Ureteroscopy with thulium fiber laser lithotripsy vs. percutaneous nephrolithotomy for the treatment of renal stones 15–20 mm
Abdulghafour Halawani1, Jessica Que1, Victor Wong1, Ben Chew1.
1Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
Introduction: Endourology has experienced revolutionary inventions in the last few decades. Thulium fiber laser (TFL) is the latest laser technology that has shown promising advantages in both pre-clinical and clinical settings, which may allow larger stones to be treated ureteroscopically. This study aimed to compare the effectiveness of TFL ureteroscopy vs. percutaneous nephrolithotomy (PCNL) in the management of renal stones 15–20 mm.
Methods: We retrospectively analyzed the medical records of 42 patients who underwent either TFL lithotripsy (n=21) or PCNL (n=21) for 15–20 mm renal stones. Stone-free rate (SFR) was assessed with one or combined imaging modalities with either non-contrast computed tomography (CT), kidney-bladder-ureter (KUB) ultrasound, or X-ray. Other variables, including operative time, stone size and density, and prior ureteral stenting, were recorded. In the case of multiple stones, the total stone surface area was measured.
Results: Characters such as patients’ age (years), prior ureteral stenting, number of stones, stone density, and total stone surface area (mm2) were similar between the groups (Table 1). The length of surgery was significantly lower in the TFL group (p=0.002) (Table 1). Compared to TFL, the PCNL group had longer hospital stays (p=0.0001) (Table 1). Our data showed no statistically significant difference in SFR between the TFL and PCNL groups.
Conclusions: This study revealed that TFL lithotripsy produced a similar SFR to PCNL, with significantly lower operative time and hospital stay. TFL can be an effective alternative to PCNL in the management of 15–20 mm renal stones; however, further randomized trials are warranted.
