia after operation, and the rest were classified as Clavien-dindo grade 1-2. The SFR was 94.3% (66/70) at 4 weeks after operation. Conclusion: It is effective and safe to use superpulse thulium fiber laser in the treatment of urinary calculi.

MP05-18 FLUID TEMPERATURE EFFECT ON SUPERPULSE THULIUM FIBER LASER STONE ABLATION

You have accessJournal of UrologyCME1 Apr 2023MP05-18 FLUID TEMPERATURE EFFECT ON SUPERPULSE THULIUM FIBER LASER STONE ABLATION Kalon L. Morgan, Andrei D. Cumpanas, Nittesh Katta, Rohit Bhatt, Antonio R. H. Gorgen, Allen Rojhani, Paul Piedras, Seyed Amiryaghoub Lavasani, Zachary E. Tano, Sohrab N. Ali, Pengbo Jiang, Roshan M. Patel, Thomas Milner, Jaime Landman, and Ralph V. Clayman Kalon L. MorganKalon L. Morgan More articles by this author , Andrei D. CumpanasAndrei D. Cumpanas More articles by this author , Nittesh KattaNittesh Katta More articles by this author , Rohit BhattRohit Bhatt More articles by this author , Antonio R. H. GorgenAntonio R. H. Gorgen More articles by this author , Allen RojhaniAllen Rojhani More articles by this author , Paul PiedrasPaul Piedras More articles by this author , Seyed Amiryaghoub LavasaniSeyed Amiryaghoub Lavasani More articles by this author , Zachary E. TanoZachary E. Tano More articles by this author , Sohrab N. AliSohrab N. Ali More articles by this author , Pengbo JiangPengbo Jiang More articles by this author , Roshan M. PatelRoshan M. Patel More articles by this author , Thomas MilnerThomas Milner More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The absorption coefficient measures the energy lost to the medium through which a laser beam passes. Prior mid-infrared laser studies have shown that as the temperature of the medium increases, there is less loss of energy into the medium. Accordingly, we evaluated the impact of irrigation temperature on the amount of stone ablation when using the superpulse Thulium fiber laser (sTFL). METHODS: Optical coherence tomography (OCT), a non-invasive, high-resolution imaging technique, was used to generate a detailed surface image during single pulse sTFL lithotripsy (0.5 J, 1.0 Hz, 1.25 ms) of 12 samples of each of the following stone compositions: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), and uric acid (UA). Stones were immersed in either room temperature (20°C) or body temperature (37°C) 0.9% saline. With the tip of a 200 µm laser fiber in contact with the stone, a single pulse was applied at two separate sites on each stone. OCT determined the volume of stone removed per each laser pulse. Data were evaluated using an unpaired t-test (Figure 1) (Table 1). RESULTS: Regardless of stone composition, the mean volume of stone ablated during sTFL at 37°C was significantly greater than at room temperature. The single pulse of the sTFL ablated 12.4%, 24.4% and 28.6% more stone at 37°C irrigation for COM stones (p=0.034), COD stones (p=0.014) and UA stones (p=0.007), respectively (Table 1). CONCLUSIONS: sTFL efficiency in ablating COM, COD, and UA stones is enhanced when using irrigation warmed to 37°C. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e51 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kalon L. Morgan More articles by this author Andrei D. Cumpanas More articles by this author Nittesh Katta More articles by this author Rohit Bhatt More articles by this author Antonio R. H. Gorgen More articles by this author Allen Rojhani More articles by this author Paul Piedras More articles by this author Seyed Amiryaghoub Lavasani More articles by this author Zachary E. Tano More articles by this author Sohrab N. Ali More articles by this author Pengbo Jiang More articles by this author Roshan M. Patel More articles by this author Thomas Milner More articles by this author Jaime Landman More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...

V02-12 URETEROCELE EXCISIONAL TECHNIQUE USING THULIUM LASER

You have accessJournal of UrologyCME1 Apr 2023V02-12 URETEROCELE EXCISIONAL TECHNIQUE USING THULIUM LASER Jordan Krieger, Ali Antar, and Margaret Knoedler Jordan KriegerJordan Krieger More articles by this author , Ali AntarAli Antar More articles by this author , and Margaret KnoedlerMargaret Knoedler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroceles are cystic dilations of the distal ureter at its insertion site into the bladder and occur in 1 in 1000 births. Endoscopic intervention is minimally invasive and can alleviate obstruction in >95% of cases. The Thulium laser is a relatively new laser with a 1940 nm wavelength and a four times higher absorption in water than the Holmium laser. This theoretically leads to better tissue ablation and hemostasis. Our objective is to demonstrate the safety and efficacy of Thulium laser use for excision of ureteroceles. METHODS: This is a 22-year-old patient with normal renal function and a complex urologic history including bilateral duplicated collecting systems, vesicoureteral reflux with bilateral deflux injections, a right-sided ureterocele, and recurrent urinary tract infections resulting in hospitalizations for pyelonephritis. She was taken to the operating room for an endoscopic right ureterocele excision using Thulium laser. We used the Soltive SuperPulsed Thulium Fiber Laser (200 micron) with settings of 1 joule (J) for pulse energy and 20 hertz for frequency (20 watts). Total energy used was 2756 J. Tissue ablation and hemostasis were excellent, and no additional time was required at the end of the case to obtain hemostasis from the excised edges. She discharged the same day without issues. RESULTS: Six weeks later the patient followed-up in our clinic with a renal ultrasound demonstrating no hydronephrosis and a decompressed ureterocele. She denied any flank pain or recurrent infections. CONCLUSIONS: Thulium laser excision is a safe and efficacious treatment option for management of symptomatic ureteroceles. It showed excellent tissue ablation and hemostatic properties. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e172 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Krieger More articles by this author Ali Antar More articles by this author Margaret Knoedler More articles by this author Expand All Advertisement PDF downloadLoading ...

Superpulsed thulium fiber laser: Clinical results of the first multicenter study of rirs in children

Superpulsed thulium fiber laser: Clinical results of the first multicenter study of rirs in children

Comparing dusting and fragmenting efficiency using the new SuperPulsed thulium fiber laser versus a 120 W Holmium:YAG laser.

Holmium:YAG laser lithotripsy requires high amperage power and has an upper limit of frequency and a minimal fiber size. The technology utilizing thulium-doped fiber offers low pulse energy settings and high pulse frequencies up to 2,400 Hz. We compared the novel SuperPulsed thulium fiber laser (SOLTIVE™; Olympus) to a commercially available 120 W Ho:YAG laser. Bench-top testing was conducted with 125 mm3 standardized BegoStones (Bego USA). Time to ablate the stone into particles <1 mm was recorded for efficiency calculations. Finite energy was delivered, and resulting particle sizes were measured to determine fragmentation (0.5 kJ) and dusting (2 kJ) efficiencies. Remaining mass or number of fragments were measured to compare efficacy. SOLTIVE™ was faster at ablating stones to particles <1 mm (2.23±0.22 mg/s, 0.6 J 30 Hz short pulse) compared to Ho:YAG laser (1.78±0.44 mg/s, 0.8 J 10 Hz short pulse) (p<0.001). Following 0.5 kJ of energy in fragmentation testing, fewer particles >2 mm remained using SOLTIVE™ than Ho:YAG laser (2.10 vs. 7.20 fragments). After delivering 2 kJ, dusting (1.05±0.08 mg/s) was faster using SOLTIVE™ (0.1 J 200 Hz short pulse) than 120 W 0.46±0.09 mg/s (0.3 J 70 Hz Moses) (p=0.005). SOLTIVE™ (0.1 J 200 Hz) produced more dust particles <0.5 mm (40%) compared to 24% produced by the P120 W laser at 0.3 J 70 Hz Moses and 14% at 0.3 J 70 Hz long pulse (p=0.015). The efficacy of SOLTIVE™ is superior to the 120 W Ho:YAG laser by producing smaller dust particles and fewer fragments. Further studies are warranted.

Симультанная билатеральная ретроградная интраренальная хирургия c использованием тулиевого волоконного лазера.

Introduction. Urolithiasis is a common disease and up to 15% of patients have multiple kidney stones. Retrograde intrarenal surgery (RIRS) can be used in the surgical treatment of kidney stones because this method is highly effective. Patients with multiple kidney stones often necessitate several surgeries. In this study we our own experience of bilateral RIRS to analyze its effectiveness and safety. Materials and methods. From January 2021 to February 2022 the simultaneous bilateral RIRS were performed to 11 patients (7 man and 4 woman). The maximal size of stone was 21 mm (the average size of the right kidney was 15,0 mm ± 6,0 mm and the left kidney – 11,7 mm ± 4,3 mm). Average stone density was more than 1000 HU. The mean age of the patients was 57±13 years. Bilateral retrograde intrarenal surgery was performed simultaneously by two surgeons using flexible ureteroscopes using a SuperPulsed thulium fiber laser. The following parameters were assessed: surgical intervention time; stone free rate (SFR); degree of ureteral injury according to the post-ureteroscopic lesion scale (PULS); the need for drainage of the ureter in the postoperative period, assessment of the creatinine level, glomerular filtration rate (GFR) and C-reactive protein in the postoperative period; postoperative complications according to the Clavien-Dindo classification. Results and their discussion. The average duration of the surgery was 56±11 minutes. The SFR level was 90,9 %. At the final inspection of the ureters: on the right side injury Grade 0 according to the PULS scale was recorded in 10 patients, Grade 1 – in 2 patients; on the left side Grade 0 – in 9 patients, Grade 1 – in 2 patients. The surgery was completed with the installation of ureteral catheters in 10 and 9 cases on the right and left sides, respectively. Three surgical interventions ended with the installation of ureteral stents on one side or another. The level of creatinine and C-reactive protein in the postoperative period increased on average by 10.2±5.7 μmol/l and 1.8±0.6 mg/l, respectively. The GFR decreased by 7.2 ± 2.6 ml/min. A complication was registered in 1 patient – increased body temperature on the 1st day, stopped by antibiotic therapy (Clavien-Dindo II). Conclusions. Simultaneous bilateral RIRS using single-use flexible ureteroscopes and a SuperPulsed thulium fiber laser is a safe and effective procedure for patients with bilateral nephrolithiasis.

Upper tract urothelial carcinoma: can the tumor be removed en bloc?

Diagnosis and treatment of upper tract urothelial carcinoma (UTUC) remain important problems of clinical urology. UTUC en bloc i.e. in one-piece removal during organ-sparing surgery is still hardly possible. The most typical endourological operations are either electrosurgery, holmium or thulium YAG laser tumor vaporization.We present a clinical case of ureteroscopic en bloc UTUC removal using a new super pulse thulium fiber laser (SPTFL, FiberLase U3). Recent innovations and trends in this field are also discussed. The technical steps of en bloc ureteroscopic tumor removal allowing for diagnosis verification, identification of pT stage and surgical margin are described. The further innovations in laser UTUC removal include modulation of laser pulse length and development of the correlation between preoperative tumor characteristics and possibility of en bloc removal.

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

Comparison of Superpulse Thulium Fiber Laser vs Holmium Laser for Ablation of Renal Calculi in an In Vivo Porcine Model.

Introduction and Objectives: We sought to compare the effectiveness and efficiency of the superpulse thulium fiber laser (sTFL to the holmium: yttrium-aluminum-garnet [Ho:YAG] laser for ureteroscopic "dusting" of implanted renal stones in an in vivo porcine model. Methods: Twenty-four porcine kidneys (12 juvenile female Yorkshire pigs) were randomized to Ho:YAG or sTFL treatment groups. Canine calcium oxalate stones were scanned with computed tomography to calculate stone volume and stone density; the stones were randomized and implanted into each renal pelvis via an open pyelotomy. In all trials, a 14F, 35 cm ureteral access sheath was placed. With a 9.9F dual lumen flexible ureteroscope, laser lithotripsy was performed using dusting settings: Ho:YAG 200 μm laser fiber at 16 W (0.4 J, 40 Hz) or sTFL 200 μm laser fiber at 16 W (0.2 J, 80 Hz). Lithotripsy continued until no fragments over 1 mm were observed. No stone basketing was performed. Throughout the procedures, intrarenal and renal pelvis temperatures were measured using two percutaneously positioned K-type thermocouples, one in the upper pole calyx and one in the renal pelvis. After the lithotripsy, the ureteropelvic junction was occluded, the kidneys were bivalved, and all residual fragments were collected, dried, weighed, and then measured with an optical laser particle sizer. Results: Implanted stones were similar in volume and density in both groups. Intraoperative collecting system temperatures were similar for both groups (all <44°C). Compared to Ho:YAG, sTFL ablated stones faster (9 vs 27 minutes, p < 0.001) with less energy expenditure (8 vs 26 kJ, p < 0.001), and a greater stone clearance rate (73% vs 45%, p = 0.001). After sTFL lithotripsy, 77% of the remaining fragments were ≤1 mm vs 17% of fragments ≤1 mm after Ho:YAG treatment (p < 0.001). Conclusions: In an in vivo porcine kidney, using dusting settings, sTFL lithotripsy resulted in shorter ablation times, higher stone clearance rates, and markedly smaller stone fragments than Ho:YAG lithotripsy.

Author Reply Re: Vaddi CM, Ramakrishna P, Ganeshan S, Swamy S, Anandan H, Babu M, et al. The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery. Indian J Urol 2022;38:191-6.

Author Reply Re: Vaddi CM, Ramakrishna P, Ganeshan S, Swamy S, Anandan H, Babu M, et al. The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery. Indian J Urol 2022;38:191-6.

Re: Vaddi CM, Ramakrishna P, Ganeshan S, Swamy S, Anandan H, Babu M, et al. The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery. Indian J Urol 2022; 38:191-6.

Re: Vaddi CM, Ramakrishna P, Ganeshan S, Swamy S, Anandan H, Babu M, et al. The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery. Indian J Urol 2022; 38:191-6.

Comparing Pediatric Ureteroscopy Outcomes with SuperPulsed Thulium Fiber Laser and Low-Power Holmium:YAG Laser.

The thulium fiber laser is a promising new lithoptripsy technology never before studied in the pediatric population. Our center adopted the first platform in North America, the SuperPulsed thulium fiber laser (SPTF). We aimed to compare outcomes in pediatric ureteroscopy using the SPTF to those using the gold standard, low-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This is a retrospective, consecutive cohort study of unilateral ureteroscopy with laser lithotripsy performed in pediatric patients from 2016 to 2021 as an early adopter of the SPTF. Thirty-day complications and stone-free status, defined as the absence of a stone fragment on followup imaging within 90 days, were analyzed using logistic regression. Operative times were compared using linear regression. Propensity scores for use of SPTF were used in regression analyses to account for potential cohort imbalance. A total of 125 cases were performed in 109 pediatric patients: 93 with Ho:YAG and 32 with SPTF. No significant difference was noted in age (p=0.2), gender (p=0.6), stone burden (p >0.9) or stone location (p=0.1). The overall stone-free rate was 62%; 70% with SPTF and 59% with Ho:YAG. The odds of having a residual stone fragment were significantly lower with SPTF than with Ho:YAG (OR=0.39, 95% CI: 0.19-0.77, p=0.01). There was no significant difference in operative time (p=0.8). Seven (25%) complications were noted with SPTF and 19 (22%) with Ho:YAG (p=0.6). The SPTF laser was associated with a higher stone-free rate than the low-power Ho:YAG laser without compromising operative time and safety.

Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose?

To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Aug 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Pediatric Ureteroscopy Laser Outcomes The application of new medical technology in children commonly lags innovation in adult patients. Jaeger et al (page 426) at Boston Children’s Hospital in Boston, Massachusetts describe their early-adopter experience using a superpulse thulium fiber laser (SPTF) to treat upper tract stones in children.1 The group started using SPTF in September 2020. In a retrospective analysis, the authors compared stone-free rates in patients less than 21 years of age treated with either SPTF (23) or low-power Ho:YAG (holmium:yttrium-aluminum-garnet) laser (69). Stone-free rate, measured by primarily renal ultrasound within 90 days of the procedure, was higher in patients treated with SPTF (70% vs 59%). Because of concern about SPTF generating higher temperatures, the authors were careful to use continuous irrigation and low power settings. The SPTF was not associated with higher postoperative complications or an increase in operative time. The authors’ careful analysis addresses some of the limitations of the retrospective nature of this study. Nevertheless, their success with SPTF without increase in complication rate or operative time is very promising. Salvage Surgery Rates for Pediatric Testicular Torsion Hospital rating systems have weaknesses, but are there any strengths? Mandated reporting of hospital metrics can be a motivator to focus attention on specific aspects of care quality. In 2015, the US News & World Report introduced the quality metric of “time from ED/clinic to operating room” for testicular torsion in their Best Children’s Hospital Rankings. Using the Pediatric Health Information System database, which includes 52 children’s hospitals across the United States, Chun et al (page 441) from Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania compared testicular salvage rate before and after this metric was introduced.2 The authors found that the salvage rate improved. Of course, temporal association does not prove causation. However, it is suggestive that salvage rates did not change at hospitals that were receiving full score when the metric was introduced but did increase at hospitals not initially receiving the full score. From 2015 to 2019, the number of hospitals that received a full score for this question increased from 62% to 98%. Hospital rating systems are here to stay. Although it will take work, there is the potential for the pediatric urology community to replace flawed measures with meaningful ones that can nudge care quality. Dietary Risk Factors for Pediatric Kidney Stones Dietary counseling for children with stone disease is primarily based on adult data. Wang et al (page 434) from Boston Children’s Hospital in Boston, Massachusetts present one of the only studies to investigate the relationship between dietary nutrient intake and urolithiasis occurrence in children.3 At Boston Children’s, the primary care clinic was administering the Harvard Service Food Frequency Questionnaire at well child visits while the pediatric stone clinic was administering the Youth Adolescent Food Frequency Questionnaire to first-time stone formers within 6 months of diagnosis. The Harvard School of Public Health Nutrition Department has an analysis mechanism to translate data from both these validated surveys to standardized daily nutrition intake. The authors elegantly used this information to perform a case-control study in 57 stone patients and 228 controls. Unsurprisingly, they found that stone formers had higher sodium intake and lower potassium intake. Unexpectedly, they also found an association with increased calcium intake and increased beta-carotene intake. Although carrots are the most well-known dietary source of beta-carotene, high oxalate foods like spinach and kale also have beta-carotene; however, there did not appear to be an association with dietary oxalate intake. Unfortunately, the dietary surveys did not include data on water intake or specific diets (eg ketogenic diet). However, this novel exploratory study generates intriguing questions for future pediatric stone research.

PD48-02 IS THE THULIUM FIBER LASER SUPERIOR TO THE LOW-POWER HO:YAG LASER FOR URETEROSCOPY IN CHILDREN?

You have accessJournal of UrologyCME1 May 2022PD48-02 IS THE THULIUM FIBER LASER SUPERIOR TO THE LOW-POWER HO:YAG LASER FOR URETEROSCOPY IN CHILDREN? Christopher Jaeger, Caleb Nelson, Bartley Cilento, Tanya Logvinenko, and Michael Kurtz Christopher JaegerChristopher Jaeger More articles by this author , Caleb NelsonCaleb Nelson More articles by this author , Bartley CilentoBartley Cilento More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Michael KurtzMichael Kurtz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been the laser lithotripsy gold standard for several decades. The Thulium fiber laser is a new technology with unique technical properties emerging as a safe and effective alternative to Ho:YAG in adult series. Our free-standing children’s hospital recently adopted the Super Pulsed Thulium Fiber Laser (SPTF) from Olympus, which is the first such platform on the market in North America. Our objective was to compare clinical outcomes in consecutive pediatric ureteroscopies using a low-power Ho:YAG laser or the SPTF system at our center. METHODS: This is a retrospective cohort study of all unilateral ureteroscopies with laser lithotripsy performed by 3 surgeons for renal or ureteral stones at our center from 2016-2021. Demographics and procedure characteristics were compared between SPTF and Ho:YAG cases using Fisher’s Exact and Mann-Whitney U tests. Complications within 30 days of surgery and stone free status, defined as the absence of a stone fragment on follow-up imaging within 90 days of surgery, were analyzed using logistic regression. Operative times were compared using linear regression. Propensity scores using stone burden, stone location, and surgeon were constructed. Inverse probability of treatment weighting was used to account for imbalance between the cohorts. RESULTS: 125 ureteroscopies with laser lithotripsy were performed on 109 pediatric patients: 93 with Ho:YAG and 32 with SPTF. No significant difference was noted in age (p=0.36), gender (p=0.55), stone burden (p=0.96), or stone location (p=0.14). For the 92 ureteroscopies with 90 day follow-up imaging, the stone free rate (SFR) was 62%; 70% with SPTF and 59% with Ho:YAG. The odds of having a residual stone fragment were significantly lower with SPTF than with Ho:YAG (OR=0.46 (95% CI: 0.24-0.84), p=0.01). There was no significant difference in operative time (p=0.46). 7 (25%) complications were noted with SPTF and 19 (22%) with Ho:YAG (p=0.84). 2 complications were Clavien-Dindo ≥III; but were not directly attributed to a laser. CONCLUSIONS: For ureteroscopies in children, the SPTF using Thulium fiber laser technology improves the SFR achieved with low-power Ho:YAG lasers without compromising operative time or safety. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e799 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Jaeger More articles by this author Caleb Nelson More articles by this author Bartley Cilento More articles by this author Tanya Logvinenko More articles by this author Michael Kurtz More articles by this author Expand All Advertisement PDF DownloadLoading ...

A1033 - 60w superpulse thulium fiber laser for RIRS in large volume stones (>1000 mm3) – a prospective study on efficacy and outcomes

A1033 - 60w superpulse thulium fiber laser for RIRS in large volume stones (>1000 mm3) – a prospective study on efficacy and outcomes