Division of Urology, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan.
Investig Clin Urol. 2024 Sep;65(5):451-458. doi: 10.4111/icu.20240185.
Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there's no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice.
Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR).
A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds.
Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.
传统上，由于安全问题，双侧尿路结石的治疗需要分阶段进行干预。最近的研究表明，同期双侧经皮肾镜取石术（SSB-RIRS）是有效的，并发症发生率可以接受。然而，对于该手术，哪种激光最优还没有明确的数据。本研究旨在评估在多中心真实环境中使用钬激光（TFL）和大功率钬：钇-铝石榴石（Ho:YAG）激光进行 SSB-RIRS 的结果。
对 2015 年 1 月至 2022 年 6 月期间在全球 21 个中心接受 SSB-RIRS 的患者进行回顾性分析。记录围手术期和术后 3 个月的结果，重点关注并发症和结石清除率（SFR）。
共纳入 733 例患者，其中 415 例患者在第 1 组（Ho:YAG），318 例患者在第 2 组（TFL）。两组患者的人口统计学和结石特征相似。第 1 组有更多的症状性疼痛或血尿发生率（26.5% vs. 10.4%）。手术和激光时间相当。第 1 组使用篮筐的比例更高（47.2% vs. 18.9%，p<0.001）。术后并发症和住院时间相似。第 2 组双侧总体 SFR 更高。多变量回归分析表明，年龄、下极结石存在和结石直径与双侧结石清除率降低相关，而 TFL 与更高的结石清除率相关。
我们的研究表明，泌尿科医生在 SSB-RIRS 中平等使用这两种激光。再次干预率低，安全性相似，在某些情况下，单阶段双侧 SFR 可能更好。双侧下极和大体积结石有更高的残留结石碎片的可能性。
