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ORIGINAL ARTICLE
Minerva Pediatrics 2023 Oct 31
DOI: 10.23736/S2724-5276.23.07392-5
Copyright © 2023 EDIZIONI MINERVA MEDICA
language: English
Comparing outcomes of thulium fiber laser versus high-power Holmium:YAG laser lithotripsy in pediatric patients managed with RIRS for kidney stones. A multicenter retrospective study
Luigi CANDELA 1, 2 ✉, Catalina SOLANO 2, Daniele CASTELLANI 3, Jeremy Y. TEOH 4, Yiloren TANIDIR 5, Khi Y. FONG 6, Chandramohan VADDI 7, Mriganka MANI SINHA 8, Deepak RAGOORI 9, Bhaskar K. SOMANI 8, Olivier TRAXER 2, Vineet GAUHAR 10
1 Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy; 2 Hôpital Tenon AP-HP, Sorbonne University, Paris, France; 3 Unit of Urology, Azienda Ospedaliero Universitaria delle Marche, Marche Polytechnic University, Ancona, Italy; 4 S.H. Ho Urology Center, The Chinese University of Hong Kong (CUHK), Hong Kong, China; 5 Unit of Urology, Marmara University Pendik Research and Education Hospital, Istanbul, Türkiye; 6 National University Hospital (NUH), Singapore, Singapore; 7 Preeti Urology and Kidney Hospital, Telangana, India; 8 University Hospital Southampton NHS Foundation Trust, Southampton, UK; 9 Asian Institute of NephroUrology, Hyderabad, India; 10 Division of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
BACKGROUND: The aim of this study was to evaluate thulium fiber laser (TFL) safety and efficacy compared to high-power (HP) Holmium:YAG laser in pediatric patients who have undergone retrograde intrarenal surgery (RIRS) for kidney stones.
METHODS: We retrospectively reviewed data from pediatric patients who underwent RIRS for kidney stones between 2018 and 2020. Complications were assessed 4-6 weeks postoperatively. Stone-free (SF) was defined as the absence of visible fragments or as the presence of a single residual fragment ≤2 mm at 3 months postoperative imaging. Student’s t-test for continuous variables, and χ2 and Fisher’s Exact Test for categorical variables were used to compare outcomes between patients treated with HP Holmium:YAG (group 1) and TFL (group 2). Univariate (UVA) and multivariate (MVA) logistic regression analyses were performed to predict SF-associated factors.
RESULTS: Data from 126 pediatric patients were analyzed, 97 in group 1 and 29 in group 2. Preoperative characteristics were similar between cohorts. No major complication occurred in both groups. Group 2 had a shorter operative time (mean time 49.5 vs. 64.3 min, P=0.024). SF rate was 81.4% and 89.7% (P=0.45) and reintervention rate was 14.4% and 6.89% (P=0.046) in group 1 and 2, respectively. At UVA and MVA, the type of laser did not influence SF rate. However, prestenting and single stones were positively associated with SR rate.
CONCLUSIONS: Both laser technologies are safe and effective and showed similar SF rates. TFL showed less operative time and lower re-intervention rate compared to HP Holmium:YAG. Further prospective studies are needed to corroborate our findings.
KEY WORDS: Lithotripsy, laser; Urology; Pediatrics