Introduction
Laser lithotripsy is one of the standard fragmentation procedures during mini-PCNL. In this study, a holmium:YAG laser was compared with a new pulsed solid state thulium:YAG laser with special consideration of operative time and stone-free rates (SFR).
Materials
Between September 2020 and August 2022, all patients (n=100) who underwent mini-PCNL were prospectively included. In all patients, either a Ho:YAG laser (Sphinx Jr, Lisa Laser) (group 1) or a new pulsed thulium:YAG laser (RevoLix HTL, Lisa Laser) (group 2) was used as the energy source for lithotripsy. 50 patients were included in each of the two groups and all patients were treated by one surgeon. Primary endpoints were operative time and SFR. On the first postoperative day, all patients underwent either computed tomography or kidney/ureter/bladder radiography with antegrade filling to determine SFR.
Results
,Both groups were comparable in terms of age (p=0.21), gender (p=0.84), stone size (p=0.75), and stone density (p=0.78). The SFR at 24 hours was 90% in the holmium group and 92% in the thulium group (p=0.73). All patients with residual stones underwent retrograde intrarenal surgery (RIRS) for definitive stone clearance. In all of the five patients from group 1 and in one of the five patients from group 2, a residual stone was removed by RIRS. In the remaining patients of group 2, only stone dust was seen without the possibility to extract any stone material. Laser time (10.35 vs. 7.1 min; p=0.03) was significantly shorter in group 2. Total operating time from puncture to insertion of the nephrostomy also showed a significant difference between the two groups (39.2 vs. 30.6 min; p<0.05) with advantages on the side of the thulium:YAG laser. Intraoperative and postoperative complication rates were not significantly different.
Conclusion
The novel pulsed solid state thulium:YAG laser showed significant advantages over the holmium:YAG laser in terms of laser time as well as operative time. However, when comparing the initial SFR as well as the complication rates, there were no significant differences between the two lasers.
Funding
Not applicable.
Lead Authors
Benedikt Becker, MD
Department of Urology, Asklepios Hospital Barmbek
Co-Authors
Julius Bergmann,
Department of Urology, Asklepios Hospital Barmbek
Christopher Netsch,
Department of Urology, Asklepios Hospital Barmbek
Clemens M. Rosenbaum,
Department of Urology, Asklepios Hospital Barmbek
Andreas J. Gross,
Department of Urology, Asklepios Hospital Barmbek
Prospective comparison between a pulsed solid state thulium:YAG laser and a holmium:YAG laser for lithotripsy during Mini-PCNL.
Category
Abstract
Description
MP04: 02Session Name:Moderated Poster Session 04: Stones - PCNL 1