Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial

Øyvind Ulvik; Mathias Sørstrand Æsøy; Patrick Juliebø-Jones; Peder Gjengstø; Christian Beisland

doi:10.1016/j.eururo.2022.02.027

Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial

Eur Urol. 2022 Jul;82(1):73-79. doi: 10.1016/j.eururo.2022.02.027. Epub 2022 Mar 14.

Authors

Øyvind Ulvik¹, Mathias Sørstrand Æsøy², Patrick Juliebø-Jones³, Peder Gjengstø², Christian Beisland³

Affiliations

¹ Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: doc.ulvik@online.no.
² Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.
³ Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

PMID: 35300888
DOI: 10.1016/j.eururo.2022.02.027

Abstract

Background: Holmium:yttrium-aluminium-garnet (Ho:YAG) laser is the gold standard for ureterorenoscopic (URS) lithotripsy. Thulium fibre laser (TFL) has recently been introduced as a new technology and may challenge Ho:YAG as the preferred laser owing to favourable properties as demonstrated in preclinical studies.

Objective: To evaluate and compare outcomes after URS lithotripsy with Ho:YAG and TFL.

Design, setting, and participants: In a prospective randomised trial, patients aged ≥18 yr with ureteral and/or renal stones (≥5 mm) scheduled to undergo day-case URS lithotripsy were invited to participate. In total, 120 consecutively admitted patients with signed consent were included for randomisation.

Intervention: URS lithotripsy with Ho:YAG or TFL.

Outcome measurements and statistical analysis: The primary outcome was the stone-free rate (SFR) assessed on noncontrast computed tomography at 3-mo follow-up. Secondary outcomes were the operative time and complications. Outcomes were compared between the groups using the t test and χ² test.

Results and limitations: After a single session, the SFR was 67% in the Ho:YAG group and 92% in the TFL group, p = 0.001. For ureteral stones, the SFR was 100% in both groups, and for renal stones; 49% (Ho:YAG) and 86% (TFL), p = 0.001. Operative time was shorter using TFL (49 min) compared to Ho:YAG (57 min), p = 0.008. Bleeding that impaired the endoscopic view was the most frequent intraoperative adverse event and occurred in 13 patients (22%) in the Ho:YAG group and three (5%) in the TFL group, p = 0.014.

Conclusions: In this study, significantly more patients with renal stones achieved stone-free status and fewer experienced intraoperative complications using TFL compared to Ho:YAG. TFL is the emerging laser of choice for stone lithotripsy.

Patient summary: We compared outcomes after ureterorenoscopic treatment of kidney and ureteral stones using two different lasers. Our results show that the new thulium fibre laser technology is superior to the current standard laser (holmium:YAG) in clearing kidney stones and reducing operative complications.

Keywords: Complications; Holmium:YAG laser; Randomised trial; Stone-free rate; Thulium fibre laser; Ureteroscopy.

Publication types

Randomized Controlled Trial

MeSH terms

Holmium
Humans
Kidney Calculi* / surgery
Lasers, Solid-State* / adverse effects
Lithotripsy*
Lithotripsy, Laser* / adverse effects
Prospective Studies
Thulium
Ureteral Calculi* / surgery
Ureteroscopy / adverse effects
Ureteroscopy / methods

Substances

Thulium
Holmium