Thulium fibre laser superior to holmium: YAG for clearing kidney stones: Study

Norway: A new study published in European Urology found that by utilizing thulium fiber laser (TFL) instead of Holmium: yttrium-aluminum-garnet (Ho: YAG), considerably more patients with kidney stones attained the stone-free status and reported fewer intraoperative problems.

The gold standard for ureterorenoscopic (URS) lithotripsy is the Ho: YAG laser. Due to favorable qualities exhibited in preclinical research, thulium fibre laser has recently been offered as a novel technology that may challenge Ho: YAG as the favored laser. This research was carried out by Oyvind Ulvik and his team.  assess and compare results following URS lithotripsy with Ho: YAG and TFL.

Patients aged 18 years and older with ureteral and/or renal stones (5 mm) scheduled for day-case URS lithotripsy were asked to participate in this prospective randomized experiment. A total of 120 consecutively hospitalized patients with signed consent were included in the study for randomization. This research included people who had received URS lithotripsy with Ho: YAG or TFL. At the 3-month follow-up, the primary outcome was the stone-free rate (SFR) as determined by non-contrast computed tomography. The operation time and complications were secondary outcomes. The t-test and the 2 tests were used to compare outcomes between groups.

The findings of this article were as follows:

1. SFR was 67% in the Ho: YAG group and 92% in the TFL group after a single session.

2. SFR was 100% in both groups for ureteral stones, 49% (Ho: YAG), and 86% (TFL) for renal stones.

3. TFL required less time to do the procedure (49 minutes) than Ho: YAG (57 minutes).

4. The most common intraoperative adverse event was bleeding that obstructed the endoscopic image, which occurred in 13 patients (22%) in the Ho: YAG group and three (5%) in the TFL group.

In conclusion, this study found that using TFL for stone lithotripsy resulted in improved outcomes and fewer problems, particularly for renal stones.

Reference: Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Ulvik, Øyvind et al. European Urology. DOI:https://doi.org/10.1016/j.eururo.2022.02.027

Keywords: thulium fibre laser, lithotripsy, holmium, kidney stones, endoscopy, ureter, nephrology, urology, bladder, calcification, European Urology, Oyvind Ulvik