Sánchez-Puy Antoni, Bravo-Balado Alejandra, Diana Pietro, Baboudjian Michael, Piana Alberto, Girón Irene, Kanashiro Andrés K, Angerri Oriol, Contreras Pablo, Eisner Brian H, Balañà Josep, Sánchez-Martín Francisco M, Millán Félix, Palou Joan, Emiliani Esteban
Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain.
Department of Surgery, Universistat Autònoma de Barcelona, 08193 Barcelona, Spain.
J Clin Med. 2022 Jun 4;11(11):3208. doi: 10.3390/jcm11113208.
(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta's, 1 Dornier MedTech's, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.
(1) 背景：钬激光中的新型脉冲调制（PM）技术可用于治疗尿路结石，但人们对其了解甚少。我们旨在系统评估已发表的关于其碎石性能的证据。(2) 方法：进行了系统的电子检索（MEDLINE、Scopus和Cochrane数据库）。我们纳入了所有相关出版物，包括随机对照试验、非随机对照和非对照研究，以及调查采用任何新型PM的钬激光碎石性能的体外研究。(3) 结果：初步检索得到203项研究；筛选后纳入24项研究：15项体外研究，9项体内研究。10项体外研究比较了摩西模式与常规PM，1项比较了Quanta模式，1项比较了多尼尔医疗技术公司的模式，2项比较了摩西模式与超级铥光纤激光，1项比较了摩西模式与Quanta PM。七项比较研究中有六项发现，在手术时间方面，新一代PM技术具有统计学显著差异，六项中有五项在碎石时间方面有显著差异；两项研究评估了结石回推情况，均支持新一代技术。对数据进行荟萃分析时，摩西模式与常规PM在无石率、激光发射和手术时间以及并发症方面无统计学显著差异。(4) 结论：在体外研究中，摩西PM似乎比常规模式具有更好的碎石性能，但对其体内结果仍存在一些疑问。对其他PM了解甚少。尽管一些结果支持Quanta PM，但仍需要进一步研究。
