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JU INSIGHT: Comparing Pediatric Ureteroscopy Outcomes with SuperPulsed Thulium Fiber Laser and Low-Power Holmium:YAG Laser
By: Christopher D. Jaeger, MD, MMSc; Caleb P. Nelson, MD, MPH; Bartley G. Cilento, MD, MPH; Tanya Logvinenko, PhD; Michael P. Kurtz, MD, MPH< | Posted on: 01 Aug 2022
Jaeger CD, Nelson CP and Cilento BG: Comparing pediatric ureteroscopy outcomes with superpulsed thulium fiber laser and low-power holmium:yag laser. J Urol 2022; 208: 426.
Study Need and Importance
The thulium fiber laser has emerged as an alternative laser lithotripsy technology to the gold standard, holmium:yttrium-aluminum-garnet (Ho:YAG) laser. The SOLTIVE™ SuperPulsed thulium fiber laser (SPTF) was the first platform released in North America and has shown promising clinical results in an adult cohort. No center has reported outcomes in a pediatric cohort. In this single-institution, retrospective cohort study, we aimed to compare the clinical performance of low-power Ho:YAG lasers to the SPTF in matched, unilateral ureteroscopies performed in pediatric patients.
What We Found
Over 5 years, 93 cases were performed with Ho:YAG lasers compared to 32 cases with the SPTF. The observed stone-free rate (SFR) with Ho:YAG lasers was 59% compared to 70% with the SPTF (see Table). Use of the SPTF was associated with 61% lower odds of having a residual stone after ureteroscopy (95% CI: 0.19–0.77, p=0.01). Despite a significantly longer median laser time of 11 minutes with the SPTF compared to 2 minutes with the Ho:YAG lasers, use of the SPTF was not associated with a significant increase in total operative time (p=0.8). The postoperative complication rate was not associated with use of the SPTF (p=0.64).
Table. Laser comparison of SFR by stone location, complications and operative time
| Overall | Ho:YAG | SPTF | p Value | |
|---|---|---|---|---|
| No. SFR/total no. (%) | 57/92 (62) | 41/69 (59) | 16/23 (70) | 0.01* |
| No. ureteral only/total no. (%) | 32/34 (94) | 28/30 (93) | 4/4 (100) | |
| No. renal only, no lower pole stone/total no. (%) | 5/14 (36) | 2/9 (22) | 3/5 (60) | |
| No. renal only, lower pole stone/total no. (%) | 7/24 (29) | 5/19 (26) | 2/5 (40) | |
| Ureteral+renal, no lower pole stone/total no. (%) | 3/5 (60) | 1/2 (50) | 2/3 (67) | |
| No. ureteral+renal, lower pole stone/total no. (%) | 10/15 (67) | 5/9 (56) | 5/6 (83) | |
| No. complications/total no. (%) | 26/114 (23) | 19/86 (22) | 7/28 (25) | 0.64* |
| No. Clavien-Dindo grade/total no. (%) | ||||
| I | 15/114 (13) | 11/86 (13) | 4/28 (14) | |
| II | 9/114 (8) | 7/86 (8) | 2/28 (7) | |
| ≥III | 2/114 (2) | 1/86 (2) | 1/28 (4) | |
| Median mins op time (IQR) in 119 pts | 83.5 (67.0, 104.5) | 84.0 (67.3, 102.8) | 78.0 (65.8, 109.8) | 0.77† |
| *Weighted logistic regression model. †Weighted linear regression model. |
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Limitations
Our study is limited by its single-institution retrospective design, small sample size, loss to followup within a 90-day imaging window and use of multiple imaging modalities to assess stone-free status. Our study abided by the strictest definition of stone-free status and should only be compared to other studies with similar definitions.
Interpretation for Patient Care
Technological evolution should seek to advance patient care outcomes. The SPTF was associated with a higher SFR without compromising safety or operative time when compared to low-power Ho:YAG lasers. Urologists providing care to pediatric patients should consider adopting the SPTF to advance the care of pediatric patients with surgical stone disease.