Comparative study of thulium fiber laser versus holmium:yttrium-aluminum-garnet laser for ureteric stone management with semi-rigid ureteroscopy: A prospective, single-center study

doi:10.1016/j.ajur.2023.01.001

Asian Journal of Urology, 2024, 11 (3): 460-465 doi: 10.1016/j.ajur.2023.01.001

Regular Papers: Original Articles

Comparative study of thulium fiber laser versus holmium:yttrium-aluminum-garnet laser for ureteric stone management with semi-rigid ureteroscopy: A prospective, single-center study

Ankit Gupta^*(

),Arvind P. Ganpule,Ankush Puri,Abhishek G. Singh,Ravindra B. Sabnis,Mahesh R. Desai

Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

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Abstract

Objective: To compare the efficacy and safety of thulium fiber laser (TFL) and holmium:yttrium-aluminum-garnet (Ho:YAG) laser for ureteric stone management with semi-rigid ureteroscopy.

Methods: In a prospective study from January 2020 to December 2021, we compared 40 patients in each group who underwent semi-rigid ureteroscopic lithotripsy with TFL and that with Ho:YAG laser. Stone volume, stone density, stone fragmentation rates, total lasing time, total operative time, endoscopic vision, retropulsion and stone free rates were analyzed in both groups and compared.

Results: Mean stone volume was comparable in the TFL group and the Ho:YAG laser group (282.45 [standard deviation, SD 139.79] mm³ vs. 279.49 [SD 312.52] mm³; p=0.964). Mean stone density was also comparable in the TFL group and the Ho:YAG laser group (1135.30 [SD 317.04] Hounsfield unit vs. 1131.75 [SD 283.03] Hounsfield unit; p=0.959). The mean stone fragmentation rates calculated as stone volume divided by lasing time were 25.85 (SD 10.61) mm³/min and 21.37 (SD 14.13) mm³/min in the TFL group and the Ho:YAG laser group, respectively (p=0.113). The mean total lasing time (10.15 [SD] 4.69 min vs. 11.43 [SD 4.56] min; p=0.222), mean operative time (25.13 [SD 9.51] min vs. 25.54 [SD 10.32] min; p=0.866), and mean total hospital stay (2.62 [SD 0.77] days vs. 2.61 [SD 0.84] days; p=0.893) were comparable in the TFL group and in the Ho:YAG group. The vision was better and retropulsion was less in the TFL group. The stone-free rate at 1 month postoperatively was slightly better in the TFL group (100% vs. 90%; p=0.095).

Conclusion: TFL technology was associated with the comparable total surgical time, total lasing time, and stone fragmentation rate with Ho:YAG laser. However, TFL had better endoscopic vision, lesser stone retropulsion, and slightly better stone-free rates.

Key words： Laser Stone Urolithiasis Thulium Holmium

Received: 02 September 2022 Available online: 20 July 2024

Corresponding Authors: *E-mail address: ankitsurg@gmail.com (A. Gupta).

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	Ankit Gupta
	Arvind P. Ganpule
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	Abhishek G. Singh
	Ravindra B. Sabnis
	Mahesh R. Desai

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Cite this article:

Ankit Gupta,Arvind P. Ganpule,Ankush Puri, et al. Comparative study of thulium fiber laser versus holmium:yttrium-aluminum-garnet laser for ureteric stone management with semi-rigid ureteroscopy: A prospective, single-center study[J]. Asian Journal of Urology, 2024, 11(3): 460-465.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.01.001 OR http://www.ajurology.com/EN/Y2024/V11/I3/460

Trolley showing instruments and components for semi-rigid ureteroscopy.

Demographic patient data in both TFL group and Ho:YAG laser group.

Comparison of deterioration of vision during lasing in both groups during ureterolithotripsy.

Comparison of degree of retropulsion of stone while lasing in both groups.

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