1. Current status of thulium fibre laser lithotripsy: an up‐to‐date review
- Author
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Christian Beisland, Øyvind Ulvik, and Patrick Jones
- Subjects
medicine.medical_specialty ,Stone clearance ,Urology ,medicine.medical_treatment ,Stone free ,Operative Time ,Lasers, Solid-State ,Lithotripsy ,Laser technology ,Kidney Calculi ,Ureteroscopy ,Humans ,Medicine ,Optical Fibers ,Nephrostomy, Percutaneous ,medicine.diagnostic_test ,business.industry ,Length of Stay ,Lithotripsy, Laser ,Surgery ,Clinical Practice ,Treatment Outcome ,Thulium ,business ,Mini percutaneous nephrolithotomy - Abstract
Introduction Thulium Fiber Laser (TFL) is the latest laser technology, which has gained increased attention for its role in stone lithotripsy. Findings from in vitro studies have shown that it can potentially deliver reduced retropulsion and efficient stone clearance. A number of clinical studies on TFL have now been reported. Our aim was to perform an up-to-date review to scope its current status in stone lithotripsy and provide a guide for the clinical urologist METHODS: A review of world literature was performed in order to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared. Results To date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of mini percutaneous nephrolithotomy (PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, range of settings has been 0.1-4J x 7-300Hz for both URS and mini PCNL. Stones ranging from 0.4-3.2cm and 1.5-3cm have been treated with URS and mini PCNL, respectively. Final stone free rate (SFR) for TFL has ranged from 66.6 -100% and 85-100% for URS and mini PCNL respectively. Average length of stay ranged from 0.5-2.4 days in URS group but no studies reported this for mini PCNL. Operative times in all the studies (both URS and mini PCNL) were less than 60 minutes. Conclusion Initial clinical studies reveal that TFL appears to be efficacious in setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position as well as determine the optimal settings for use in clinical practice.
- Published
- 2021