Castellani Daniele, Fong Khi Yung, Traxer Olivier, Malkhasyan Vigen, Gadzhiev Nariman, Ragoori Deepak, Kamal Wissam, Kartalas Ioannis Goumas, Yuen Steffi Kar Kei, Somani Bhaskar Kumar, Gökce Mehmet Ilker, Gauhar Vineet
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Urology. 2025 May;199:47-53. doi: 10.1016/j.urology.2025.01.065. Epub 2025 Feb 3.
To evaluate outcomes after flexible ureteroscopy (F-URS) for renal stone(s) using a flexible and navigable suction ureteral access sheath (FANS-UAS) comparing Thulium fiber (TFL) vs pulsed Thulium:Yttrium aluminum garnet (p-Thulium:YAG) laser.
Data from adults who had F-URS in 5 centers were prospectively collected (April 2023-January 2024). All patients had a preoperative and within 30days CT scan. Stone-free: grade A: zero fragments; grade B: single fragment ≤2mm; grade C: single fragment 2.1-4mm; grade D: single/multiple fragments >4 mm. One-to-one propensity score-matching for age, gender, prestenting, stone volume, stone location, and Hounsfield units was performed. Within 6months after surgery, an intravenous urography or CT urography scan was performed in all patients.
Of 179 included patients, TFL was employed in 115 patients. After matching, 64 patients from each group with comparable baseline characteristics were included. Median lasing time was significantly longer in the TFL group (15.5 [10,23] minutes vs 13 [10,15] minutes, P=.02), while total surgical time did not differ. There was no case of blood transfusion and sepsis. Overall stone-free rate (SFR) was significantly different between the groups with a higher proportion of patients in p-Thu:YAG laser group undergoing reintervention for residual fragments (17.2% vs 3.1%). There was no case of new-onset hydronephrosis, ureteropelvic junction/ureteral stenosis, impaired urinary drainage, or altered pelvicalyceal anatomy at a median follow-up of 13weeks.
F-URS using FANS-UAS showed negligible serious adverse events and good SFR using both lasers. p-Thu:YAG laser showed shorter lasing time, marginal better grade A+B SFR but higher reintervention rate for residual fragments.
使用可弯曲且可导航的输尿管吸引鞘（FANS-UAS），比较铥光纤（TFL）与脉冲铥：钇铝石榴石（p-Thulium:YAG）激光在输尿管软镜（F-URS）治疗肾结石后的疗效。
前瞻性收集2023年4月至2024年1月期间在5个中心接受F-URS治疗的成年患者的数据。所有患者术前行CT扫描，并在术后30天内再次进行CT扫描。结石清除情况分级：A级：无碎片；B级：单个碎片≤2mm；C级：单个碎片2.1 - 4mm；D级：单个/多个碎片>4mm。对年龄、性别、术前支架置入、结石体积、结石位置和亨氏单位进行一对一倾向评分匹配。术后6个月内，所有患者均接受静脉肾盂造影或CT尿路造影扫描。
在纳入的179例患者中，115例使用了TFL。匹配后，每组各有64例具有可比基线特征的患者。TFL组的中位激光照射时间显著更长（15.5[10,23]分钟 vs 13[10,15]分钟，P = 0.02），而总手术时间无差异。无输血和败血症病例。两组的总体结石清除率（SFR）有显著差异，p-Thu:YAG激光组因残留碎片接受再次干预的患者比例更高（17.2% vs 3.1%）。在中位随访13周时，无新发肾积水、输尿管肾盂连接部/输尿管狭窄、尿路引流受损或肾盂肾盏解剖结构改变的病例。
使用FANS-UAS的F-URS显示，两种激光治疗的严重不良事件均可忽略不计，且结石清除率良好。p-Thu:YAG激光的激光照射时间较短，A + B级结石清除率略好，但残留碎片的再次干预率较高。
