Bulut Ender Cem, Karabacak Nihat, Teke İrem Aleyna, Çetin Serhat, Küpeli Bora
School of Medicine, Gazi University, Ankara, Turkey.
Lasers Med Sci. 2025 Oct 20;40(1):447. doi: 10.1007/s10103-025-04686-3.
Laser lithotripsy, which is widely applied in treating urinary system stones, presents difficulties such as stone migration due to retropulsion, especially in upper ureteral stones. This study aims to compare the stone migration rates of conventional Holmium:YAG (Ho:YAG), pulse modulated Ho:YAG, and Thulium Fiber Laser (TFL) in patients undergoing laser lithotripsy. A retrospective analysis of 455 patients who underwent laser lithotripsy for upper ureteral stones between 01.01.2021 and 01.06.2025 at a tertiary hospital was conducted. The cohort was divided into three groups based on the laser used: conventional 30 W Ho:YAG (Group A), pulse-modulated 65 W Ho:YAG (Group B), and TFL (Group C). Data on stone migration, operation time, laser-on time, and stone-free rates (SFR) were collected and analyzed. Significant differences in stone migration rates were observed, with Group C showing the lowest migration rate (7.8%) compared to Groups A (28.9%) and B (16.8%) (p < 0.001). TFL also resulted in significantly higher SFRs (97.1%) compared to conventional Ho:YAG laser (86.8%) (p = 0.002). Additionally, TFL reduced the need for auxiliary procedures, with only 2.9% of patients requiring flexible ureteroscopy, compared to 12.2% in Group A and 9.7% in Group B (p = 0.032). TFL significantly reduces stone migration and improves stone-free rates compared to conventional and pulse-modulated Ho:YAG lasers. Its clinical and economic benefits, including reduced need for auxiliary procedures and shorter operation times, suggest TFL as a promising alternative for upper ureteral stone treatment. Further large-scale, prospective studies are needed to validate these findings.
激光碎石术在泌尿系统结石治疗中应用广泛，但存在诸如因结石回推导致的结石移位等困难，尤其是在上段输尿管结石治疗中。本研究旨在比较接受激光碎石术的患者中，传统钬激光（Ho:YAG）、脉冲调制钬激光和铥光纤激光（TFL）的结石移位率。对一家三级医院在2021年1月1日至2025年6月1日期间接受上段输尿管结石激光碎石术的455例患者进行了回顾性分析。根据所使用的激光将队列分为三组：传统30W钬激光（A组）、脉冲调制65W钬激光（B组）和铥光纤激光（C组）。收集并分析了结石移位、手术时间、激光照射时间和结石清除率（SFR）的数据。观察到结石移位率存在显著差异，C组的移位率最低（7.8%），而A组为（28.9%），B组为（16.8%）（p＜0.001）。与传统钬激光（86.8%）相比，铥光纤激光的结石清除率也显著更高（97.1%）（p = 0.002）。此外，铥光纤激光减少了辅助手术的需求，只有2.9%的患者需要软性输尿管镜检查，而A组为12.2%，B组为9.7%（p = 0.032）。与传统和脉冲调制钬激光相比，铥光纤激光显著降低了结石移位并提高了结石清除率。其临床和经济效益，包括减少辅助手术需求和缩短手术时间，表明铥光纤激光是上段输尿管结石治疗的一种有前景的替代方法。需要进一步的大规模前瞻性研究来验证这些发现。
