Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

Castellani D 1 , Fong KY 2 , Lim EJ 3 , Chew BH 4 , Tailly T 5 , Emiliani E 6 Show all authors , Teoh JY 7 , Chai CA 8 , Heng CT 9 , Ong Lay Keat W 10 , Tanidir Y 11 , Ragoori D 12 , Galosi AB 1 , Singh A 13 , Bin Hamri S 14 , Traxer O 15 , Somani BK 16 , Gauhar V 9

Affiliations 

  • 1 Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
  • 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 3 Department of Urology, Singapore General Hospital, Singapore
  • 4 Department of Urology, University of British Columbia, Vancouver, Canada
  • 5 Department of Urology, University Hospital of Ghent, Ghent, Belgium
  • 6 Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
  • 7 S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
  • 8 Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
  • 9 Department of Urology, Ng Teng Fong General Hospital, Singapore
  • 10 Department of Urology, Penang General Hospital, Penang, Malaysia
  • 11 Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
  • 12 Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India
  • 13 Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
  • 14 Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • 15 Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
  • 16 Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom
J Urol, 2023 Aug;210(2):323-330.
PMID: 37126223 DOI: 10.1097/JU.0000000000003504

Abstract

PURPOSE: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology.

MATERIALS AND METHODS: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free.

RESULTS: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free.

CONCLUSIONS: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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