Context

Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones.

Objective

To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones.

Evidence acquisition

A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until May 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was to compare the stone-free rate (SFR) between Ho:YAG and TFL for laser lithotripsy.

Evidence synthesis

Eleven studies met our inclusion criteria, and data from 1286 and 880 patients who underwent, respectively, Ho:YAG and TFL laser lithotripsy were reviewed. Most studies included ureteroscopy (URS) and retrograde intrarenal surgeries as procedures, two included percutaneous nephrolithotomy, and one included URS exclusively. Only two studies reported results in pediatric patients. TFL was associated with a higher SFR (odds ratio [OR] 1.84, 95% confidence interval [CI]: 1.06–3.20; p = 0.031) when no residual fragment is considered, but not when SFR refers to the presence of fragments <3 mm (OR 2.48, 95% CI: 0.98–6.29; p = 0.055) or when only Ho:YAG with MOSES is considered (p = 0.068). According to the stones’ location, TFL was associated with higher SFRs than Ho:YAG for renal (OR 3.14, 95% CI: 1.69–5.86; p < 0.001) but not for ureteral (p = 0.8) stones. TFL was associated with a lower intraoperative complication rate (OR 0.34, 95% CI: 0.19–0.63; p < 0.001). No difference was found in major (p = 0.4) or overall (p = 0.4) complication rate, operative time (p = 0.051), and laser time (p = 0.9).

Conclusions

TFL is a promising laser for the treatment of urinary stones with some advantages over Ho:YAG. Further high-quality studies are needed to confirm these findings and optimize the surgical settings.

Patient summary

The use of thulium fiber laser rather than holmium:yttrium aluminum garnet permits to reach a higher stone-free rate in stones located in the kidney rather than in the ureter.

中文翻译：

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铥光纤激光器与钬：钇铝石榴石碎石术：系统评价和荟萃分析

语境

铥光纤激光器 (TFL) 成为治疗尿路结石的钬：钇铝石榴石 (Ho:YAG) 激光器的竞争对手。

客观的

比较Ho:YAG与TFL激光碎石治疗肾结石和输尿管结石的疗效。

证据获取

使用 PubMed/Medline、Embase 和 Web of Science 数据库进行文献检索，以识别截至 2023 年 5 月发布的报告。遵循系统评价和荟萃分析指南的首选报告项目来识别合格的研究。主要结果是比较激光碎石术中 Ho:YAG 和 TFL 的无结石率 (SFR)。

证据综合

11 项研究符合我们的纳入标准，并对分别接受 Ho:YAG 和 TFL 激光碎石术的 1286 名和 880 名患者的数据进行了审查。大多数研究包括输尿管镜检查 (URS) 和逆行肾内手术作为手术，其中两项包括经皮肾镜取石术，一项仅包括 URS。只有两项研究报告了儿科患者的结果。当不考虑残留片段时，TFL 与较高的 SFR 相关（比值比 [OR] 1.84，95% 置信区间 [CI]：1.06–3.20；p  = 0.031），但当 SFR 指存在 <3 的片段时则不然。 mm（OR 2.48，95% CI：0.98–6.29；p  = 0.055）或仅考虑具有 MOSES 的 Ho:YAG 时（p  = 0.068）。根据结石的位置，对于肾结石，TFL 与较高的 SFR 相关（OR 3.14，95% CI：1.69–5.86；p  < 0.001），但与输尿管结石 ( p  = 0.8) 无关。TFL 与较低的术中并发症发生率相关（OR 0.34，95% CI：0.19–0.63；p  < 0.001）。主要并发症发生率 ( p  = 0.4) 或总体并发症发生率 ( p  = 0.4)、手术时间 ( p  = 0.051) 和激光时间 ( p = 0.9)没有差异 。

结论

TFL 是一种很有前途的治疗尿路结石的激光，与 Ho:YAG 相比具有一些优势。需要进一步的高质量研究来证实这些发现并优化手术设置。

患者总结

使用铥光纤激光器而不是钬：钇铝石榴石可以使位于肾脏而不是输尿管的结石达到更高的无结石率。