Presented by: Fabrice Henry MD
Cleveland Clinic Glickman Urological Institute

Introduction

There has been an influx of novel laser technologies for the treatment of urolithiasis. We sought to evaluate the current utilization patterns of the various laser modalities in the surgical management of stones among Endourologists.

Materials

An online survey was distributed to Endourological Society members using RedCAP.  Questions included demographics, laser modality, indication-specific laser settings, laser acquisition models, and surgeon knowledge. Statistical analysis was done using R statistical software.

Results

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183 responses were received after two email blasts to members of the Endourological Society.  Most respondents were in the United States (33.3%), followed by Canada (10.9%). Most respondents had been in practice at least > 10 years (63.9%), were academic urologists (62.8%) and had fellowship training in Endourology (65.6%). The most frequently used laser was high-power holmium (HPH, 71.6%), followed by low-power holmium (LPH, 44.4%) and thulium fiber laser (TFL, 43.8%). Most laser units were purchased on capital, with smaller percentages acquired through placement or rental agreements. There was no significant difference in acquisition models between laser types. 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 an 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).

Although most surgeons are confident in their ability to select the best laser setting (44.2% often, 40.7% always), the majority change laser settings during a case (52.2% often, 16.8% always).  Most surgeons are interested in further education on laser usage (68.5%).

Conclusion

Despite being relatively new, TFL is being used as commonly as LPH lasers indicating rapid adoption.   Notably, there is a desire for further learning opportunities regarding laser use.

Funding

None

Co-Authors

Jianbo Li,
Cleveland Clinic Glickman Urological Institute

Jorge Gutierrez, MD
Cleveland Clinic Glickman Urological Institute

Sri Sivalingam, MD
Cleveland Clinic Glickman Urological Institute