Investig Clin Urol.
2024 Sep;65(5):451-458. 10.4111/icu.20240185.
Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study
- Chai CA
1 - Inoue T2
- Somani BK3
- Yuen SKK4
- Ragoori D5
- Gadzhiev N6
- Tanidir Y7
- Emiliani E8
- Hamri SB9
- Lakmichi MA10
- Chandramohan V11
- Naselli A12
- Soebhali B13
- Gokce MI14
- Tursunkulov AN15
- Chillón FRdF16
- Chew BH17
- Traxer O18
- Castellani D19
- Gauhar V20
- Affiliations
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- 1Division of Urology, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- 2Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan
- 3Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
- 4SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
- 5Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, India
- 6Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
- 7Department of Urology, School of Medicine, Marmara University, İstanbul, Türkiye
- 8Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain
- 9Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia
- 10Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
- 11Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
- 12IRCCS San Giuseppe Hospital, Multimedica, Milan, Italy
- 13Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
- 14Department of Urology, Ankara University School of Medicine, Ankara, Türkiye
- 15Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan
- 16Department of Urology, Clinica Universidad de Navarra, Madrid, Spain
- 17Department of Urology, University of British Columbia, Vancouver, Canada
- 18Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
- 19Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
- 20Department of Urology, Ng Teng Fong General Hospital, Singapore
- KMID: 2559106
- DOI: http://doi.org/10.4111/icu.20240185
Abstract
- Purpose
Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there’s no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice.
Materials and Methods
Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR).
Results
A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds.
Conclusions
Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.
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