Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Eur Urol. 2024 Jun;85(6):529-540. doi: 10.1016/j.eururo.2024.01.011. Epub 2024 Jan 29.
Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones.
To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones.
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.
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).
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.
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.
铥光纤激光（TFL）作为钬：钇铝石榴石（Ho：YAG）激光治疗尿路结石的竞争者出现。
比较 Ho：YAG 和 TFL 激光碎石术治疗肾结石和输尿管结石的疗效。
使用 PubMed/Medline、Embase 和 Web of Science 数据库进行文献检索，以确定截至 2023 年 5 月发表的报告。遵循系统评价和荟萃分析的首选报告项目，以确定合格的研究。主要结局是比较 Ho：YAG 和 TFL 激光碎石术的结石清除率（SFR）。
11 项研究符合纳入标准，分别对 1286 例和 880 例接受 Ho：YAG 和 TFL 激光碎石术的患者进行了数据分析。大多数研究包括输尿管镜检查（URS）和逆行性肾内手术，两项研究包括经皮肾镜取石术，一项研究仅包括 URS。只有两项研究报告了儿科患者的结果。当不考虑残留碎片时，TFL 与更高的 SFR（比值比 [OR] 1.84，95%置信区间 [CI]：1.06-3.20；p=0.031）相关，但当 SFR 指存在 <3mm 的碎片时（OR 2.48，95%CI：0.98-6.29；p=0.055）或仅考虑使用 MOSES 的 Ho：YAG 时（p=0.068）则不然。根据结石位置，TFL 与 Ho：YAG 相比，在治疗肾结石时具有更高的 SFR（OR 3.14，95%CI：1.69-5.86；p<0.001），但在治疗输尿管结石时则不然（p=0.8）。TFL 与较低的术中并发症发生率（OR 0.34，95%CI：0.19-0.63；p<0.001）相关。在主要（p=0.4）或总体（p=0.4）并发症发生率、手术时间（p=0.051）和激光时间（p=0.9）方面，没有差异。
TFL 是一种有前途的治疗尿路结石的激光，与 Ho：YAG 相比具有一些优势。需要进一步的高质量研究来证实这些发现并优化手术设置。
与钬：钇铝石榴石相比，使用铥光纤激光可提高肾结石（而非输尿管结石）的结石清除率。
