Comparative study of the efficacy and safety of a new generation of thulium fiber lasers for ureteroscopy and lithotripsy
- Authors: Martov A.G.1,2,3, Ergakov D.V.1,2, Andronov A.S.1,2, Dutov S.V.1,2, Adilkhanov M.M.1
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Affiliations:
- GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”
- A.I. Burnazyan SRC FMBC, FMBA of Russia
- Moscow State University by Lomonosov
- Issue: No 2 (2023)
- Pages: 90-98
- Section: Endourology
- URL: https://journals.eco-vector.com/1728-2985/article/view/528313
- DOI: https://doi.org/10.18565/urology.2023.2.90-98
- ID: 528313
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Abstract
Introduction. The development and implementation in clinical practice of a 3rd generation thulium fiber laser with the possibility of computer control (modulation) of the shape, amplitude and pulse repetition rate opens up new possibilities for thulium fiber laser lithotripsy.
Aim. To carry out a comparative study of the efficacy and safety of thulium fiber laser lithotripsy using a of the 2nd (FiberLase U3) and 3rd generation devices (FiberLase U-MAX).
Materials and methods. A total of 218 patients with solitary ureteral stones, who underwent to ureteroscopy with lithotripsy using 2nd and 3rd generation thulium fiber lasers (IRE-Polus, Russia) from January 2020 to May 2022 with the same peak power (500 W), laser settings of 1 joule, 10 Hz and with a laser fiber diameter of 365 μm, were included in the prospective study. For lithotripsy using FiberLase U-MAX laser a new original modulated pulse, which was found and optimized in a preclinical study, was used. Depending on the laser, the patients were divided into 2 groups. In 111 patients, stone fragmentation was performed on FiberLase U3 (2nd generation), while 107 patients were undergone to lithotripsy on a new laser device FiberLase U-MAX (3rd generation). Stone size ranged from 6 mm to 28 mm (11±4 mm). The duration of procedure and lithotripsy, the quality of the endoscopic picture during fragmentation (from 0 to 3 points, 0-bad, 3-excellent), the frequency of retrograde migration of stones, as well as damage to ureteral mucosa (of 1-3 degrees) were evaluated.
Results. The time of lithotripsy was significantly lower in the group 2 than in the group 1 (12.3±4.6 vs. 24.7±6.2 min; p<0.05). The average quality of the endoscopic picture was significantly better in the group 2 (2.5±0.4 vs. 1.8±0.2 points; p<0.05). Clinically significant retrograde migration of stone or its fragments (the need for additional ESWL, flexible ureteroscopy) was noted in 16% vs. 8% of patients in group 1 and 2, respectively (p<0.05). Damage to ureteral mucosa of the 1st and 2nd degree due to laser exposure in the group 1 was noted in 24 (22%) and 8 (7%) cases, compared to 21 (20%) and 7 (7%) cases in group 2, respectively. Stone-free state was 84% in group 1 and 92% in group 2.
Conclusion. Modulation of the laser pulse shape allowed to improve endoscopic visibility, increase the speed of lithotripsy, reduce the frequency of retrograde stone migration without increasing the trauma to ureteral mucosa.
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About the authors
A. G. Martov
GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”; A.I. Burnazyan SRC FMBC, FMBA of Russia; Moscow State University by Lomonosov
Author for correspondence.
Email: martovalex@mail.ru
ORCID iD: 0000-0001-6324-6110
Ph.D., MD, corresponding member of RAS, Professor, Head of the Department of Urology and Andrology; Head of the urologic department No2; leading researcher at the Department of Urology and Andrology of Medical Scientific and Educational Center
Russian Federation, Moscow; Moscow; MoscowD. V. Ergakov
GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”; A.I. Burnazyan SRC FMBC, FMBA of Russia
Email: dergakov@mail.ru
ORCID iD: 0000-0003-1682-7208
Ph.D., associate professor at the Department of Urology and Andrology; urologist
Russian Federation, Moscow; MoscowA. S. Andronov
GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”; A.I. Burnazyan SRC FMBC, FMBA of Russia
Email: dr.andronov@mail.ru
ORCID iD: 0000-0002-5492-6808
Ph.D., associate professor at the Department of Urology and Andrology; urologist at the Urologic department
Russian Federation, Moscow; MoscowS. V. Dutov
GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”; A.I. Burnazyan SRC FMBC, FMBA of Russia
Email: hammerwise@gmail.com
ORCID iD: 0000-0002-5384-355X
Ph.D., assistant at the Department of Urology and Andrology; urologist at the Urologic department No2
Russian Federation, Moscow; MoscowM. M. Adilkhanov
GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow”
Email: dr.adilhanov@mail.ru
ORCID iD: 0000-0003-2282-8645
urologist at the Urologic department No2
Russian Federation, MoscowReferences
- Martov A.G., Ergakov D.V., Huseynov M.A., Andronov A.S., Dutov S.V., Vinnichenko V.A., Kovalenko A.A. Initial experience of clinical application of tulium contact lithotripsy in transurethral treatment of urolithiasis. Urology. 2018;1:112–120.
- Martov A., Ergakov D., Baykov N., Guseynov M., Andronov A., Moscow S.D. V04-11 the superpulse thulium fiber laser in the management of giant distal ureter stone. J. Urol. 2020;203(Suppl. 4):e390.
- Olympus. Superpulsed Laser System SOLTIVE Premium: Sell Sheet; S00316EN. 10/20 OEKG. 2020. Available online: https://d3a0ilwurc1bhm.-cloudfront.net/asset/084438885177/c947cc763044fc953bb2253b056edf7b (accessed on 25 October 2020).
- Martov A., Ergakov D., Guseynov M., Coninck V., Keller E., Traxer O. VS1-2 SuperPulse Thulium Fiber Laser for Ureteroscopic Lithotripsy: 1 Year Experience. J. Endourol. 2018;32:A495.
- Ergakov D., Martov A.G., Guseynov M. The Comparative Clinical Study of Ho: YAG and SuperPulse Tm Fiber Laser Lithotripters. Eur. Urol. 2018;17 Suppl:e1391.
- Traxer O., Martov A., Ergakov D., Guseynov M. V01-01 prospective transurethral lithotripsy study with superpulse TM fiber laser. J. Urol. 2019;201(Suppl. 4):e85.
- Martov A., Ergakov D., Guseynov M., Andronov A.,Plekhanova O.A. Clinical Comparison of Super Pulse Thulium Fiber Laser and High-Power Holmium Laser for Ureteral Stone Management. J. Endourol. 2020:795–800.
- Zorn K.C., Liberman D. GreenLight 180W XPS photovaporization of the prostate: how I do it. Can J Urol. 2011;18(5):5918–5926.
- Traxer O., Corrale M. Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results – A Systematic Review. J. Clin. Med. 2021;10:390. https://doi.org/ 10.3390/jcm10153390
- Khusid J.A., Khargi R., Seiden B. et al. Thulium fiber laser utilization in urological surgery: A narrative review. Investig Clin Urol. 2021;62(2): 136–147.
- Elashry O.M., Tawfik A.M. Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol. 2012;9(12):691–698.
- Corrales M., Sierra A., Traxer O. Moses and Moses 2.0 for Laser Lithotripsy: Expectations vs. Reality. J Clin Med. 2022;11(16):4828.
- Ventimiglia E., Doizi S., Kovalenko A., Andreeva V., Traxer O. Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium:YAG and super-pulse thulium fibre lasers. BJU Int. 2020;126(1):159–167.
- Ulvik Ø, Æsøy MS, Juliebø-Jones P et al. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. 2022;82(1):73–79.
- Traxer O., Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189(2):580–584.
- Okhunov Z., Jiang P., Afyouni A.S., Ayad M., Arada R., Brevik A., Akopian G., Patel R.M., Landman J., Clayman R.V. Caveat Emptor: The Heat Is «ON»-An In Vivo Evaluation of the Thulium Fiber Laser and Temperature Changes in the Porcine Kidney During Dusting and Fragmentation Modes. J Endourol. 2021;35(11):1716–1722.
- Jiang P., Okhunov Z., Afyouni A.S., Ali S.N., Sharifi H., Bhatt R., Brevik A., Ayad M., Larson K., Osann K., Patel R.M., Landman J., Clayman R. Comparison of Superpulse Thulium Fiber Laser vs. Holmium Laser for Ablation of Renal Calculi in an In-Vivo Porcine Model. J Endourol. 2022 Nov 18.
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