(UroToday.com) At the WCET 2024 conference, Dr. Wilson Molina from the University of Kansas Medical Center presented a study comparing the intraoperative and postoperative outcomes of the SOLTIVE Thulium Fiber Laser (TFL) with the high-power Holmium:yttrium-aluminum-garnet (Ho:YAG) laser during flexible ureteroscopy (fURS). This study also assessed physician satisfaction between the two laser systems, focusing on a variety of critical factors, including but not limited to noise and effort to concentrate.
Dr. Molina begin his presentation by emphasizing that flexible ureteroscopy (fURS) is a standard treatment for kidney stones smaller than 2 cm, utilizing laser energy sources for stone fragmentation. The Ho:YAG has long been considered the gold standard for this procedure, but the newer Thulium fiber laser (TFL) has emerged as a strong challenger. This study aimed to compare the outcomes of Ho:YAG versus TFL in terms of stone-free rates, total operative time, ablation efficiency, and speed.
This ongoing prospective randomized trial at a tertiary care center involves patients undergoing fURS for urolithiasis. Dr. Molina’s study exclusion criteria include urinary diversion, the use of more than one laser, and the presence of ureteral stones. Stone characteristics were determined using pre-operative CT scans, with the largest stone diameter recorded. The stone-free rate (SFR) was assessed post-operatively through follow-up CT scans. Additionally, surgeons completed questionnaires evaluating their satisfaction with the laser systems, particularly regarding noise and the effort required to concentrate during the procedure.
To date, 57 patients have been enrolled in the trial. However, since the abstract submission, the number of enrolled patients has increased to approximately 90, and Dr. Molina noted that the study is expected to close after enrolling 10 more patients, with final results likely to be presented at the AUA meeting. The results indicated that while the Ho:YAG laser was associated with less energy use (p<0.05), there were no significant differences between the Ho:YAG and TFL in terms of stone-free rates (p=0.68), total operative time, or laser time. Importantly, TFL was associated with superior surgeon satisfaction (p<0.01) and significantly better outcomes related to noise encumbrance (p<0.001). These outcomes included a subjective analysis of surgeon satisfaction, highlighting the ease of maneuverability and handling with the TFL, as well as the improved communication and concentration it facilitated during procedures.
Dr. Molina concluded his talk by stating that both the Ho:YAG and TFL lasers are excellent choices for lithotripsy, achieving similar outcomes in terms of stone-free rates and operative efficiency. However, the Ho:YAG laser was associated with lower energy use, while the TFL was favored for its easier maneuverability, handling, and the improved communication and concentration it allowed during procedures, as reflected in the subjective surgeon satisfaction analysis.
Following the presentation, a Q&A discussion was held. The first question from a moderator concerned the methodology used for randomization and the exclusion criteria. Dr. Molina responded that randomization was conducted on the day of surgery in a coin flip fashion, as both laser modalities were available in the operating room. He also restated the exclusion criteria to clarify for the moderator. Furthermore, the second moderator inquired whether the stone's location, size, and patient demographics were similar in both study arms, to which Dr. Molina confirmed that they were.
Presented by: Wilson Molina, M.D. from University of Kansas Medical Center.
Written by: Seyedamirvala Saadat, Research Specialist at Department of Urology, University of California Irvine, @Val_Saadat on X during the 2024 World Congress of Endourology and Uro-Technology (WCET) Annual Meeting, August 12 -16, 2024, Seoul, South Korea