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Objective To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. Materials and methods From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3–4 weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. Results The success rate was higher in the ureteroscopy group than in the SWL group ( p  = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group ( p  = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group ( p  = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30 h in the ureteroscopy group. SWL was performed without the need for hospital admission. Conclusion Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

To investigate the feasibility of conventional (basketing + dusting) and Moses (pop-dusting) holmium lasers during flexible ureteroscopy (FURS) in the treatment of 2–3 cm renal calculi and to compare the efficiency and safety of the two methods, a total of 230 patients with 2–3 cm kidney stones who underwent FURS were randomly divided into the conventional group and the Moses group. The mode of lithotripsy in the conventional group was fragmentation and dusting. The mode of lithotripsy in the Moses group was dusting and pop-dusting. Clinical and perioperative variables and complications were compared between the two cohorts. Multivariate analyses of factors contributing to the stone-free rate (SFR) and operation time were performed. No statistically significant differences were found in the demographics, renal stone-related data, SFR, or complications between the cohorts. The laser energy was higher in the Moses cohort than in the conventional cohort (119.3 ± 15.2 vs. 92.8 ± 15.1 kJ; P < 0.001), and the operation time was shorter in the Moses cohort than in the conventional cohort (99.5 ± 18.9 vs. 105.3 ± 13.7 min; P = 0.009). When there was isolated stone, the operation time was shorter in the Moses cohort than in the conventional cohort (99.6 ± 17.5 vs. 111.4 ± 10.7 min; P < 0.001), while there was no significant difference between the two cohorts when there were multiple stones (99.5 ± 20 vs. 101.2 ± 14 min; P = 0.415). Multivariate analyses found that an increase in stone volume can decrease the SFR and prolong the operation time, and use of a Moses laser can shorten the operation time. Both holmium laser modes during FURS can effectively treat 2–3 cm renal calculi. The Moses mode is recommended as the first choice for the treatment of isolated 2–3 cm renal stones. When treating multiple stones, the efficiency of these two laser modalities is the same.Trial registrationChiCTR2200056091

This study aims to compare the efficacy of ureteroscopy with holmium laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculus (UC). We enrolled 86 patients with UC treated in our urology department from November 2020 to November 2022. Group A (n=43) underwent ureteroscopic holmium laser lithotripsy, while Group B (n=43) received ESWL. We recorded treatment duration, post-treatment hematuria duration, and post-treatment stone clearance rates. Renal function and stress response were assessed before and 3 days after treatment. Post-treatment complications were documented, and patient quality of life was evaluated using the SF-36 health questionnaire. Group A exhibited significantly shorter treatment and post-treatment hematuria durations compared to Group B (P < .05). In stones >1 cm, group A demonstrated a higher clearance rate (P < .05). Post-treatment, Group A showed improved renal function and lower stress response (P < .05). The incidence of post-treatment complications did not differ significantly between groups (P > .05), but SF-36 scores were higher in Group A (P < .05). Ureteroscopy with holmium laser lithotripsy proves effective in UC treatment, contributing to a shortened recovery period and enhanced patient quality of life.

Background We aimed to evaluate and compare the rise in the temperature for the safety of the kidney parenchyma on firing the Holmium: Yttrium Aluminium Garnet laser and the Thulium Fiber Laser during laser lithotripsy in humans. Method We included 30 pre-stented patients with renal calculi undergoing Retrograde intra-renal surgery. They were randomized into two groups – 15 patients underwent holmium laser lithotripsy and 15 patients underwent TFL laser lithotripsy. We used Philips paediatric esophageal probe to measure rise in temperature on firing holmium or TFL laser with irrigation at 10 ml/min and pressure at 100 mmHg. Different laser settings were used. Result The mean size of the calculi was 0.8 mm. The rise in temperature with holmium and TFL lasers depended on the firing time and irrigation flow, keeping power constant. On continuous firing for 10s, 20s, and 30s, the average rise in temperature went up to 28.67 °C, 29.70 °C, and 37.17 °C with holmium and with TFL it was 28.77 °C, 29.83 °C, and 37.62 °C, respectively. The difference in rise in temperature between two groups was statistically insignificant with p-values > 0.05. The maximum temperature reached with TFL was 39.4 °C with a 30s lasing time, and that with Ho: YAG was 38.9 °C. Conclusions The rise in temperature was almost equivalent with holmium and TFL. Hence, both Ho: YAG and TFL can be safely used in laser lithotripsy. Adequate irrigation is a must during the surgery. The continuous lasing time should be strictly restricted to less than 20s.

Background Kidney stone disease is a common problem. The holmium: yttrium–aluminum–garnet (HO:YAG) laser is currently the gold standard laser for ureterorenoscopic (URS) lithotripsy. Recently, the superpulse thulium fiber laser (SP TFL) has shown potential as a substitute for the HO:YAG laser. We aim to compare and evaluate the clinical efficacy and safety of the HO:YAG laser and SP TFL in the treatment of upper urinary calculi in this trial. Methods In this randomized, positive control, blinded management, single-center clinical study, patients with upper urinary calculi will be randomized (1:1) to the experimental group (SP TFL group) or the control group (HO:YAG laser group). Patients in both groups will undergo URS lithotripsy under general anesthesia, and according to the results of randomization, the patients will be treated with an SP TFL (trial group) or a holmium laser (control group). The primary outcome is the stone-free rate at 30 ± 7 days after surgery. The secondary outcomes include the duration of surgery, the duration of laser use, the length of postoperative hospital stay, postoperative clinical indicators, total hospitalization costs, the second-stage stone clearance rate, perioperative complications, the average hemoglobin change, and the mean white blood cell count change. Discussion This study aims to evaluate and compare the clinical efficacy and safety of the SP TFL and HO:YAG for URS lithotripsy in the treatment of upper urinary calculi. Trial registration {2a and 2b} chictr.org.cn ChiCTR2300076893. Registered on October 24, 2023, with ChiCTR ( https://www.chictr.org.cn/bin/project/edit?pid=206827 ). Protocol version {3} August 15, 2023 (V.20230815).

Introduction The use of lasers has created a major impact in the management of stones. The aim of our study is to evaluate and compare the effectiveness and safety profile of Thulium fiber laser (TFL) and Holmium: YAG (Ho: YAG) laser in ureteric stones. Methods It is a prospective randomized single-centre study carried out from December 2022 to December 2023. About 110 patients were subjected to the study with 55 randomized to each group. All underwent ureterorenoscopic lithotripsy either with TFL or Ho: YAG laser. Patient demographic data, stone-related factors, and complications were analyzed in both groups and compared. Results Mean stone volume was comparable in the Ho: YAG laser and TFL group (578.62 [SD 296.48] mm 3 vs. 556.64 [SD 246.18] mm 3 ; P  = 0.67). Mean total operative time was significantly different between the two groups (Ho: YAG − 27.3 (SD 2.77) vs. TFL − 24.8 (SD 2.58) minutes, P  = 0.005). Mean lasing time was also found to be significantly different (Ho: YAG − 15.16 (SD 3.97) vs. TFL − 13.13 (SD 3.21) minutes, P  = 0.004). Ablation speed was also significantly different (Ho: YAG mean 35.67 (SD 9.13) vs. TFL mean 40.48 (SD 10.60) mm 3 /min, P =  0.012). Stone-free rates (SFR) at 3 months follow-up were similar in TFL and Ho: YAG laser group. Conclusions Shorter lasing time, decreased overall operative time, and higher ablation speed are a few selective advantages of TFL over Ho: YAG laser. The SFR and complication rates remained almost the same in both.

Objective To compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10–20 mm lower pole stone (LPS). Methods This study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10–20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively. Results A total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up ( p  = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p  = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p  < 0.001). Conclusion A satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.

IntroductionThe aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium–aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm).MethodsA prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber.ResultsNinety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2–14.6) min, in 150-μm SP TFL—11.4 (7.7–14.9) min (p = 0.390), in Ho:YAG—14.1 (10.8–18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8–15.2) kJ; 150-μm SP TFL − 10.8 (7.3–13.5) kJ (p = 0.626) and in Ho:YAG—15.2 (11.1–25.3) kJ (p = 0.005).ConclusionsIrrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.

Background Lithiasis is a common and recurrent disease. Flexible ureteroscopy (fURS) is the cornerstone of laser treatment of kidney stones. Kidney stones destruction requires its laser pulverization into small fragments in order to remove them through the ureter or improve their spontaneous expulsion along the urinary tract. However, most of the time, all the micro-fragments and dust created cannot be extracted using our surgical tools and may stay intra-renally at the end of the procedure. Adjuvant treatments (such as forced diuresis, inversion or mechanical pressure) were previously described to improve the expulsion of stone fragments after extra-corporeal shock wave lithotripsy. Nevertheless, the impact of adjuvant treatment after fURS remains unclear and mainly theoretical. Objective The primary objective is to show that the injection of 40 mg of furosemide in slow intravenous during 10 min, after the procedure, increases the stone-free rate 3 months after a fURS for destruction of kidney stones with laser. Methods/design The study will be a two-parallel group randomized, controlled, multicentric trial with a blinding evaluation. Nine French departments of urology will participate. Patients will be randomized in 2 groups: the experimental group (injection of 40 mg of furosemide at the end of the surgery) and a control one (usual care). Patients will be followed up for 3 months (± 2 weeks) after the surgery. Then, we will perform a low dose abdomino-pelvic CT scan. The primary outcome is the stone-free rate at 3 months. A centralized review of the images will be performed by two specialized radiologists, in a blind and crossed way to allow a homogenization of the results. The secondary outcomes will include the rate of early post-operative urinary tract infection (UTI), the evaluation of post-operative pain, and the safety of the use of furosemide in patients treated by fURS for renal stone laser destruction. As secondary objectives, it is also planned to look at the effect of the prescription of an alpha-blocker as usual treatment on stone-free rate and to assess the agreement between the imaging analysis of the urologist and the specialized radiologist. Discussion Lithiasis is a public health problem. It affects about 10% of the general population. This prevalence is increasing (multiplied by 3 in 40 years), partly due to changes in the population’s eating habits over the years. The lithiasis patient is a patient with a chronic disease requiring annual follow-up and who may suffer from multiple recurrences, with a recurrence rate at 5 years of 50%. Recurrences are partly due to residual fragments left in the kidneys at the end of the operation. Other risk factors for recurrence include dietary hygiene and the presence of an associated metabolic disease. The metabolic blood and urine tests recommended by the Association Française d’Urologie (AFU) can be used to manage these last two problems. As far as residual fragments are concerned, their presence leads to an early recurrence of stones because they form the bed for a new aggregation of crystals in the kidneys. Being able to reduce the rate of residual fragments in patients with the use of furosemide at the end of the intervention therefore seems essential in the management of recurrences in our patients. This will also improve our patients’ quality of life. Indeed, lithiasis disease leads to chronic pain associated with acute pain that motivates consultations to the emergency for specialized management. This study is the first to evaluate the impact of forced diuresis with the use of furosemide on the stone-free rate after a fURS for destruction of kidney stone with laser. Trial registration ClinicalTrials.gov Identifier: NCT05916963 , first received: 22 June 2023. EU Clinical Trials Register EudraCT Number: 2022-502890-40-00.

PurposeTo compare the clinical efficacy and safety between the FURL with 365 μm and 200 μm holmium laser for treating nephrolithiasis.Materials and methodsA prospective randomized controlled trial was performed including analysis of data from 200 patients with nephrolithiasis. A total of 180 patients were randomized into two groups according to 1:1 ratio. In the 365 μm holmium laser group, kidney stones were disintegrated into less than 2 mm fragments with a 365 µm holmium laser fiber with the settings of 30–45 W under direct visualization; in the control group, the conventional 200 μm holmium laser was used. Descriptive statistics and logistic regression analyses tested the association among operation time, stone-free rate (SFR) and incidence of complications.ResultsOperation time in the FURL with 365 μm laser was significantly shortened and no significance was observed in the complication rate. Stone size and location were identified as two major confounding factors for the operation time and SFR. Moreover, the FURL using 365 μm laser showed less operation time for renal stones with the diameter between 1 and 2 cm, stones located in lower calyx and multiple calculi; stones larger than 2 cm and/or located in lower pole inclined to present better SFR using the FURL with 365 μm laser.ConclusionsThe FURL combined with 365 μm holmium laser is safer and highly efficacious for the management of nephrolithiasis when compared to conventional FURL procedures, especially for those located in lower pole and larger than 2 cm.