Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study
Por:
Chai, CA, Inoue, T, Somani, BK, Yuen, SKK, Ragoori, D, Gadzhiev, N, Tanidir, Y, Emiliani, E, Bin Hamri, S, Lakmichi, MA, Chandramohan, V, Naselli, A, Soebhali, B, Gokce, MI, Tursunkulov, AN, Chillón, FRD, Chew, B, Traxer, O, Castellani, D, Gauhar, V
Publicada:
1 sep 2024
Resumen:
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.
Filiaciones:
Chai, CA:
Univ Malaya, Fac Med, Dept Surg, Div Urol, Kuala Lumpur 50603, Malaysia
Inoue, T:
Kobe Univ, Hara Genitourinary Private Hosp, Dept Urol, Kobe, Hyogo, Japan
Somani, BK:
Univ Hosp Southampton NHS Trust, Dept Urol, Southampton, England
Yuen, SKK:
Chinese Univ Hong Kong, SH Ho Urol Ctr, Dept Surg, Hong Kong, Peoples R China
Ragoori, D:
Asian Inst Nephrol & Urol, Dept Urol, Hyderabad, India
Gadzhiev, N:
St Petersburg State Univ Hosp, Dept Urol, St Petersburg, Russia
Tanidir, Y:
Marmara Univ, Sch Med, Dept Urol, Istanbul, Turkiye
Emiliani, E:
Autonomos Univ Barcelona, Fdn Puigvert, Dept Urol, Barcelona, Spain
Bin Hamri, S:
King Saud Bin Abdulaziz Univ, Dept Surg, Div Urol, Minist Natl Guard Hlth Affairs, Jeddah, Saudi Arabia
Lakmichi, MA:
Univ Hosp Mohammed VIth Marrakesh, Dept Urol, Marrakech, Morocco
Chandramohan, V:
Preeti Urol & Kidney Hosp, Dept Urol, Hyderabad, India
Naselli, A:
IRCCS San Giuseppe Hosp, Multimed, Milan, Italy
Soebhali, B:
Muliawarman Univ, Abdul Wahab Sjahranie Hosp, Dept Urol, Med Fac, Samarinda, Indonesia
Gokce, MI:
Ankara Univ, Dept Urol, Sch Med, Ankara, Turkiye
Tursunkulov, AN:
AkfaMedline Hosp, Urol Div, Tashkent, Uzbekistan
Chillón, FRD:
Clin Univ Navarra, Dept Urol, Madrid, Spain
Chew, B:
Univ British Columbia, Dept Urol, Vancouver, BC, Canada
Traxer, O:
Univ Politecn Marche, Urol Unit, Azienda Osped Univ Marche, Ancona, Italy
Castellani, D:
Sorbonne Univ, Tenon Hosp, AP HP, Dept Urol, Paris, France
Gauhar, V:
Ng Teng Fong Gen Hosp, Dept Urol, Singapore, Singapore
gold
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