Presented by: Cassidy Lleras BS
New York Medical College

Introduction

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large and complex kidney stones. Miniaturization of the PCNL ("mini-PCNL") has shown promising outcomes through a smaller incision. There is limited data regarding the use of MOSES™ Lumenis holmium laser in mini-PCNL, specifically in regards to stone composition and location. We aim to explore outcomes in patients with renal calculi of varying composition and location who underwent mini-PCNL using the MOSES™ holmium laser.  

Materials

We retrospectively reviewed records of patients who underwent mini-PCNL with the MOSES™ holmium laser from July 2018 to April 2022. Patient demographics, comorbidities, and preoperative demographics were extracted. Treatment time was defined as time from stone removal initiation until completion, including lithotripsy, basketing, and extraction, while lithotripsy time was defined as time spent on fragmentation. Kruskal-Wallis tests were used for statistical analysis. 

Results

,

A total of 251 patients were included. Postoperatively, the majority of patients (95%) were stone free, while 12 patients had residual stone. Complication rate was low at 1% (n=3). Median stone treatment time was 8.2 min while median lithotripsy time was 1.75 min. Overall treatment efficiency (diameter of stone/treatment time) was 0.48 mm/min. Median lithotripter efficiency (diameter of stone/lithotripsy time) was 9.3 mm/min. Lithotripsy efficiency was similar among primary stone locations (p=0.113) and primary compositions (p=0.075). After taking time spent evacuating stone fragments into account, treatment efficiency was also similar among stone locations (p=0.182) and compositions (p=0.131).  

Conclusion

The laser was clinically equivalent across stone type and location. With high stone free rates and minimal complications, our study provides evidence for the effective use of MOSES™ holmium laser in mini-PCNL in kidney stone treatment, to which future lasers/lithotripters may be compared.  

Funding

Statistical analysis was funded by LUMENIS. 

Lead Authors

Maytal Babajanian, BS
New York Medical College

Co-Authors

Max R. Drescher, MD
University of Maryland School of Medicine

Natalia Arias Villela, MD
University of Maryland School of Medicine

Andy Martinez, MD
Chesapeake Urology Associates

William Meeks,
American Urological Association

Emily Galen, BS
American Urological Association

Joel Abbott, MD
Pacific West Urology

Meagan Dunne, MD
Chesapeake Urology Associates

Daniel C. Rosen, MD
New York Medical College

Julio G. Davalos, MD
Chesapeake Urology Associates