Vaddi Chandra Mohan, Ramakrishna Paidakula, Ganeshan Soundarya, Swamy Siddalinga, Anandan Hemnath, Babu Manas, Panda Rakesh
Department of Urology, Preeti Urology and Kidney Hospital, Remedy Hospital LN, Hyderabad, Telangana, India.
Indian J Urol. 2022 Jul-Sep;38(3):191-196. doi: 10.4103/iju.iju_60_22. Epub 2022 Jul 1.
Our aim is to evaluate the clinical efficiency and safety of 60W Thulium fiber laser (TFL) during retrograde intrarenal surgery (RIRS). The performance of the TFL across different ranges of stone volumes and stone densities is assessed.
Between October 2019 and August 2020, a prospective study was done on 135 patients with < 20 mm renal stones, who underwent RIRS using TFL. Stone parameters, total laser time, total energy delivered (kJ), and fiber burn-back were recorded. Laser efficacy (J/mm) and ablation speed (mm/s) were calculated.
Data of 126 of 135 patients included in the study were analyzed. The mean patient age was 45.04 ± 12.30 years. Mean stone size was 15.19 ± 4.52 mm, and mean stone volume was 1061.85 ± 806.81 mm. Mean laser time was 19.78 ± 12.32 min. At higher stone volume (>1000 mm), J/mm decreased significantly from 16.18 ± 5.90 to 10.92 ± 3.21 ( < 0.001) and the ablation speed increased significantly (0.77 ± 0.28-1.04 ± 0.28 mm/s [ < 0.001]). Stone density did not have a significant influence on the laser efficacy [B = -0.31 (-2.45 to 1.82, p=0.771)] or on the ablation speed [B = -0.06 (-0.17 to 0.05, p=0.278)]. Overall SFR was 93.6%. The complication rate was 16.6% (21/126). Out of the 21, 12 patients had hematuria and 9 had fever, which were of Clavien grades 1-2.
Superpulse TFL is efficient and safe. The work efficiency increases for larger volume stones. The work efficiency remains the same across different stone densities. No complication more than Clavien grade 2 was encountered.
我们的目的是评估60W铥光纤激光（TFL）在逆行性肾内手术（RIRS）中的临床有效性和安全性。评估了TFL在不同结石体积和结石密度范围内的性能。
2019年10月至2020年8月，对135例肾结石<20mm的患者进行了前瞻性研究，这些患者接受了使用TFL的RIRS。记录结石参数、总激光时间、总能量（kJ）和光纤烧蚀情况。计算激光效能（J/mm）和消融速度（mm/s）。
对研究纳入的135例患者中的126例数据进行了分析。患者平均年龄为45.04±12.30岁。平均结石大小为15.19±4.52mm，平均结石体积为1061.85±806.81mm。平均激光时间为19.78±12.32分钟。在结石体积较大（>1000mm）时，J/mm从16.18±5.90显著降至10.92±3.21（<0.001），消融速度显著增加（0.77±0.28 - 1.04±0.28mm/s [<0.001]）。结石密度对激光效能[B = -0.31（-2.45至1.82，p = 0.771）]或消融速度[B = -0.06（-0.17至0.05，p = 0.278）]没有显著影响。总体结石清除率（SFR）为93.6%。并发症发生率为16.6%（21/126）。在这21例中，12例患者出现血尿，9例患者发热，均为Clavien 1 - 2级。
超脉冲TFL有效且安全。结石体积较大时工作效率提高。不同结石密度下工作效率保持不变。未遇到超过Clavien 2级的并发症。
