Presented by: Ben H Chew MD, MSc FRCSC
University of British Columbia

Introduction

Thulium fiber laser (TFL) has emerged as an effective tool for endoscopic laser lithotripsy since its introduction in 2019. In this prospective, international clinical registry, the Endourological Society's T.O.W.E.R. Research Consortium evaluated the ablative performance, stone-free rates (SFRs), and safety of the first commercially available TFL system, SOLTIVE™ SuperPulsed Laser System (Olympus, Southborough, MA)) in a large patient cohort.

Materials

413 patients undergoing ureteroscopy for ureteral and/or renal stones using the SOLTIVE™ TFL laser were prospectively recruited and treated across eight international institutions between 12/2021- 4/2023. Baseline clinical characteristics, intraoperative lithotripsy efficiency, (adverse events, and post-operative outcomes were collected up to 90 days post-procedure. Kidney and ureteral stones were analyzed according to stone volume. Adverse events, re-interventions, and SFRs were assessed at 1 and 3 months.

Results

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Laser lithotripsy was performed by dusting, fragmentation, and by combination in 68.1%, 2.5%, 28.3% and 48.3%, 13.6% and 33.9% of kidney and ureteral cases, respectively. The overall SFRs for kidney and ureteral stones were 66% and 80% at 1 month, and 67% and 85% at 3 months. Lower SFRs were observed with the highest quartile energy delivery in both kidney and ureter (p<.001). This also correlated with stone size as larger stones required more energy. Kidney stones >9.7 mm and ureteral stones >12.1 mm resulted in lower SFR (p<0.001). If ≥17.2 kJ of laser energy was used in the kidney and ≥3.39 kJ in the ureter, this resulted in lower SFR (p=0.001). Across the cohort, the mean ablation rate was 4.2±18.1mm³/s for renal stones (mean 855.6±400.7 HU), and 2.4±6.7 mm3/s for ureteral stones (mean 790.5±358.5 HU). No ureteral perforations occurred across all procedures. Post-procedure serious adverse events (11) occurred in 2.91% (UTI 5, Sepsis 1, fever 2, pyelonephritis 1, acute kidney injury 1, stricture 2) and 7.02% re-intervention rates (salvage SWL, URS or PCNL) throughout the 90 day follow-up period.

Conclusion

The SOLTIVE™ SuperPulsed Laser System is effective in ureteroscopic lithotripsy for stone disease, with low complication and re-intervention rates and comparable SFRs to Ho:YAG lasers.

Funding

Olympus Medical

Co-Authors

Kyochul Koo, MD, FACS
Yonsei University

Mitchell R. Humphreys, MD
Mayo Clinic

Wilson R. Molina, MD
Kansas University

Bodo E. Knudsen, MD
Ohio State University

Mantu Gupta, MD
Mt. Sinai

Victor K.F. Wong, BSc
University of British Columbia

Abdulghafour Halawani, MD, FACS
King Abdulaziz University

Peter Kronenberg, MD
KUB

Palle Osther, MD
University of Southern Denmark

Olivier Traxer, MD
Sorbonne Université