Victoria Jahrreiss, Francesco Ripa, Clara Cerrato, Carlotta Nedbal, Amelia Pietropaolo, Bhaskar Somani
{"title":"采用 MOSES 和非 MOSES 技术的钬：YAG 激光与激光碎石术的比较：采用相似激光设置的前瞻性单中心倾向得分匹配分析。","authors":"Victoria Jahrreiss, Francesco Ripa, Clara Cerrato, Carlotta Nedbal, Amelia Pietropaolo, Bhaskar Somani","doi":"10.1177/17562872241272974","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies.</p><p><strong>Methods: </strong>Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4-1 J, 20-40 Hz) with dusting and pop-dusting technique. The independent <i>t</i>-test, Mann-Whitney <i>U</i> test, and Chi-squared test were used, with a <i>p</i>-value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis.</p><p><strong>Results: </strong>A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, <i>p</i> = 0.42), pre-stenting (37% and 35%, <i>p</i> = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, <i>p</i> = 0.73), and ureteral access sheath use (37% and 35%, <i>p</i> = 0.77) respectively.While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%.</p><p><strong>Conclusion: </strong>While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334132/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of ureteoroscopy and laser stone fragmentation between Holmium: YAG laser with MOSES versus non-MOSES technology: a prospective single-center propensity score-matched analysis using similar laser settings.\",\"authors\":\"Victoria Jahrreiss, Francesco Ripa, Clara Cerrato, Carlotta Nedbal, Amelia Pietropaolo, Bhaskar Somani\",\"doi\":\"10.1177/17562872241272974\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies.</p><p><strong>Methods: </strong>Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4-1 J, 20-40 Hz) with dusting and pop-dusting technique. The independent <i>t</i>-test, Mann-Whitney <i>U</i> test, and Chi-squared test were used, with a <i>p</i>-value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis.</p><p><strong>Results: </strong>A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, <i>p</i> = 0.42), pre-stenting (37% and 35%, <i>p</i> = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, <i>p</i> = 0.73), and ureteral access sheath use (37% and 35%, <i>p</i> = 0.77) respectively.While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%.</p><p><strong>Conclusion: </strong>While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes.</p>\",\"PeriodicalId\":23010,\"journal\":{\"name\":\"Therapeutic Advances in Urology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334132/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17562872241272974\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562872241272974","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Comparison of ureteoroscopy and laser stone fragmentation between Holmium: YAG laser with MOSES versus non-MOSES technology: a prospective single-center propensity score-matched analysis using similar laser settings.
Background: In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies.
Methods: Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4-1 J, 20-40 Hz) with dusting and pop-dusting technique. The independent t-test, Mann-Whitney U test, and Chi-squared test were used, with a p-value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis.
Results: A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, p = 0.42), pre-stenting (37% and 35%, p = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, p = 0.73), and ureteral access sheath use (37% and 35%, p = 0.77) respectively.While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%.
Conclusion: While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes.
期刊介绍：
Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology.
The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.
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