Jahrreiss Victoria, Ripa Francesco, Cerrato Clara, Nedbal Carlotta, Pietropaolo Amelia, Somani Bhaskar
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
University Hospital Southampton NHS Trust, Southampton, UK.
Ther Adv Urol. 2024 Aug 20;16:17562872241272974. doi: 10.1177/17562872241272974. eCollection 2024 Jan-Dec.
In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies.
Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4-1 J, 20-40 Hz) with dusting and pop-dusting technique. The independent -test, Mann-Whitney test, and Chi-squared test were used, with a -value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis.
A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, = 0.42), pre-stenting (37% and 35%, = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, = 0.73), and ureteral access sheath use (37% and 35%, = 0.77) respectively.While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%.
While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes.
体外研究表明，钬激光调制光学增强系统（MOSES）技术可提高碎石效率并减少结石回推，但与非MOSES技术相比的临床证据仍然匮乏。我们对采用MOSES技术的钬激光与非MOSES技术在输尿管镜检查和激光碎石术（URSL）中的应用进行了比较。
前瞻性收集并分析患者数据及结果，包括患者人口统计学信息、结石参数和临床结局。将采用无MOSES技术的标准钬激光进行URSL的患者（第1组）与采用MOSES技术的钬激光患者（第2组）进行比较，两组使用相同的临床激光参数设置（0.4 - 1焦耳，20 - 40赫兹），并采用粉末化和爆破粉末化技术。使用独立样本t检验、曼 - 惠特尼U检验和卡方检验，P值<0.05为有统计学意义。鉴于队列规模不同，我们进行了倾向得分1:1匹配分析。
共分析了206例患者（1:1匹配）（男性94例，女性112例），中位年龄56岁（范围：39 - 68岁）。第1组和第2组在输尿管结石方面匹配（分别为27.7%和22.3%，P = 0.42），术前置管情况匹配（分别为37%和35%，P = 0.66），结石平均数量匹配（分别为1.76 ± 1.3和1.82 ± 1.4，P = 0.73），输尿管通路鞘使用情况匹配（分别为37%和35%，P = 0.77）。虽然临床结局无显著统计学差异，但第2组结石尺寸略大，为14.8 ± 10.8毫米，而第1组为11.7 ± 8.0毫米；第2组手术时间更短，为42.7 ± 30.6分钟，而第1组为48.5 ± 25分钟；第2组围手术期并发症发生率更低，为3.9%，而第1组为4.9%；第2组结石清除率更高，为90.3%，而第第1组为87.4%。
虽然MOSES技术在临床结局方面对结石治疗略有益处，但无统计学意义。随着这场争论的持续，需要高质量的随机研究来表明这些结局是否存在真正差异。
