Presented by: Crystal Valadon MD, MBA
The University of Kansas Health System

Introduction

Currently, evidence is limited when comparing high-power laser platforms in ureteroscopic lithotripsy. We aimed to examine the outcomes of the SuperPulsed Thulium Fiber™ (SPTF) versus the high-power holmium:yttrium-aluminum-garnet (HoYAG) laser for lithotripsy.

Materials

We conducted a retrospective chart review from 01/2019-12/2021 on patients undergoing elective ureteroscopy to address stone disease regardless of stone size, location, or scope type. Exclusion criteria included patients with an untreated positive urine culture prior to 3 months of the procedure and patients who did not have a follow-up imaging exam or did not complete the 12-week post-procedural visit. The utilized HoYAG platform was the Lumenis Pulse P120H™ (120W, Boston Sci®, US), while the TFL comprised the Soltive™ SPTF (60W, Olympus®, Japan) laser. Stone-free status (SFS) was defined as the absence of stone fragments ≥ 2mm on imaging (ultrasound or CT scan) at the 12-week postoperative visit.

Results

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Of the initial 508 patients, 336 met the study criteria. Patients and stone characteristics were comparable, with no significant difference between groups. Dusting technique was utilized more often in the SPTF group (18.5% vs. 6.2%, p=0.03). The median total laser time and ablation efficiency (kJ/cm³) were similar between groups. Despite we found higher median total laser energy and higher ablation speeds (mm³/s) when utilizing the SPTF, total operative time was not significantly different. Overall, SFSs for HoYAG and TFL were 85.9% vs. 85.3% (OR 1.07, CI95% 0.56–2.06, p=0.82), respectively. In the stone location subgroup analysis, SFSs were comparable between groups – Table 1. 

Conclusion

Overall, there is no significant difference in SFS between HoYAG and SPTF groups, along with similar ablation efficiency and complication rates. Although ablation speed was significantly higher in the SPTF, total operative time was comparable.

Funding

No funding.

Lead Authors

Wilson Molina, MD
The University of Kansas Health System

Co-Authors

Willian Ito, MD
The University of Kansas Health System

Nicholas Choi, BS
University of Kansas School of Medicine

George Letner, BS
University of Kansas School of Medicine

Dillon Prokop, BS
University of Kansas School of Medicine

Crystal Valadon, MD
University of Kansas School of Medicine

Donald Neff, MD
The University of Kansas Health System

David Duchene, MD
The University of Kansas Health System