TY - JOUR
T1 - Thulium Fiber Laser Versus Holmium:Yttrium Aluminum Garnet for Lithotripsy
T2 - A Systematic Review and Meta-analysis
AU - Uleri, Alessandro
AU - Farré, Alba
AU - Izquierdo, Paula
AU - Angerri, Oriol
AU - Kanashiro, Andrés
AU - Balaña, Josep
AU - Gauhar, Vineet
AU - Castellani, Daniele
AU - Sanchez-Martin, Francisco
AU - Monga, Manoj
AU - Serrano, Adolfo
AU - Gupta, Mantu
AU - Baboudjian, Michael
AU - Gallioli, Andrea
AU - Breda, Alberto
AU - Emiliani, Esteban
N1 - Publisher Copyright:
© 2024 European Association of Urology
PY - 2024/6
Y1 - 2024/6
N2 - Context: Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones. Objective: To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones. Evidence acquisition: A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until May 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was to compare the stone-free rate (SFR) between Ho:YAG and TFL for laser lithotripsy. Evidence synthesis: Eleven studies met our inclusion criteria, and data from 1286 and 880 patients who underwent, respectively, Ho:YAG and TFL laser lithotripsy were reviewed. Most studies included ureteroscopy (URS) and retrograde intrarenal surgeries as procedures, two included percutaneous nephrolithotomy, and one included URS exclusively. Only two studies reported results in pediatric patients. TFL was associated with a higher SFR (odds ratio [OR] 1.84, 95% confidence interval [CI]: 1.06–3.20; p = 0.031) when no residual fragment is considered, but not when SFR refers to the presence of fragments <3 mm (OR 2.48, 95% CI: 0.98–6.29; p = 0.055) or when only Ho:YAG with MOSES is considered (p = 0.068). According to the stones’ location, TFL was associated with higher SFRs than Ho:YAG for renal (OR 3.14, 95% CI: 1.69–5.86; p < 0.001) but not for ureteral (p = 0.8) stones. TFL was associated with a lower intraoperative complication rate (OR 0.34, 95% CI: 0.19–0.63; p < 0.001). No difference was found in major (p = 0.4) or overall (p = 0.4) complication rate, operative time (p = 0.051), and laser time (p = 0.9). Conclusions: TFL is a promising laser for the treatment of urinary stones with some advantages over Ho:YAG. Further high-quality studies are needed to confirm these findings and optimize the surgical settings. Patient summary: The use of thulium fiber laser rather than holmium:yttrium aluminum garnet permits to reach a higher stone-free rate in stones located in the kidney rather than in the ureter.
AB - Context: Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones. Objective: To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones. Evidence acquisition: A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until May 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was to compare the stone-free rate (SFR) between Ho:YAG and TFL for laser lithotripsy. Evidence synthesis: Eleven studies met our inclusion criteria, and data from 1286 and 880 patients who underwent, respectively, Ho:YAG and TFL laser lithotripsy were reviewed. Most studies included ureteroscopy (URS) and retrograde intrarenal surgeries as procedures, two included percutaneous nephrolithotomy, and one included URS exclusively. Only two studies reported results in pediatric patients. TFL was associated with a higher SFR (odds ratio [OR] 1.84, 95% confidence interval [CI]: 1.06–3.20; p = 0.031) when no residual fragment is considered, but not when SFR refers to the presence of fragments <3 mm (OR 2.48, 95% CI: 0.98–6.29; p = 0.055) or when only Ho:YAG with MOSES is considered (p = 0.068). According to the stones’ location, TFL was associated with higher SFRs than Ho:YAG for renal (OR 3.14, 95% CI: 1.69–5.86; p < 0.001) but not for ureteral (p = 0.8) stones. TFL was associated with a lower intraoperative complication rate (OR 0.34, 95% CI: 0.19–0.63; p < 0.001). No difference was found in major (p = 0.4) or overall (p = 0.4) complication rate, operative time (p = 0.051), and laser time (p = 0.9). Conclusions: TFL is a promising laser for the treatment of urinary stones with some advantages over Ho:YAG. Further high-quality studies are needed to confirm these findings and optimize the surgical settings. Patient summary: The use of thulium fiber laser rather than holmium:yttrium aluminum garnet permits to reach a higher stone-free rate in stones located in the kidney rather than in the ureter.
KW - Holmium:yttrium aluminum garnet
KW - Lithotripsy
KW - Meta-analysis
KW - Outcome
KW - Percutaneous nephrolithotomy
KW - Retrograde intrarenal surgery
KW - Stone-free rate
KW - Systematic review
KW - Thulium fiber laser
KW - Ureteroscopy
UR - http://www.scopus.com/inward/record.url?scp=85185177460&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2024.01.011
DO - 10.1016/j.eururo.2024.01.011
M3 - Review article
C2 - 38290963
AN - SCOPUS:85185177460
SN - 0302-2838
VL - 85
SP - 529
EP - 540
JO - European Urology
JF - European Urology
IS - 6
ER -