Research output: Contribution to journal › Article › peer-review
Comparing Thulium Fiber Versus High-Power Holmium Laser Lithotripsy Combined with the Flexible and Navigable Suction Access Sheath in Flexible Ureteroscopy for Kidney Stone Disease : A Propensity Score Matched Analysis by the Global FANS Collaborative Group. / Gauhar, Vineet; Traxer, Olivier; Fong, Khi Yung; Sietz, Christian; Chew, Ben Hall; Bin Hamri, Saeed; Gökce, Mehmet Ilker; Gadzhiev, Nariman; Yuen, Steffi Kar Kei; Malkhasyan, Vigen; Ragoori, Deepak; Tanidir, Yiloren; Somani, Bhaskar Kumar; Castellani, Daniele.
In: Journal of Endourology, Vol. 39, No. 1, 01.2025, p. 42-49.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Comparing Thulium Fiber Versus High-Power Holmium Laser Lithotripsy Combined with the Flexible and Navigable Suction Access Sheath in Flexible Ureteroscopy for Kidney Stone Disease
T2 - A Propensity Score Matched Analysis by the Global FANS Collaborative Group
AU - Gauhar, Vineet
AU - Traxer, Olivier
AU - Fong, Khi Yung
AU - Sietz, Christian
AU - Chew, Ben Hall
AU - Bin Hamri, Saeed
AU - Gökce, Mehmet Ilker
AU - Gadzhiev, Nariman
AU - Yuen, Steffi Kar Kei
AU - Malkhasyan, Vigen
AU - Ragoori, Deepak
AU - Tanidir, Yiloren
AU - Somani, Bhaskar Kumar
AU - Castellani, Daniele
PY - 2025/1
Y1 - 2025/1
N2 - Objective: We aim to evaluate stone-free rate (SFR) and complications after flexible ureteroscopy (F-URS) for kidney stones, using a flexible and navigable suction ureteral access sheath (FANS), comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet laser (HPHL). Methods: Data from adults who underwent F-URS in 15 centers were prospectively analyzed (August 2023-January 2024). Exclusion criteria were ureteral stones, concomitant bilateral procedures, and renal abnormalities. One-to-one propensity score matching for age, gender, stone location, stone volume, and Hounsfield unit was performed. SFR was assessed using computed tomography scan within 30 days and defined as zero fragments. Data are presented as median (25th-75th quartiles). Multivariable logistic regression was performed to evaluate predictors of SFR. Results: Of included patients, HPHL was used in 114 patients and TFL in 181 patients. After matching, 96 patients from each group with similar baseline characteristics were included. There was no difference between the groups regarding the use of disposable scopes, lithotripsy mode, and ureteroscopy, lasing and total surgical time. There was no case of sepsis, and blood transfusion was necessary for only one patient in the HPHL group. The incidence of transient fever was similar (3.4% in HPHL vs 3.8% in TFL group). Postoperative day 1 loin pain did not differ significantly. Postoperative stay did not differ significantly [1 [0, 2] in HPHL vs 1 [0, 1] days in TFL group, p = 0.12]. Thirty-day SFR was similar (52.1% for HL vs 64.6% for TFL group, p = 0.11). At multivariable analysis, the use of TFL (odds ratio 1.95, 95% confidence interval 1.01-3.82) was significantly associated with higher odds of being stone-free. Conclusions: Both lasers are safe and efficacious and can be suitably used for F-URS with FANS with high SFR and minimal complications.
AB - Objective: We aim to evaluate stone-free rate (SFR) and complications after flexible ureteroscopy (F-URS) for kidney stones, using a flexible and navigable suction ureteral access sheath (FANS), comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet laser (HPHL). Methods: Data from adults who underwent F-URS in 15 centers were prospectively analyzed (August 2023-January 2024). Exclusion criteria were ureteral stones, concomitant bilateral procedures, and renal abnormalities. One-to-one propensity score matching for age, gender, stone location, stone volume, and Hounsfield unit was performed. SFR was assessed using computed tomography scan within 30 days and defined as zero fragments. Data are presented as median (25th-75th quartiles). Multivariable logistic regression was performed to evaluate predictors of SFR. Results: Of included patients, HPHL was used in 114 patients and TFL in 181 patients. After matching, 96 patients from each group with similar baseline characteristics were included. There was no difference between the groups regarding the use of disposable scopes, lithotripsy mode, and ureteroscopy, lasing and total surgical time. There was no case of sepsis, and blood transfusion was necessary for only one patient in the HPHL group. The incidence of transient fever was similar (3.4% in HPHL vs 3.8% in TFL group). Postoperative day 1 loin pain did not differ significantly. Postoperative stay did not differ significantly [1 [0, 2] in HPHL vs 1 [0, 1] days in TFL group, p = 0.12]. Thirty-day SFR was similar (52.1% for HL vs 64.6% for TFL group, p = 0.11). At multivariable analysis, the use of TFL (odds ratio 1.95, 95% confidence interval 1.01-3.82) was significantly associated with higher odds of being stone-free. Conclusions: Both lasers are safe and efficacious and can be suitably used for F-URS with FANS with high SFR and minimal complications.
KW - Humans
KW - Ureteroscopy/methods
KW - Kidney Calculi/therapy
KW - Propensity Score
KW - Female
KW - Male
KW - Lithotripsy, Laser/methods
KW - Thulium
KW - Middle Aged
KW - Lasers, Solid-State/therapeutic use
KW - Suction/instrumentation
KW - Adult
KW - Ureteroscopes
KW - Treatment Outcome
KW - Aged
KW - thulium fiber laser
KW - retrograde intrarenal surgery
KW - flexible ureteroscopy
KW - laser lithotripsy
KW - kidney calculi
KW - holmium laser
UR - https://www.mendeley.com/catalogue/afaa6f32-d8e5-3d75-a1fe-96bc926802f9/
U2 - 10.1089/end.2024.0653
DO - 10.1089/end.2024.0653
M3 - Article
C2 - 39676748
VL - 39
SP - 42
EP - 49
JO - Journal of Endourology
JF - Journal of Endourology
SN - 0892-7790
IS - 1
ER -
ID: 135969230