Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: A single-center experience.

OBJECTIVES: To estimate the efficacy and safety of SuperPulsed thulium-fiber laser ureteral lithotripsy and to identify optimal laser settings. METHODS: Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium-fiber laser (NTO IRE-Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser-on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three-point Likert scale. Complications were assessed using the Clavien-Dindo classification system. RESULTS: A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94-357) mm3 . The median (interquartile range) total energy was 1 (0.4-2) kJ, and laser-on time 1.2 (0.5-2.7) min. The median (interquartile range) stone ablation speed was 140 (80-279) mm3 /min, energy for ablation of 1 mm3 was 5.6 (3-9.9) J/mm3 and energy consumption was 0.9 (0.6-1) J/min. A correlation was found between retropulsion and the energy used (r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6-2774.1; P = 0.028). No predictors for worse visibility were identified. CONCLUSION: The SuperPulsed thulium-fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting.

Superpulsed Thulium Fiber Laser for Stone Dusting: In Search of a Perfect Ablation Regimen-A Prospective Single-Center Study.

Objective: To compare the efficacy of the standard and higher frequency regimens for superpulsed thulium fiber laser (SP TFL) retrograde intrarenal surgery (RIRS). Materials and Methods: A prospective study of patients with renal calculi of 10-30 mm was performed. For RIRS, we used the SP TFL (NTO IRE-Polus, Russia) and a 9.5F flexible ureteroscope with 270° deflection and 3.6F working channel. Retropulsion and visibility were assessed based on the surgeon's feedback using three-point Likert scales. The stone-free rate was assessed at 3 months with CT. Results: A total of 40 patients were included in the study with a mean age of 56 years, mean stone density of 880 ± 381 HU, mean stone size of 16.5 ± 6.8 mm, and median stone volume of 883 (interquartile range 606-1664) mm3. Both ablation efficacy and speed were higher in the 200-Hz mode (2.7 J/mm3vs 3.8 J/mm3 and 5.5 mm3/second vs 8.0 mm3/second, respectively); moreover, the higher frequency correlated with increased ablation speed (r = -0.21, p = 0.019). However, both increased energy and frequency did not lead to increase of laser-on time or intraoperative complication rates. Conclusions: SP TFL is able to effectively disintegrate stones during RIRS with minimal complication rates. The use of higher frequency regimens showed higher efficacy and ablation speed and was not associated with increased complication rates.

Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy.

PURPOSE: To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL). METHODS: Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire. RESULTS: A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases. CONCLUSIONS: TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.