Spinos Theodoros, Somani Bhaskar K, Tatanis Vasileios, Skolarikos Andreas, Tokas Theodoros, Knoll Thomas, Peteinaris Angelis, Vagionis Athanasios, Liatsikos Evangelos, Kallidonis Panagiotis
Department of Urology, University of Patras Hospital, 26504, Patras, Greece.
European Association of Urology Endourology Section, Arnhem, The Netherlands.
World J Urol. 2024 Dec 16;43(1):34. doi: 10.1007/s00345-024-05408-0.
Optimal laser settings during endoscopic stone disease management still represents a debatable issue. The aim of this systematic review is to summarize all existing evidence regarding the comparison of high-power (HP) versus low-power (LP) laser settings during different endoscopic lithotripsy procedures.
PubMed, Scopus and Cochrane databases were systematically screened, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All endoscopic laser lithotripsy surgical approaches were included, including ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and transurethral lithotripsy for bladder stones. Pediatric patients were also included.
In total, 10 studies met the inclusion criteria and were included in final qualitative synthesis. In most studies total operative time (OT) was shorter for the HP group. Mean fragmentation time was homogenously significantly shorter in the HP group. Stone-free rates (SFR) ranged from 59.0% to 100% for the LP group and from 78.9% to 100% for the HP group. Total complication rates were higher for the LP group in six studies, equivalent between the two groups in one study and higher in the HP group in one study.
HP laser lithotripsy is a safe and efficient approach for URS, RIRS, PCNL and cystolithotripsy. HP laser settings were associated with significantly shorter total operative time, while some studies reported also better SFR in the HP groups. The implementation of more Randomized Controlled Trials comparing HP and LP laser lithotripsy in different stone settings is of outmost importance, so that better conclusions can be drawn.
内镜下结石病治疗过程中的最佳激光设置仍是一个有争议的问题。本系统评价的目的是总结所有现有证据，以比较不同内镜碎石手术中高功率（HP）与低功率（LP）激光设置的效果。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对PubMed、Scopus和Cochrane数据库进行系统筛选。纳入所有内镜激光碎石手术方法，包括输尿管镜检查（URS）、逆行肾内手术（RIRS）、经皮肾镜取石术（PCNL）和经尿道膀胱结石碎石术。儿科患者也被纳入。
共有10项研究符合纳入标准并被纳入最终的定性综合分析。在大多数研究中，HP组的总手术时间（OT）较短。HP组的平均碎石时间总体上显著更短。LP组的结石清除率（SFR）在59.0%至100%之间，HP组在78.9%至100%之间。在6项研究中，LP组的总并发症发生率更高，1项研究中两组相当，1项研究中HP组更高。
HP激光碎石术是URS、RIRS、PCNL和膀胱结石碎石术的一种安全有效的方法。HP激光设置与显著更短的总手术时间相关，同时一些研究报告HP组的SFR也更好。开展更多比较不同结石情况下HP和LP激光碎石术的随机对照试验至关重要，以便能得出更好的结论。
