Enikeev Dmitry, Herrmann Thomas R W, Taratkin Mark, Azilgareeva Camilla, Borodina Anastasia, Traxer Olivier
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Curr Opin Urol. 2023 Mar 1;33(2):95-107. doi: 10.1097/MOU.0000000000001057. Epub 2022 Oct 21.
To review and summarize preclinical and clinical data on thulium fiber laser's (TFL) effectiveness (ablation rate, stone-free rate etc.) and safety in terms of laser injuries and thermal damage. This enables us to assess how the in-vitro evidence translates into the clinical real-life scenario.
In this analysis, a total of 21 preclinical trials have been included. Most of the trials use conventional Holmium:YAG laser as a comparator, with only a few assessing lasers with pulse modulation. Most of the trials focus on the superior ablation rate and superior dusting features of TFL, as well as comparison of retropulsion (both in conventional Ho:YAG and in a pulse modulation), with a few studies assessing safety aspects. A total of 13 trials assessed TFL, clinically, in percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The clinical data obtained suggest that lithotripsy by TFL is safe, facilitates effective stone fragmentation, and results in a reduction of retropulsion. Unfortunately, most of the clinical trials lack a direct comparator, and so no clear-cut comparisons are possible.
During in-vitro studies, TFL demonstrated to be a new energy source with a great potential for improved ablation, lower retropulsion and improved dusting. These claims are supported in contemporary clinical studies, reporting superior ablation and negligible retropulsion in both PCNL and RIRS. However, it should be noted that the data regarding clinical results compared with conventional Ho:YAG is still limited.
回顾并总结有关铥光纤激光（TFL）有效性（消融率、无石率等）以及激光损伤和热损伤方面安全性的临床前和临床数据。这使我们能够评估体外证据如何转化为临床实际情况。
在本次分析中，共纳入了21项临床前试验。大多数试验使用传统钬激光（Ho:YAG）作为对照，只有少数试验评估了具有脉冲调制的激光。大多数试验关注TFL的卓越消融率和出色的粉末化特性，以及反冲比较（包括传统Ho:YAG和脉冲调制），少数研究评估了安全方面。共有13项试验在经皮肾镜取石术（PCNL）和逆行肾内手术（RIRS）中对TFL进行了临床评估。获得的临床数据表明TFL碎石术是安全的，有助于有效碎石，并减少反冲。不幸的是，大多数临床试验缺乏直接对照物，因此无法进行明确的比较。
在体外研究中，TFL被证明是一种具有巨大潜力的新能源，可改善消融、降低反冲并改善粉末化。当代临床研究支持了这些说法，报告了PCNL和RIRS中卓越的消融和可忽略不计的反冲情况。然而，应注意与传统Ho:YAG相比有关临床结果的数据仍然有限。
