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 Ganpule, Ankush Puri, Abhishek Singh, Ravindra Sabnis, Mahesh Desai
Abstract
To compare the efficacy and safety of thulium fiber laser (TFL) and holmium laser for ureteric stone management with semi-rigid ureteroscopy. 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 holmium laser. Stone volume, stone density, stone fragmentation rate, total lasing time, total operative time, endoscopic vision, retropulsion and stone free rates were analyzed in both groups and compared. Mean stone volume was comparable in the TFL group and the holmium laser group (282.45 [SD 139.79] mm3 vs. 279.49 [SD 312.52] mm3; p=0.96). Mean stone density was also comparable in TFL the group and the holmium laser group (1135.3 [SD 317.04] Hounsfield unit vs. 1131.75 [SD 283.03] Hounsfield unit; p=0.959). The mean stone fragmentation rate calculated as stone volume divided by lasing time was 25.85 (SD 10.61) mm3/min and 21.37 (SD 14.13) mm3/min in TFL group and holmium 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. 25.5 [SD 10.3] min; p=0.866), and the mean total hospital stay (2.62 [SD 0.77] days vs. 2.6 [SD 0.84] days; p=0.89) were comparable in TFL group and in holmium group. The vision was better and retropulsion was less in the TFL group. Stone-free rates at 1 month postoperatively were slightly better in the TFL group (100% vs. 90%; p=0.095). TFL technology was associated with comparable total surgical time, total lasing time, and stone fragmentation rate with holmium laser. However, TFL had better endoscopic vision, lesser stone retropulsion, and slightly better stone-free rates.