Introduction and Objective: A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. Materials and Methods: In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 μm fiber. Lasers compared were as follows: 60 W TFL, 120 W HL with MOSES, and conventional 120, 100, and 30 W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost-effectiveness was modeled using laser purchase price, fiber, and operating room (OR) time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. Results: The laser and total operating times were significantly different between the five systems (p < 0.001). The 120 W HL with MOSES was the fastest with 60.9 minutes of laser and 68.3 minutes of procedure times, while the 30 W HL was the slowest with 281.2 minutes of laser and 297.5 minutes of procedure times. The 60 W TFL was faster than the 30 W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (Rs = -0.98; p = 0.002). When estimating cost per procedure, the MOSES HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared with the 100 W HL. Conclusions: When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume.

中文翻译：

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哪种激光系统最适合大膀胱结石的膀胱碎石术？

简介和目的：有多种激光源可用于治疗膀胱结石。本研究的目的是比较铥光纤激光器 (TFL) 与具有不同功率或技术（包括 MOSES™）的四个钬激光器 (HL) 在模拟膀胱碎石术期间的时间和成本效率。材料和方法：在激光膀胱碎石术的台式模拟中，将 25 个相同的 4 厘米 BegoStone（一水草酸钙稠度）放置在 3D 打印膀胱模型内的网格上。激光器使用 550 μm 光纤以最大能量运行。比较的激光器如下：60 W TFL、带 MOSES 的 120 W HL 以及传统的 120、100 和 30 W HL。对每种激光器进行了五次试验，终点包括激光时间、总时间、光纤剥离数量和总能量。使用激光器购买价格、光纤和手术室 (OR) 时间成本对成本效益进行建模。使用 Tukey's B 事后方差分析来比较结果。Spearman 测试用于评估激光功率和手术时间之间的相关性。结果：五个系统之间的激光和总操作时间显着不同 (p < 0.001)。采用 MOSES 的 120 W HL 最快，激光时间为 60.9 分钟，手术时间为 68.3 分钟，而 30 W HL 最慢，激光时间为 281.2 分钟，手术时间为 297.5 分钟。60 W TFL 比 30 W HL 更快，但比更高功率的 HL 慢。较高的激光功率与较短的手术时间相关（Rs = -0.98；p = 0.002）。在估算每次手术的成本时，MOSES HL 最便宜，但购买成本最高。与 100 W HL 相比，TFL 对于大膀胱结石的成本效益不高。结论：治疗大膀胱结石时，激光总功率与激光和手术时间高度相关，TFL 受总功率限制。使用最具成本效益的激光器将取决于外壳体积。