Scientific publications
Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study. Scientific Publication
Chu Ann Chai 1 , Takaaki Inoue 2 , Bhaskar Kumar Somani 3 , Steffi Kar Kei Yuen 4 , Deepak Ragoori 5 , Nariman Gadzhiev 6 , Yiloren Tanidir 7 , Esteban Emiliani 8 , Saeed Bin Hamri 9 , Mohamed Amine Lakmichi 10 , Vaddi Chandramohan 11 , Angelo Naselli 12 , Boyke Soebhali 13 , Mehmet Ilker Gokce 14 , Azimdjon N Tursunkulov 15 , Fernando Ramón de Fata Chillón 16 , Ben Hall Chew 17 , Olivier Traxer 18 , Daniele Castellani 19 , Vineet Gauhar 20
Purpose: Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there's no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice.
Materials and methods: Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR).
Results: A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds.
Conclusions: Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.
CITATION Investig Clin Urol. 2024 Sep;65(5):451-458.
doi: 10.4111/icu.20240185
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