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A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm3)

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Abstract

Purpose

Our objective was to analyse the clinical efficiency of TFL in large volume stones during retrograde intrarenal surgery.

Materials and methods

Patients with large volume renal stones (> 1000 mm3) operated at two different centres, from May 2020 to April 2021, were enrolled in this study. Retrograde intrarenal surgery was performed using 60W Superpulse thulium fibre laser™ (IPG Photonics, Russia). Demographic data, stone parameters, laser time, and total operating time were recorded, and laser efficacy (J/mm3) and ablation speed (mm3/s) were calculated. NCCT KUB was done at 3 months postoperatively to calculate stone-free rate.

Results

A total of 76 patients were included and analysed in the study. Mean stone volume was 1753.12 ± 1245.81 (1169.27–2193.25) mm3, mean stone density was 1104.46 ± 313.09 (875.00–1317.00) HU, mean laser time was 537.79 ± 689.89 (21.00–1080.00) sec, mean operating time was 43.38 ± 12.96 (35.00–51.25) min, mean laser efficacy was 20.30 ± 15.5 (8.88–25.57) J/mm3, and mean ablation speed was 1.32 ± 0.7 (0.82–1.64) mm3/sec. A strong positive correlation was found between the stone volume and ablation speed (r = 0.659, p = 0.000), and a moderate negative correlation was found between the stone volume and laser efficacy (J/mm3) (r = − 0.392, p = 0.000). With increasing volume of the stone, J/mm3 decreased significantly and ablation speed increased significantly (p < 0.001). Complications occurred in 21.05% (16/76) patients, most of which were Clavien grades 1–2. Overall SFR is 96.05%.

Conclusion

Laser efficiency increases at higher stone volumes (> 1000 mm3), as less energy is required to ablate every mm3 of stone.

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Data availability

All the data are available with the authors for review.

References

  1. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2018) EAU guidelines on urolithiasis 2018. European association of urology guidelines

  2. Sabnis RB, Jagtap J, Mishra S, Desai M (2012) Treating renal calculi 1–2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int Br J Urol 110(8):E346. https://doi.org/10.1111/j.1464-410X.2012.11089.x

    Article  Google Scholar 

  3. Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R (2012) A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol 26(1):52–57. https://doi.org/10.1089/end.2011.0235

    Article  PubMed  Google Scholar 

  4. Goldberg H, Golomb D, Shtabholtz Y, Tapiero S, Creiderman G, Shariv A, Lifhshitz D (2017) The “old” 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World J Urol 35(12):1947–1954. https://doi.org/10.1007/s00345-017-2075-8

    Article  PubMed  Google Scholar 

  5. Fried NM, Irby PB (2018) Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 15(9):563–573. https://doi.org/10.1038/s41585-018-0035-8

    Article  PubMed  Google Scholar 

  6. Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser—a systematic review. Transl Androl Urol 8(Suppl 4):S398. https://doi.org/10.21037/tau.2019.08.01

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lekarev V, Dymov A, Vinarov A, Sorokin N, Minaev V, Minaev N, Tsypina S, Yusupov V (2020) Mechanism of lithotripsy by superpulse thulium fiber laser and its clinical efficiency. Appl Sci 10(21):7480. https://doi.org/10.3390/app10217480

    Article  CAS  Google Scholar 

  8. Corrales M, Traxer O (2022) Retrograde intrarenal surgery: laser showdown (Ho: YAG vs thulium fiber laser). Curr Opin Urol 32(2):179–184. https://doi.org/10.1097/MOU.0000000000000971

    Article  PubMed  Google Scholar 

  9. Enikeev D, Taratkin M, Klimov R, Alyaev Y, Rapoport L, Gazimiev M, Traxer O (2020) Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy. World J Urol 38(12):3069–3074. https://doi.org/10.1007/s00345-020-03134-x

    Article  CAS  PubMed  Google Scholar 

  10. Rice P, Somani BK (2021) A systematic review of thulium fiber laser: applications and advantages of laser technology in the field of urology. Res Rep Urol 13:519. https://doi.org/10.2147/RRU.S233979

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ergakov D, Martov AG, Guseynov M (2018) The comparative clinical study of Ho: YAG and superpulse Tm fiber laser lithotripters. Eur Urol Suppl 17(2):e1391. https://doi.org/10.1016/S1569-9056(18)31816-5

    Article  Google Scholar 

  12. Danilovic A, Cavalanti A, Rocha BA, Traxer O, Torricelli FC, Marchini GS, Mazzucchi E, Srougi M (2018) Assessment of residual stone fragments after retrograde intrarenal surgery. J Endourol 32(12):1108–1113. https://doi.org/10.1089/end.2018.0529

    Article  PubMed  Google Scholar 

  13. Ghani KR, Wolf JS (2015) What is the stone-free rate following flexible ureteroscopy for kidney stones? Nat Rev Urol 12(5):281–288. https://doi.org/10.1038/nrurol.2015.74

    Article  PubMed  Google Scholar 

  14. Ventimiglia E, Pauchard F, Gorgen ARH, Panthier F, Doizi S, Traxer O (2021) How do we assess the efficacy of Ho: YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm3 and laser activity concepts. World J Urol 39(3):891–896. https://doi.org/10.1007/s00345-020-03241-9

    Article  PubMed  Google Scholar 

  15. Majdalany SE, Levin BA, Ghani KR (2021) The efficiency of Moses technology holmium laser for treating renal stones during flexible ureteroscopy: relationship between stone volume, time, and energy. J Endourol 35(3):14. https://doi.org/10.1089/end.2021.0592

    Article  Google Scholar 

  16. Corrales M, Traxer O (2021) Initial clinical experience with the new thulium fiber laser: First 50 cases. World J Urol 39(10):3945–3950. https://doi.org/10.1007/s00345-021-03616-6

    Article  CAS  PubMed  Google Scholar 

  17. Enikeev D, Grigoryan V, Fokin I, Morozov A, Taratkin M, Klimov R, Glybochko P (2021) Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: a single- center experience. Int J Urol 28(3):261–265. https://doi.org/10.1111/iju.14443

    Article  CAS  PubMed  Google Scholar 

  18. Traxer O, Corrales M (2021) Managing urolithiasis with thulium fiber laser: updated real-life results—asystematicreview. J Clin Med 10(15):3390. https://doi.org/10.3390/jcm10153390

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. El-Nahas AR, Almousawi S, Alqattan Y, Alqadri IM, Al-Shaiji TF, Al-Terki A (2019) Dusting versus fragmentation for renal stones during flexible ureteroscopy. Arab J Urol 17(2):138–142. https://doi.org/10.1080/2090598X.2019.1601002

    Article  PubMed  PubMed Central  Google Scholar 

  20. Humphreys MR, Shah OD, Monga M, Chang YH, Krambeck AE, Sur RL, Chew BH (2018) Dusting versus basketing during ureteroscopy–which technique is more efficacious? A prospective multicenter trial from the EDGE research consortium. J Urol 199(5):1272–1276. https://doi.org/10.1016/j.juro.2017.11.126

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India

    Abhishek Singh, Rohan Batra, Arvind Ganpule, Ravindra Sabnis & Mahesh Desai

  2. Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India

    Chandra Mohan Vaddi, Soundarya Ganesan, Paidakula Ramakrishna, Siddalinga Swamy, Hemnath Anandan, Manas Babu & Rakesh Panda

Authors
  1. Abhishek Singh
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  2. Chandra Mohan Vaddi
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  4. Rohan Batra
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  5. Paidakula Ramakrishna
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  11. Ravindra Sabnis
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  12. Mahesh Desai
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Contributions

AS: data collection, manuscript editing. CV: project development, data collection, manuscript editing. SG: project development, data collection, data analysis, manuscript writing. RB: data collection, data analysis. RP: data collection, manuscript editing. SSPM: manuscript editing. HA: manuscript editing. MB: manuscript editing. RP: manuscript editing. AG: manuscript editing. RS: manuscript editing. MD: manuscript editing.

Corresponding author

Correspondence to Soundarya Ganesan.

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No conflicts of interest.

Ethics approval

The study was approved by the institutional ethics committee (Approval no. ECSTTH/EC Meet 03/2020/01).

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Informed consent was obtained from all individual participants included in the study.

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Singh, A., Vaddi, C.M., Ganesan, S. et al. A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm3). World J Urol 41, 2289–2295 (2023). https://doi.org/10.1007/s00345-023-04476-y

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