Top

Published in:

01-02-2020 | Urolithiasis | Original Article

Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 μm holmium laser for nephrolithiasis: a prospective, randomized, controlled trial

Authors: Pei Lu, Keliang Chen, Zijie Wang, Rijin Song, Jiexiu Zhang, Bianjiang Liu, Guohua Zeng, Zengjun Wang, Wei Zhang, Min Gu

Published in: World Journal of Urology | Issue 2/2020

Abstract

Purpose

To compare the clinical efficacy and safety between the FURL with 365 μm and 200 μm holmium laser for treating nephrolithiasis.

Materials and methods

A prospective randomized controlled trial was performed including analysis of data from 200 patients with nephrolithiasis. A total of 180 patients were randomized into two groups according to 1:1 ratio. In the 365 μm holmium laser group, kidney stones were disintegrated into less than 2 mm fragments with a 365 µm holmium laser fiber with the settings of 30–45 W under direct visualization; in the control group, the conventional 200 μm holmium laser was used. Descriptive statistics and logistic regression analyses tested the association among operation time, stone-free rate (SFR) and incidence of complications.

Results

Operation time in the FURL with 365 μm laser was significantly shortened and no significance was observed in the complication rate. Stone size and location were identified as two major confounding factors for the operation time and SFR. Moreover, the FURL using 365 μm laser showed less operation time for renal stones with the diameter between 1 and 2 cm, stones located in lower calyx and multiple calculi; stones larger than 2 cm and/or located in lower pole inclined to present better SFR using the FURL with 365 μm laser.

Conclusions

The FURL combined with 365 μm holmium laser is safer and highly efficacious for the management of nephrolithiasis when compared to conventional FURL procedures, especially for those located in lower pole and larger than 2 cm.

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482CrossRef

Kirac M, Bozkurt OF, Tunc L, Guneri C, Unsal A, Biri H (2013) Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm. Urolithiasis 41(3):241–246CrossRef

Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American urological association/endourological society guideline. Part I. J Urol 196(4):1153–1160CrossRef

Desai J, Zeng G, Zhao Z, Zhong W, Chen W, Wu W (2013) A novel technique of ultra-mini-percutaneous nephrolithotomy: introduction and an initial experience for treatment of upper urinary calculi less than 2 cm. Biomed Res Int 2013:490793CrossRef

Turk C (2016) Urolithiasis guidelines: retrospective view and perspectives. UrolA. 55(10):1317–1320CrossRef

Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS et al (2005) Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173(6):1991–2000CrossRef

Khemees TA, Shore DM, Antiporda M, Teichman JM, Knudsen BE (2013) Evaluation of a new 240-µm single-use holmium:YAG optical fiber for flexible ureteroscopy. J Endourol Endourol Soc 27(4):475–479CrossRef

Resorlu B, Oguz U, Resorlu EB, Oztuna D, Unsal A (2012) The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology 79(1):61–66CrossRef

Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ et al (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63(8):e1–e37CrossRef

10.

Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23(6):478–480CrossRef

11.

Ghani KR, Wolf JS Jr (2015) What is the stone-free rate following flexible ureteroscopy for kidney stones? Nat Rev Urol 12(5):281–288CrossRef

12.

Dauw CA, Simeon L, Alruwaily AF, Sanguedolce F, Hollingsworth JM, Roberts WW et al (2015) Contemporary practice patterns of flexible ureteroscopy for treating renal stones: results of a Worldwide Survey. J Endourol Endourol Soc 29(11):1221–1230CrossRef

13.

Huang Z, Fu F, Zhong Z, Zhang L, Xu R, Zhao X (2012) Flexible ureteroscopy and laser lithotripsy for bilateral multiple intrarenal stones: is this a valuable choice? Urology 80(4):800–804CrossRef

14.

Bariani GM, de Celis Ferrari AC, Precivale M, Arai R, Saad ED, Riechelmann RP (2015) Sample size calculation in oncology trials: quality of reporting and implications for clinical cancer research. Am J Clin Oncol 38(6):570–574CrossRef

15.

Baghdadi M, Emiliani E, Talso M, Servian P, Barreiro A, Orosa A et al (2017) Comparison of laser fiber passage in ureteroscopic maximum deflection and their influence on deflection and irrigation: do we really need the ball tip concept? World J Urol 35(2):313–318CrossRef

16.

Vassar GJ, Teichman JM, Glickman RD (1998) Holmium: YAG lithotripsy efficiency varies with energy density. J Urol 160(2):471–476CrossRef

17.

Spore SS, Teichman JM, Corbin NS, Champion PC, Williamson EA, Glickman RD (1999) Holmium: YAG lithotripsy: optimal power settings. J Endourol Endourol Soc 13(8):559–566CrossRef

18.

Hu H, Lu Y, He D, Cui L, Zhang J, Zhao Z et al (2016) Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly. Urolithiasis 44(5):427–434CrossRef

19.

Yang J, Tao RZ, Lu P, Chen MX, Huang XK, Chen KL et al (2018) Efficacy analysis of self-help position therapy after holmium laser lithotripsy via flexible ureteroscopy. BMC Urol 18(1):33CrossRef

Title: Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 μm holmium laser for nephrolithiasis: a prospective, randomized, controlled trial
Authors: Pei Lu
Keliang Chen
Zijie Wang
Rijin Song
Jiexiu Zhang
Bianjiang Liu
Guohua Zeng
Zengjun Wang
Wei Zhang
Min Gu
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Urolithiasis
Laser
Published in: World Journal of Urology / Issue 2/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02776-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 μm holmium laser for nephrolithiasis: a prospective, randomized, controlled trial

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2020

A modified technique for intralesional injection of collagenase Clostridium histolyticum for Peyronie’s disease results in reduced procedural morbidity using a standardized hematoma classification rubric

Sixty years in the making: collagenase Clostridium histolyticum, from benchtop to FDA approval and beyond

Management of Peyronie’s disease with collagenase Clostridium histolyticum in the acute phase

The clinicopathological characteristics and prognostic value of squamous differentiation in patients with bladder urothelial carcinoma: a meta-analysis

Evolution of the surgical sealing patch TachoSil® in Peyronie’s disease reconstructive surgery: technique and contemporary literature review

The prognostic impact of hexaminolevulinate-based bladder tumor resection in patients with primary non-muscle invasive bladder cancer treated with radical cystectomy