Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

No AccessJournal of UrologyAdult Urology1 May 2023Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry Daniele Castellani, Khi Yung Fong, Ee Jean Lim, Ben Hall Chew, Thomas Tailly, Esteban Emiliani, Jeremy Yuen-Chun Teoh, Chu Ann Chai, Heng Chin Tiong, William Ong Lay Keat, Yiloren Tanidir, Deepak Ragoori, Andrea Benedetto Galosi, Abhishek Singh, Saeed Bin Hamri, Olivier Traxer, Bhaskar Kumar Somani, and Vineet Gauhar Daniele CastellaniDaniele Castellani *Correspondence: Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy telephone: +393471814691; E-mail Address: [email protected] https://orcid.org/0000-0001-7354-9190 Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy More articles by this author , Khi Yung FongKhi Yung Fong Yong Loo Lin School of Medicine, National University of Singapore, Singapore More articles by this author , Ee Jean LimEe Jean Lim Department of Urology, Singapore General Hospital, Singapore More articles by this author , Ben Hall ChewBen Hall Chew Department of Urology, University of British Columbia, Vancouver, Canada More articles by this author , Thomas TaillyThomas Tailly Department of Urology, University Hospital of Ghent, Ghent, Belgium More articles by this author , Esteban EmilianiEsteban Emiliani Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain More articles by this author , Jeremy Yuen-Chun TeohJeremy Yuen-Chun Teoh S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China More articles by this author , Chu Ann ChaiChu Ann Chai Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia More articles by this author , Heng Chin TiongHeng Chin Tiong Department of Urology, Ng Teng Fong General Hospital, Singapore More articles by this author , William Ong Lay KeatWilliam Ong Lay Keat Department of Urology, Penang General Hospital, Penang, Malaysia More articles by this author , Yiloren TanidirYiloren Tanidir Department of Urology, Marmara University School of Medicine, Istanbul, Turkey More articles by this author , Deepak RagooriDeepak Ragoori Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India More articles by this author , Andrea Benedetto GalosiAndrea Benedetto Galosi Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy More articles by this author , Abhishek SinghAbhishek Singh Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India More articles by this author , Saeed Bin HamriSaeed Bin Hamri 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 More articles by this author , Olivier TraxerOlivier Traxer Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France More articles by this author , Bhaskar Kumar SomaniBhaskar Kumar Somani Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom More articles by this author , and Vineet GauharVineet Gauhar Department of Urology, Ng Teng Fong General Hospital, Singapore More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003504AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression was performed to evaluate independent predictors of being stone-free. Results: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. Conclusions: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate. REFERENCES 1. . Surgical management of stones: American Urological Association/Endourological Society guideline, part I. J Urol.2016; 196(4):1153-1160. Link, Google Scholar 2. . EAU Guidelines 2022 on Urolithiasis; 2022. Accessed February 21, 2023. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urolithiasis-2022_2022-03-24-142444_crip.pdf. Google Scholar 3. . Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol.2014; 24(2):179-183. Crossref, Medline, Google Scholar 4. . Real-world global outcomes of retrograde intrarenal surgery in anomalous kidneys: a high volume international multicenter study. Urology.2022; 159:41-47. Crossref, Medline, Google Scholar 5. . Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol.2014; 33(2):257-273. Crossref, Medline, Google Scholar 6. . Is spinal anesthesia a safe alternative for retrograde intrarenal surgery for stone disease in daily practice?Arch Españoles Urol.2022; 75(4):361-367. Crossref, Medline, Google Scholar 7. . New lasers for stone treatment. Urol Clin North Am.2022; 49:1-10. Crossref, Medline, Google Scholar 8. . The future of laser technology in kidney stones. Curr Opin Urol.2022; 32(4):411-414. Crossref, Medline, Google Scholar 9. . Use of the MOSES technology to improve holmium laser lithotripsy outcomes: a preclinical study. J Endourol.2017; 31(6):598-604. Crossref, Medline, Google Scholar 10. . Stone ablation rates using innovative pulse modulation technology: vapor tunnel, virtual basket, and bubble blast. An in vitro experimental study. Lasers Surg Med.2022; 54(4):580-587. Crossref, Medline, Google Scholar 11. . Fragmentation and dusting of large kidney stones using compact, air-cooled, high peak power, 1940-nm, thulium fiber laser. Proc SPIE.2018; 10468:104680O. Google Scholar 12. . The laser of the future: reality and expectations about the new thulium fiber laser—a systematic review. Transl Androl Urol.2019; 8(S4):S398-S417. Crossref, Medline, Google Scholar 13. . Pulse-modulated holmium:YAG laser vs the thulium fiber laser for renal and ureteral stones: a single-center prospective randomized clinical trial. J Urol.2023; 209(2):374-383. Link, Google Scholar 14. . Which is the best laser for lithotripsy? Holmium laser. Eur Urol Open Sci.2022; 44:27-29. Crossref, Medline, Google Scholar 15. . Which is the best laser for lithotripsy? Thulium fiber laser. Eur Urol Open Sci.2022; 44:15-17. Crossref, Medline, Google Scholar 16. . Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR). World J Urol.2022; 41(2):567-574. Crossref, Medline, Google Scholar 17. . Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching. Am J Epidemiol.2014; 179(2):226-235. Crossref, Medline, Google Scholar 18. . Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat.2011; 10(2):150-161. Crossref, Medline, Google Scholar 19. . The R.I.R.S. scoring system: an innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery. BMC Urol.2017; 17(1):105. Crossref, Medline, Google Scholar 20. . Prestenting improves ureteroscopic stone-free rates. J Endourol.2007; 21(11):1277-1280. Crossref, Medline, Google Scholar 21. . Comparison and outcomes of dusting versus stone fragmentation and extraction in retrograde intrarenal surgery: results of a systematic review and meta-analysis. Cent Eur J Urol.2022; 75(3):317-327. Crossref, Medline, Google Scholar 22. . Efficiency of retrograde intrarenal surgery in lower pole stones: disposable flexible ureterorenoscope or reusable flexible ureterorenoscope?.Eur Urol Open Sci.2022; 39:S81-S3650. Crossref, Google Scholar 23. . What is MOSES effect: a historical perspective. J Endourol.2019; 33(5):353-357. Crossref, Medline, Google Scholar 24. . High power holmium:YAG versus thulium fiber laser treatment of kidney stones in dusting mode: ablation rate and fragment size studies. Lasers Surg Med.2019; 51(6):522-530. Crossref, Medline, Google Scholar 25. . Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol.2020; 38(2):497-503. Crossref, Medline, Google Scholar 26. . Retrograde intrarenal surgery: past, present, and future. Investig Clin Urol.2021; 62(2):121-135. Crossref, Medline, Google Scholar 27. . Computed tomography radiation dose in patients with suspected urolithiasis. JAMA Intern Med.2015; 175(8):1413-1416. Crossref, Medline, Google Scholar 28. . The 2023 stone-free CT mandate: addressing the two sides of the debate. J Endourol.2022; 36(12):1522-1525. Crossref, Medline, Google Scholar Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. AINU 08/2022). Author Contributions: VG, JY-CT, and DC conceived the study; VG and DC led the development of the manuscript; TT, EE, WOLK, CAC, HCT, YT, DR, AS, and SBH performed data acquisition; EJL and KYF performed statistics; BHC, ABG, OT, and BKS reviewed the paper for critical intellectual content; all Authors participated in manuscript writing, review, and approval of the final version of the manuscript for submission. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordslithotripsyureteroscopyurologic surgical proceduressolid-statekidney calculilaserlasersMetricsAuthor Information Daniele Castellani Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy *Correspondence: Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy telephone: +393471814691; E-mail Address: [email protected] More articles by this author Khi Yung Fong Yong Loo Lin School of Medicine, National University of Singapore, Singapore More articles by this author Ee Jean Lim Department of Urology, Singapore General Hospital, Singapore More articles by this author Ben Hall Chew Department of Urology, University of British Columbia, Vancouver, Canada More articles by this author Thomas Tailly Department of Urology, University Hospital of Ghent, Ghent, Belgium More articles by this author Esteban Emiliani Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain More articles by this author Jeremy Yuen-Chun Teoh S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China More articles by this author Chu Ann Chai Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia More articles by this author Heng Chin Tiong Department of Urology, Ng Teng Fong General Hospital, Singapore More articles by this author William Ong Lay Keat Department of Urology, Penang General Hospital, Penang, Malaysia More articles by this author Yiloren Tanidir Department of Urology, Marmara University School of Medicine, Istanbul, Turkey More articles by this author Deepak Ragoori Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India More articles by this author Andrea Benedetto Galosi Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy More articles by this author Abhishek Singh Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India More articles by this author Saeed Bin Hamri 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 More articles by this author Olivier Traxer Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France More articles by this author Bhaskar Kumar Somani Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom More articles by this author Vineet Gauhar Department of Urology, Ng Teng Fong General Hospital, Singapore More articles by this author Expand All Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. AINU 08/2022). Author Contributions: VG, JY-CT, and DC conceived the study; VG and DC led the development of the manuscript; TT, EE, WOLK, CAC, HCT, YT, DR, AS, and SBH performed data acquisition; EJL and KYF performed statistics; BHC, ABG, OT, and BKS reviewed the paper for critical intellectual content; all Authors participated in manuscript writing, review, and approval of the final version of the manuscript for submission. Advertisement PDF downloadLoading ...