Flexible Ureteroscopic Lithotripsy with the Pulsed Thulium:Yttrium Aluminum Garnet Laser Thulio: Preliminary Results from a Prospective Study

• Published in: European urology open science (Online) Vol. 67; pp. 77 - 83
• Main Authors: Proietti, Silvia, Marchioni, Michele, Oo, Mon Mon, Scalia, Riccardo, Gisone, Stefano, Monroy, Rebeca Escobar, Schips, Luigi, Gaboardi, Franco, Giusti, Guido
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2024; Elsevier
• Subjects: Endo-Urology; Endourology; Flexible ureteroscopy; Laser; Lithotripsy; Pulsed thulium:yttrium aluminum garnet; Renal stone; Ureteral stone; Flexible ureteroscopy; Renal stone; Endourology; Pulsed thulium:yttrium aluminum garnet; Laser; Lithotripsy; Ureteral stone
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2024.07.114

In this prospective study of 50 patients who underwent flexible ureteroscopy for ureteral and renal stones, the pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser Dornier Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations with longer-term follow-up using different laser sources are required to confirm both the clinical laser performance and the safety of p-Tm:YAG laser for urinary stone treatment and also potentially the superiority of this technology over the already established urology laser machines. Recently, the new pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser technology has been introduced in endourology for lithotripsy. The aim of this study was to assess and validate the clinical laser performance and safety profile of p-Tm:YAG laser in a series of patients with renal and ureteral stones who underwent flexible ureteroscopy (fURS). Prospective data were collected for patients who underwent fURS with the p-Tm:YAG laser Thulio (Dornier MedTech Systems GmbH, Wessling, Germany) at our institution by using two different laser fiber core diameters (270 and 200 μm). The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade ≥1 and the comparison between laser fibers of different diameters in all the parameters analyzed. Descriptive statistics relied on medians and interquartile ranges for continuous covariates, and on frequencies and percentages for categorical covariates. After stratification according to fiber types, differences between groups were tested with Wilcoxon and chi-square tests as appropriate. All the analyses and graphics were performed using R software (version 4.2.2). The SFR was 82% at 1-mo follow-up. In six out of 50 procedures (12%), Clavien-Dindo grade I–II complications were recorded. There were no differences regarding all the laser parameters considered between patients who were treated with 270 or 200 μm laser fibers (p > 0.05). Limitations of the study include small sample size in a single center and the lack of comparative groups. In this prospective study of 50 patients who underwent fURS for ureteral and renal stones, the p-Tm:YAG laser Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations using different laser sources are required to confirm the clinical laser performance and safety of p-Tm:YAG laser for urinary stones treatment. In this report, we looked at the outcomes for the pulsed thulium:yttrium aluminum garnet laser Dornier Thulio in patients who underwent flexible ureteroscopy for ureteral and renal stones. We found that this new laser technology is effective and safe, representing a good alternative to the other laser machines available for stone lithotripsy. We need more studies with larger populations to establish the superiority of this laser technology over the others.