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) versus pulsed Thulium:Yttrium aluminum garnet (p-Thulium:YAG) laser.
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, pre-stenting, 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.
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=0.02), while total surgical time did not differ. There was no case of blood transfusion and sepsis. Overall 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.
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.
Urology. 2025 Feb 03 [Epub ahead of print]
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
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy. Electronic address: ., Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France., Moscow Urology Center, Botkin Hospital, Moscow, Russian Federation., Department of Urology,Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation., Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India., Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.