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.
Journal of endourology. 2024 Dec 16 [Epub ahead of print]
Vineet Gauhar, Olivier Traxer, Khi Yung Fong, Christian Sietz, Ben Hall Chew, Saeed Bin Hamri, Mehmet Ilker Gökce, Nariman Gadzhiev, Steffi Kar Kei Yuen, Vigen Malkhasyan, Deepak Ragoori, Yiloren Tanidir, Bhaskar Kumar Somani, Daniele Castellani
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France., Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Department of Urology Medical, University of Vienna, Vienna, Austria., Department of Urology, University of British Columbia, Vancouver, Canada., Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation., SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Endourological Department, A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation., Department of Urology, Asian Institute of Nephrology & Urology, Telangana, India., Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy.