Thulium Fiber Laser Research Articles

Thulium fiber laser cystolithotripsy under local anesthesia: A day care procedure.

Bladder stones account for 5% of all urolithiasis. Patients present with LUTS or acute urinary retention. Thus, warranting an early intervention. Minimally invasive approach with laser lithotripsy is the present gold standard to treat bladder stones. To evaluate the outcomes of TFL (60 W) for bladder stones performed under local anesthesia as a day-care procedure. This was a retrospective single-center study conducted after obtaining IRB approval. Study period was between June 2021 and June 2022 were included. All patients were operated under local anesthesia as a day care procedure. The procedure was carried out using an 18 Fr laser sheath and calculus dusted using TFL energy (15-30 W). Parameters including operative time in minutes, complications were recorded. Patients were encouraged oral and normal voiding in the immediate post-op period. A total of 47 patients with bladder stones presented during this period. Of these, 30 underwent laser lithotripsy (TFL) for bladder calculi. The clinical presentation of patients was LUTS in 28 (93%) and 5 (16%) patients had AUR. The average size of the stone in this series was 15 ± 2.8 mm. The mean duration of laser lithotripsy was 15 ± 5.4 min. Energy to dust the stone was variable with mean LASER energy of 18.23 ± 10 W. All patients tolerated the procedure well and none required conversion to conventional anesthesia. One patient failed to void in the post-op period. 100% clearance rate was documented in all patients. Thulium fiber laser for transurethral cystolithotripsy of bladder stones under local anesthesia is a feasible technique with minimal morbidity and good outcome.

Comparison Between Thulium Fiber Laser and High-power Holmium Laser for Anatomic Endoscopic Enucleation of the Prostate: A Propensity Score–matched Analysis from the REAP Registry

BackgroundDifferent lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date. ObjectiveTo compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes. Design, setting, and participantsThe study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery. Outcome measurements and statistical analysisTo adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR). Results and limitationsAfter PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate was higher in the HP-HoLEP arm (22% vs 8%; p = 0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%; p = 0.120). Rates of other early and delayed complications were low and comparable between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature. ConclusionsThis real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS. Patient summaryAs lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.

Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment.

Riehl's melanosis is a hyperpigmentation disorder that has a significant psychological and social impact on individuals. In the past 10 years, new categories have been developed, raising questions about how to classify Riehl's melanosis. The mechanism of this disease remains unclear, although the type IV hypersensitivity response caused by allergic sensitization, as well as genetic, ultraviolet radiation, and autoimmune factors, is to blame. Clinical manifestation, dermoscopy, reflectance confocal microscopy, patch/photopatch testing, histopathology, and a novel multimodality skin imaging system have been used for the diagnosis. A variety of therapies including topical skin-lightening agents, oral tranexamic acid, glycyrrhizin compound, chemical peels, and lasers and light therapies (intense pulsed light, 1064-nm Q-Switched Nd: YAG laser, 755-nm PicoWay laser, nonablative 1927-nm fractional thulium fiber laser, new pulsed-type microneedling radiofrequency), with improved effectiveness. The latest findings on possible biomarkers and their relationship to other autoimmune diseases were also summarized.

Evaluating the clinical outcomes of thulium fiber laser (TFL) in comparison to holmium laser in the treatment of urinary tract stones – A systematic review

Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) had been considered the gold standard for treating urinary tract stones. However, advancements in laser technology have introduced thulium fiber laser (TFL) as a potential alternative. Preliminary studies have indicated that TFL may have certain advantages over Ho:YAG laser in lithotripsy. This systematic review compared the clinical outcomes of TFL and Ho:YAG laser for urinary tract stone treatment, focusing on operating time, stone-free rate (SFR), retropulsion, and complications. A systematic search was conducted on PubMed and ScienceDirect for original articles published within the last 5 years, comparing the clinical outcomes of Ho:YAG and TFL in lithotripsy. Inclusion criteria were English-language studies focusing on Ho:YAG and TFL laser energy for urinary tract stones, with accessible full-text articles comparing clinical outcomes. Excluded were studies discussing lasers for conditions other than urinary tract stones or using lasers other than TFL and Ho:YAG. Four studies (544 procedures) met the criteria and underwent risk of bias assessment using Risk of Bias 2 (ROB-2) for randomized trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for cohort studies. The data were presented in tables and charts. In this review, TFL demonstrated a shorter operating time compared to Ho:YAG (and higher stone-free rates in two studies. TFL also had a lower incidence of stone retropulsion. Intra-operative complication rates varied between the groups for ureterorenoscopy (URS) and retrograde intrarenal surgery (RIRS) procedures, while TFL had a higher rate of prolonged haematuria during mini percutaneous nephrolithotomy (PCNL) procedures. Postoperative complications were similar in both groups. Limitations of this review include procedural and laser setting heterogeneity, a small number of studies, and the lack of registration and protocols. In conclusion, TFL is an effective and safe alternative to Ho:YAG laser for lithotripsy, offering shorter operation time, higher stone-free rates, and reduced stone retropulsion.

In Pursuit of the Optimal Dusting Settings with the Thulium Fiber Laser: An In Vitro Assessment.

Objective: Low energy and high frequency settings are used in stone dusting for holmium lasers. Such settings may not be optimal for thulium fiber laser (TFL). With the seemingly endless combination of settings, we aim to provide guidance to the practicing urologists and assess the efficiency of the TFL platform in an automated in vitro "dusting model." Materials/Methods: Three experimental setups were designed to investigate stone dusting produced by an IPG Photonics TLR-50 W TFL system using 200 μm fiber and soft BegoStone phantoms. The most popular 10 and 20 W dusting settings among endourologist familiar with TFL were evaluated. We directly compared short pulse (SP) vs long pulse (LP) mode using various combinations of pulse energy (Ep) and pulse frequency (F). Thereafter, we tested the 10 and 20 W settings and compared them among each other to elucidate the most efficient settings at each power. Treatments were performed under the same total laser energy delivered to the stone at four different standoff distances (SDs) with a clinically relevant scanning speed of either 1 or 2 mm/sec. Ablation volumes were quantified by optical coherence tomography to assess stone dusting efficiency. Fragment size after ablation at different pulse energies was evaluated by sieving and evaluating under a microscope after treatment. Results: Overall, SP provided greater ablation volume when compared with LP. Our dusting efficiency model demonstrated that the maximum stone ablation was achieved at the combination of high energy/low frequency settings (p < 0.005) and at a SD of 0.2 mm. At all tested pulse energies, no stone phantoms were broken into fragments >1 mm. Conclusions: During stone dusting with TFL, SP offers superior ablation to LP settings. Optimal dusting at clinically relevant scanning speeds of 1 and 2 mm/sec occurs at high energy/low frequency settings. Thulium lithotripsy with high Ep does not result in increased fragment size.

Enhanced popcorning using polyanionic chelating solutions as irrigation.

Poly-anionic compounds can chelate divalent cations and dissolve calcium oxalate stone. Our objective was to assess how much concurrent irrigation with poly-anionic chelating solutions during non-contact laser lithotripsy or popcorning could improve stone ablation rate. A popcorning model was created by lowering a ureteroscope with thulium fiber laser into a test tube calyx. Begostones of matching size and mass were placed in the test tube and treated with the laser while irrigating with different iso-osmolar poly-anionic solutions. We compared 0.9% sodium chloride (NaCl), sodium citrate, sodium hexa-metaphosphate, and sodium ethylenediaminetetraacetate (EDTA) solutions. After treatment, residual stones were passed through a 1mm sieve, and remaining fragments greater than 1mm were weighed as remaining stone mass. Average remaining stone mass after lithotripsy with NaCl irrigation was 27.8% (± 10.0%). The average remaining stone mass after lithotripsy with hexa-metaphosphate, sodium citrate, and EDTA irrigation was 28.9% (± 13.4%), 17.5% (± 10.5%), and 9.8% (± 5.7%) respectively. Compared with NaCl, there was a 37% reduction in remaining stone mass when using citrate (p = 0.008) and a 64.7% reduction when using EDTA irrigation during lithotripsy (p < 0.001). Concurrent irrigation with citrate or EDTA solutions synergistically enhances the efficacy laser lithotripsy in this in vitro popcorning model. This may lead to tangible improvements in endoscopic stone removal outcomes; however, the effectiveness on different stone types and safety during short duration lithotripsy should be further investigated.

Ureteroscopic lithotripsy by thulium fiber laser versus holmium laser: A single-center prospective randomized study.

Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications. A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6-10 Hz, 1J) for TFL and up to 10 W for HO: YAG (5-10 Hz, 0.5-1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded. Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2-25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4-38.5), and it was statistically significant (P = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2-10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3-18.4) (P = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group. TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups.

A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones

To evaluate stone-free rate, device maneuverability, and complications after retrograde intrarenal surgery (RIRS) using 2 different sizes of flexible and navigable suction ureteral access sheaths (FANS). A retrospective analysis was performed for patients who underwent RIRS for renal stones of any size, number, and location between November 2021 and October 2022. Group 1 had FANS of 12 French. Group 2 had FANS of 10 French. Both sheaths have a Y-shaped suction channel. Tip of 10 French FANS has 20% more flexibility. Lithotripsy was achieved using either thulium fiber or high-power holmium lasers. A 5-point Likert scale was used to assess the performance of each sheath. There were 16 patients in Group 1 and 15 patients in Group 2. Baseline demographics and stone parameters were similar. Four patients in Group 2 had the same session bilateral RIRS. Sheath insertion was successful in all renal units but one. Ten French FANS had a higher percentage of excellent scores for ease of use, manipulation, and visibility. Neither of the sheaths had an average or difficult rating for all evaluation scales. A fornix rupture requiring prolonged stenting occurred in group 2. All patients were discharged within 24hours of surgery. One patient in each group visited the emergency department (analgesic treatment). There were no infectious complications. At 3 months, a computed tomography scan showed that the absence of residual fragments >2mm was significantly higher in Group 2 (94.7% vs 68.8%, P=0.01). The 10 Fr FANS showed a higher stone-free rate. There was no infectious complication using both sheaths.

Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance.

Cystinuria is a rare genetic condition that is responsible for cystine stones. Besides stone recurrence, patients with cystine stones have reduced health-related quality of life, increased rates of chronic kidney disease and hypertension. Although lifestyle measures, medical therapy and close follow up are essential to reduce and monitor cystine stone recurrences, surgical intervention is frequently needed for most cystinuria patients. Shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and active surveillance all have a role, and technological advances in endourology are vital in achieving a stone-free status and to prevent recurrences. The complexity of managing cystine stones necessitates a multidisciplinary team discussion, patient involvement and an individualised approach in a specialist centre for optimum management. Thulium fibre laser and virtual reality may have an increasing role in the future of cystine stone management.

MT9 European Clinical Attitudes and Experiences of a Thulium Fiber Laser System: A Cross-Sectional, Multi-National Survey

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser technology has long been established as the gold standard for endoscopic laser lithotripsy. However, interest in and use of Thulium Fiber Laser (TFL) technology for laser lithotripsy in the field of urology has grown. This study investigated European clinical attitudes and experiences of a TFL, the SOLTIVE Premium SuperPulsed System (Olympus Corporation, Japan), for stone management procedures.

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones &lt;2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon’s expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology.

Pulsed-wave vs Continuous-wave Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP): A Comparison of Perioperative Outcomes

To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia. 238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3months after surgery. CW-ThuFLEP showed shorter operative time (61.5 vs 67.4minutes, P=.04). Enucleation time (50.2 vs 53.3minutes, P=.12), enucleation efficiency (0.8 vs 0.7g/min, P=.38), catheterization time (2.2 vs 2.1days, P=.29), irrigation volume (32.9 vs 32.8L, P=.71), hospital stay (2.8 vs 2.6days, P=.29) and hemoglobin drop (0.38 vs 0.39g/dL, P=.53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value. PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences.

Incidence of Ureteric strictures Following Ureteroscopic Laser Lithotripsy: Holmium:YAG Versus Thulium Fiber Laser.

We aimed to compare the incidence of ureteric strictures between holmium:yttrium aluminum garnet and thulium fiber laser following ureteroscopic laser lithotripsy. In the present era of miniaturization of endourologic armamentarium and better optics, how safe are lasers to fire inside ureter? It is a prospective comparative study over a period of 2 years that included patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Patients were randomly divided into 2 groups: group A underwent holmium:yttrium aluminum garnet laser lithotripsy and group B underwent thulium fiber laser lithotripsy. A total of 478 patients were analyzed after excluding patients not willing to participate and patients lost to follow-up. Two hundred forty patients underwent holmium:yttrium aluminum garnet laser lithotripsy (group A) and 238 patients underwent thulium fiber laser lithotripsy (group B). The demographic data of 2 groups were comparable. The mean age of patients in group A and group B was 36.5 ± 12.52 years and 38.62 ± 10.71 years, respectively. The mean operative time in group A and group B was 47 ± 15 and 36 ± 13 minutes, respectively, while the mean laser time in group A and group B was 13.5 ± 45 minutes and 9.25 ± 3.2 minutes, respectively. Four (1.67%) patients in group A and 11 (4.62%) patients in group B developed ureteric strictures during follow-up, and the difference was statistically significant (P <.001). The mean length of stricture was 2.67 ± 1.27 cm in group A and 4.42 ± 2.2 cm in group B, and the difference was statistically significant. Thulium fiber laser, projected as safe laser previously, has a higher incidence of ureteric strictures compared to holmium:yttrium aluminum garnet laser when used for ureteroscopic laser lithotripsy.

Re: Pulse-Modulated Holmium:YAG Laser vs the Thulium Fiber Laser for Renal and Ureteral Stones: A Single-center Prospective Randomized Clinical Trial

Re: Pulse-Modulated Holmium:YAG Laser vs the Thulium Fiber Laser for Renal and Ureteral Stones: A Single-center Prospective Randomized Clinical Trial

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry.

We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free. Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.

Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice—Lessons Learnt from Global Multicenter Experience of 1250 Patients

BackgroundBilateral kidney stones are commonly treated in staged procedures. ObjectiveTo evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design, setting, and participantsData from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysisContinuous variables are presented as medians and 25–75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitationsA total of 1250 patients were included. The median age was 48.0 (36–61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55–90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18–7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28–15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96–17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12–7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35–2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16–7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14–2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32–4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. ConclusionsSSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summaryIn this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.

Ejaculation-sparing enucleation of benign prostate hyperplasia: is it almost feasible?

Introduction. Patients often request maintenance of antegrade ejaculation, and try to find the clinic, surgeon, and treatment to store it. Despite an established technique, the long-term results of ejaculation-sparing operations at a large prostate volume remain unstable. This is not allowed to give patients a guarantee in maintaining this component in their sexual life.Objective. To evaluate the frequency of ejaculation maintenance after laser ejaculatory-sparing prostate enucleation.Materials &amp; methods. Since 2017 ejaculation-sparing laser enucleations have been performed in prostate volume (V pr &gt; 80 cc) in 84 patients. Fifty-four patients (64%) had three lobes benign prostate hyperplasia (BPH) and two lobes — 30 patients (36%). Preoperative voiding parameters were IPSS score — 21.0 ± 2.7, QoL — 4.8 ± 0.6, residual urine volume (V res) — 139 ± 43 mL, Q max — 8.1 ± 2.0 mL. We estimate the result as positive if antegrade ejaculation remained after intervention. If ejaculation volume decreased, then as partially positive and negative — ejaculation was absent postoperatively. We conducted questionnaire and follow-up examination 3 – 6 months after intervention.Results. Thulium-fiber laser enucleations have been performed in all cases without any serious complications. Followup 3 – 6 months after operation showed V pr — 29 ± 4 cc, V res — 19 ± 17 mL, Q max — 19.1 ± 3.1 mL/sec. IPSS score — 8.1 ± 1.9 and QoL — 2.6 ± 0.7. There are the following technical remarks: 1) tissue-sparing in the verumontanum; 2) no or minor mechanical tissue tension during enucleation; 3) avoid additional resection in the bladder neck; 4) refuse total coagulation; 5) no urethral catheter tension after operation; 6) catheter balloon inflow only in the bladder, not in the fossa. Antegrade ejaculation has stored at 17 (20%) patients, partial ejaculation — at 34 (40%) patients, so overall efficacy is 60%. The presence of a median lobe is shown to be negative prognostic factor due to the absence of full antegrade ejaculation in all cases. A partial ejaculation was achieved at 21 patients. Based on the obtained results we have optimized the three-lobe prostate enucleation technique. Four from our initial 7 patients had full storage of ejaculation and 3 — partial.Conclusion. The possibility of BPH laser surgery to store ejaculation function at the request of the patients is modest. The presence of the median lobe makes the full ejaculation-sparing impossible. In cases of two lobes BPH full storage of the ejaculation was at 57% and partial at 43%, respectively. The following evaluation of the described technique is mandatory.

PD45-08 THULIUM FIBER LASER VS HOLMIUM:YAG LASER: A PROSPECTIVE CASE-CONTROL STUDY IN LARGE URETERIC STONES

You have accessJournal of UrologyCME1 Apr 2023PD45-08 THULIUM FIBER LASER VS HOLMIUM:YAG LASER: A PROSPECTIVE CASE-CONTROL STUDY IN LARGE URETERIC STONES Mohamed Hatem, Abdullah Aljarod, Hatem Kamkoum, Tawiz Gul, Mohamed Ebrahim, Mohamad Rejeb, Kalpana Singh, Abdulla AL-Ansari, Omar Aboumarzouk, and Morshed Salah Mohamed HatemMohamed Hatem More articles by this author , Abdullah AljarodAbdullah Aljarod More articles by this author , Hatem KamkoumHatem Kamkoum More articles by this author , Tawiz GulTawiz Gul More articles by this author , Mohamed EbrahimMohamed Ebrahim More articles by this author , Mohamad RejebMohamad Rejeb More articles by this author , Kalpana SinghKalpana Singh More articles by this author , Abdulla AL-AnsariAbdulla AL-Ansari More articles by this author , Omar AboumarzoukOmar Aboumarzouk More articles by this author , and Morshed SalahMorshed Salah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The new Thulium Fiber Laser (TFL) has been recently introduced as an alternative lithotripsy technology. TFL is a promising alternative to Holmium:YAG (Ho:YAG) owing to its use of a more suitable TFL wavelength, smaller fibers, and potential for using a smaller and less expensive laser system. TFL has already showed its efficacy and safety in lithotripsy. We aimed to compare between TFL and Ho:YAG ureteroscopic lithotripsy for large stones >1cm. METHODS: We prospectively case controlled studied patients with ureteral calculi in the period between June 2020-July 2022. All adult patients with ureteric stones that required to undergo ureterolithotripsy were included. TFL or HO:YAG were used alternatively between the two modalities. The age, co-morbidities, body mass index (BMI), stone size, and volume were recorded. The evaluated parameters were stone-free rate (SFR), operative time, and complication rate. The surgical research section review board approved the study. Chi-Square tests with standardized residuals were calculated to see association with categorical variables and the groups. RESULTS: A total of 172 adult patients with ureteric stones >1cm were included in this study. 87 patients in the TFL group with a mean age of 37.9+-8.8 and 85 in the Ho:YAG group with a mean age of 39.4+-10.5 (p=0.34). There was no difference regarding BMI (26+-3.6 vs 26+-3.7)(p=0.96), Co-morbidity (16% vs 24% with multiple comorbidities)(p=0.49), anaesthesia type using general or spinal (57% vs 55%) (p=0.77), stone volume (1.6+-0.5 vs 1.5+-0.5)(p=0.41), or basket use (15% vs 15%)(p=0.95). Interestingly, the TFL group took longer to perform, with higher operative time than the Ho:YAG group (81.7+-42.2 vs 67+-35.1 (p=0.016)). This was likely due to the fact the TFL group did have more multiple stones requiring lithotripsy than the Ho:YAG group, however this was not statistically significant, but clearly, clinically significant whereby there was a 27% vs 19% multiple stones rate (p=0.23). There was no difference in the SFR (95% vs 96% (p=0.72)), second look ureteroscopy (14% vs 8%) (p=0.25)) or early or late complication rates, 1% vs 4% (p=0.3) and 0% vs. 1% (p=0.31), respectively. All patients were stone and complication free on follow up. CONCLUSIONS: TFL has proven its efficacy and safety with high SFR and low early and late complication rates. TFL ureteroscopic lithotripsy took longer to perform than Ho:YAG, probably due to having a higher stone burden, however statistically not significant. Source of Funding: No funding for this review was received. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1165 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Hatem More articles by this author Abdullah Aljarod More articles by this author Hatem Kamkoum More articles by this author Tawiz Gul More articles by this author Mohamed Ebrahim More articles by this author Mohamad Rejeb More articles by this author Kalpana Singh More articles by this author Abdulla AL-Ansari More articles by this author Omar Aboumarzouk More articles by this author Morshed Salah More articles by this author Expand All Advertisement PDF downloadLoading ...

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

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 ...

MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM

You have accessJournal of UrologyCME1 Apr 2023MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM Chandra Mohan Vaddi, Ramakrishna Paidakula, Siddalinga Swamy P. M., Soundarya Ganesan, Hemnath U. A., Manas Babu B., and Rakesh Panda Chandra Mohan VaddiChandra Mohan Vaddi More articles by this author , Ramakrishna PaidakulaRamakrishna Paidakula More articles by this author , Siddalinga Swamy P. M.Siddalinga Swamy P. M. More articles by this author , Soundarya GanesanSoundarya Ganesan More articles by this author , Hemnath U. A.Hemnath U. A. More articles by this author , Manas Babu B.Manas Babu B. More articles by this author , and Rakesh PandaRakesh Panda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.19AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) has been recommended as the first choice for lower pole stone >10 mm. The objective of the study is to analyse whether Retrograde intrarenal surgery (RIRS) with newly upcoming Thulium fiber laser (TFL) can be an equally effective alternative. Primary Aim: To compare the different treatment modalities in terms of efficacy (stone free rate, need for auxiliary procedures) and safety (complication rate).Secondary aim: To compare the perioperative outcomes (operative time, fluoroscopic time, length of hospitalization). METHODS: Study Design: Prospective randomised controlled study Study period: October 2021 – May 2022 Study Population: Patients with lower pole stones 10-20 mm Group A - RIRS, Group B – Mini PCNL The energy source used was 60 W TFL (IPG Photonics, Massachusetts, United States) in both Group A and B. NCCT KUB was done at 2 months post operatively to calculate stone free rate. Institutional Ethics Committee approval was obtained. RESULTS: Mean stone size was 13.93±2.92 mm in Group A and 15.04±3.18 mm in Group B. In Group A, fluoroscopy time was significantly lower (31.96±14.34 vs 337.68±131.85, p<0.001), hospital stay was significantly lower (1.37±0.63 vs 3.24±1.01, p<0.001) and stone free rate (SFR) was comparable to Group B (88.9% vs 92.3%, p=1.000). There was no significant difference in operative time, complication rate or need for auxiliary procedure (Table 1). The ablation speed was significantly higher (9.47±5.61 vs 1.55±1.95, p<0.001), the laser efficacy was significantly lower (3.18±3.83 vs 16.43±7.07, p<0.001) and the laser time was significantly lower (141.04±86.98 vs 992.63±488.30, p<0.001) in Group B, as fragmentation rather than dusting was done with TFL. Table 1 CONCLUSIONS: RIRS with TFL for lower pole stones has SFR comparable to MiniPCNL, lower fluoroscopy time and hospital stay. No significant difference was found in operative time, complication rate or requirement of auxiliary procedure. Thus, RIRS with TFL is an effective alternative to miniPCNL for lower pole stones 10-20 mm Parameter RIRS with TFL (n=25) MiniPCNL with TFL(n=25) P value Age (years) 44.52 ± 14.21 48.64 ± 12.70 0.5091 Stone Size (mm) 13.93 ± 2.92 15.04 ± 3.18 0.1441 Volume (mm³) 1016.72 ± 341.11 1037.08 ± 428.83 0.4641 Density (HU) 1111.44 ± 252.61 1181.12 ± 288.14 0.3603 Operative Time (Minutes) 48.63 ± 8.57 50.80 ± 15.13 0.4521 Fluoroscopy Time (sec)*** 31.96 ± 14.34 337.68 ± 131.85 <0.0011 Complication rate 4/27 (14.8%) 5/25 (20%) 0.2134 Hospital Stay (Days)*** 1.37 ± 0.63 3.24 ± 1.01 <0.0011 Duration of Follow-Up 7.97 ± 2.47 8.29 ± 2.66 0.6503 Auxiliary Procedure (Yes) 2 (7.4%) 1 (4.0%) 1.0004 Overall Stone free rate 88.9% 92.3% 1.0004 ***Significant at p<0.05, 1: Wilcoxon-Mann-Whitney U Test, 2: Chi-Squared Test, 3: t-test, 4: Fisher's Exact Test Source of Funding: Self © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chandra Mohan Vaddi More articles by this author Ramakrishna Paidakula More articles by this author Siddalinga Swamy P. M. More articles by this author Soundarya Ganesan More articles by this author Hemnath U. A. More articles by this author Manas Babu B. More articles by this author Rakesh Panda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...