Presented by: Fabrice Henry MD
Glickman Urological & Kidney Institute, Cleveland Clinic

Introduction

The introduction of Thulium Fiber Laser (TFL) has changed the landscape of laser use in the surgical management of urolithiasis.  Given the paucity of literature on how surgeons are utilizing TFL in practice, we sought to evaluate current utilization patterns of this technology among Endourologists.

Materials

An online survey was distributed to Endourological Society members using RedCAP. Questions included demographics, laser modality (low-power holmium (LPH), high-power holmium (HPH), and TFL), indication-specific laser settings (i.e., ureteral dusting and fragmentation; renal dusting, fragmentation and pop dusting; percutaneous nephrolithotomy (PCNL), and cystolitholapaxy).  Data was analyzed using R statistical software.

Results

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183 responses were received after two email blasts to Endourological Society members.  TFL was used significantly more often by urologists in practice less than 10 years compared to those in practice 20 years or more (53% vs 28.1%, p=0.009), by those in academic hospitals compared to private practices (52.2% vs 13.2%, p<0.001), and by those with Endourology fellowship training (47.5% vs 27.0%, p=0.011)

TFL was used most for renal stone dusting (37.1%), followed by ureteral stone dusting (31.6%). Use was similar between ureteral stone fragmentation (27.3%), renal stone pop dusting (25.7%) and renal stone fragmentation (27.5%). It was least commonly utilized in cystolitholapaxy (15.8%) and PCNL (13.5%).

Energy settings (J) were significantly lower for TFL in most scenarios, except for ureteral stone fragmentation.  Frequency settings were significantly higher for TFL versus LPH in all settings except ureteral fragmentation, and significantly higher versus HPH in renal stone fragmentation. (See Table 1).   Most surgeons indicated an interest in further education on laser usage in stones surgery (68.5%).

Conclusion

Despite being a relatively new technology, TFL is being more commonly used. When using TFL, surgeons tend to use lower energy and higher frequency compared to holmium lasers. Our study indicates there is variation in the uptake of TFL technology by urologists within the endourological society and indicates a need for further education in available technology in the management of urolithiasis.

Funding

None

Co-Authors

Jianbo Li,
Glickman Urological & Kidney Institute, Cleveland Clinic

Jorge Gutierrez, MD
Glickman Urological & Kidney Institute, Cleveland Clinic

Sri Sivalingam, MD
Glickman Urological & Kidney Institute, Cleveland Clinic