Propensity Score Matched Analysis of Thulium Fiber vs Pulsed Thulium:Yttrium Aluminum Garnet Laser Lithotripsy in Flexible Ureteroscopy for Kidney Stone Disease Using a Flexible and Navigable Suction Ureteral Access Sheath: Results From a Prospective, Multicenter Study of the EAU Section of Endourology

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2025-05-01 DOI:10.1016/j.urology.2025.01.065

Daniele Castellani , Khi Yung Fong , Olivier Traxer , Vigen Malkhasyan , Nariman Gadzhiev , Deepak Ragoori , Wissam Kamal , Ioannis Goumas Kartalas , Steffi Kar Kei Yuen , Bhaskar Kumar Somani , Mehmet Ilker Gökce , Vineet Gauhar

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Abstract

Objective

To evaluate outcomes after flexible ureteroscopy (F-URS) for renal stone(s) using a flexible and navigable suction ureteral access sheath (FANS-UAS) comparing Thulium fiber (TFL) vs pulsed Thulium:Yttrium aluminum garnet (p-Thulium:YAG) laser.

Methods

Data from adults who had F-URS in 5 centers were prospectively collected (April 2023-January 2024). All patients had a preoperative and within 30 days CT scan. Stone-free: grade A: zero fragments; grade B: single fragment ≤2 mm; grade C: single fragment 2.1-4 mm; grade D: single/multiple fragments >4 mm. One-to-one propensity score-matching for age, gender, prestenting, stone volume, stone location, and Hounsfield units was performed. Within 6 months after surgery, an intravenous urography or CT urography scan was performed in all patients.

Results

Of 179 included patients, TFL was employed in 115 patients. After matching, 64 patients from each group with comparable baseline characteristics were included. Median lasing time was significantly longer in the TFL group (15.5 [10,23] minutes vs 13 [10,15] minutes, P = .02), while total surgical time did not differ. There was no case of blood transfusion and sepsis. Overall stone-free rate (SFR) was significantly different between the groups with a higher proportion of patients in p-Thu:YAG laser group undergoing reintervention for residual fragments (17.2% vs 3.1%). There was no case of new-onset hydronephrosis, ureteropelvic junction/ureteral stenosis, impaired urinary drainage, or altered pelvicalyceal anatomy at a median follow-up of 13 weeks.

Conclusion

F-URS using FANS-UAS showed negligible serious adverse events and good SFR using both lasers. p-Thu:YAG laser showed shorter lasing time, marginal better grade A+B SFR but higher reintervention rate for residual fragments.

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采用灵活可导航的吸式输尿管通路套行输尿管软镜治疗肾结石患者时，铥纤维与脉冲铥钇铝石榴石激光碎石的倾向评分匹配分析。结果来自一项前瞻性，多中心研究的泌尿系统科EAU。

目的：评价柔性输尿管镜（F-URS）治疗肾结石后的效果，并将铥纤维（TFL）与脉冲铥：钇铝石榴石（p-铥：YAG）激光进行比较。方法：前瞻性收集5个中心（2023年4月- 2024年1月）的F-URS成人数据。所有患者术前及30天内均行CT扫描。无石：A级：零碎片；B级：单片≤2mm；C级：单片2.1-4 mm；D级：单个/多个碎片> 4mm。对年龄、性别、支架植入前、结石体积、结石位置和Hounsfield单位进行一对一倾向评分匹配。所有患者术后6个月内行静脉尿路造影或CT尿路造影扫描。结果：179例患者中，115例采用TFL。匹配后，每组64例具有可比基线特征的患者入组。TFL组的中位激光照射时间明显更长（15.5[10,23]分钟vs 13[10,15]分钟，p=0.02），而总手术时间没有差异。无输血及败血症病例。总体SFR在两组之间有显著差异，p-Thu:YAG激光组接受残留碎片再干预的患者比例较高（17.2% vs 3.1%）。在中位随访13周期间，没有新发肾积水、输尿管盂连接处/输尿管狭窄、尿路引流受损或骨盆解剖改变的病例。结论：使用FANS-UAS的F-URS的严重不良事件可以忽略不计，两种激光器的SFR均良好。p-Thu:YAG激光具有较短的激光时间，较好的A+B级SFR，但残余碎片的再干预率较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.