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Panthier F, Gauhar V, Ventimiglia E, Kwok JL, Keller EX, Traxer O. Rethinking Stone-free Rates and Surgical Outcomes in Endourology: A Point of View from PEARLS Members. Eur Urol 2024; 86:198-199. [PMID: 38890068 DOI: 10.1016/j.eururo.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
There is a lack of consensus on definitions for the success of endourological stone treatments. The zero-fragment rate (residual fragments [RFs] <1 mm) is now considered more accurate than the stone-free rate (RFs ≤4 mm). As stone volume may be adopted as the recommended method for preoperative estimation of the stone burden, the volumetric stone-free rate may be superior to standard linear RF measurements in defining success.
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Affiliation(s)
- Frédéric Panthier
- Sorbonne University GRC Urolithiasis no. 20, Tenon Hospital, Paris, France; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France; Department of Urology, Westmoreland Street Hospital, UCLH NHS Foundation Trust, London, UK.
| | - Vineet Gauhar
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jia-Lun Kwok
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Etienne Xavier Keller
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists Endourology and Urolithiasis Working Group, Arnhem, The Netherlands; Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis no. 20, Tenon Hospital, Paris, France; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
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Proietti S, Marchioni M, Oo MM, Scalia R, Gisone S, Monroy RE, Schips L, Gaboardi F, Giusti G. Flexible Ureteroscopic Lithotripsy with the Pulsed Thulium:Yttrium Aluminum Garnet Laser Thulio: Preliminary Results from a Prospective Study. EUR UROL SUPPL 2024; 67:77-83. [PMID: 39286758 PMCID: PMC11403138 DOI: 10.1016/j.euros.2024.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 09/19/2024] Open
Abstract
Background and objective Recently, the new pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser technology has been introduced in endourology for lithotripsy. The aim of this study was to assess and validate the clinical laser performance and safety profile of p-Tm:YAG laser in a series of patients with renal and ureteral stones who underwent flexible ureteroscopy (fURS). Methods Prospective data were collected for patients who underwent fURS with the p-Tm:YAG laser Thulio (Dornier MedTech Systems GmbH, Wessling, Germany) at our institution by using two different laser fiber core diameters (270 and 200 μm). The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade ≥1 and the comparison between laser fibers of different diameters in all the parameters analyzed. Descriptive statistics relied on medians and interquartile ranges for continuous covariates, and on frequencies and percentages for categorical covariates. After stratification according to fiber types, differences between groups were tested with Wilcoxon and chi-square tests as appropriate. All the analyses and graphics were performed using R software (version 4.2.2). Key findings and limitations The SFR was 82% at 1-mo follow-up. In six out of 50 procedures (12%), Clavien-Dindo grade I-II complications were recorded. There were no differences regarding all the laser parameters considered between patients who were treated with 270 or 200 μm laser fibers (p > 0.05). Limitations of the study include small sample size in a single center and the lack of comparative groups. Conclusions and clinical implications In this prospective study of 50 patients who underwent fURS for ureteral and renal stones, the p-Tm:YAG laser Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations using different laser sources are required to confirm the clinical laser performance and safety of p-Tm:YAG laser for urinary stones treatment. Patient summary In this report, we looked at the outcomes for the pulsed thulium:yttrium aluminum garnet laser Dornier Thulio in patients who underwent flexible ureteroscopy for ureteral and renal stones. We found that this new laser technology is effective and safe, representing a good alternative to the other laser machines available for stone lithotripsy. We need more studies with larger populations to establish the superiority of this laser technology over the others.
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Affiliation(s)
- Silvia Proietti
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Mon Mon Oo
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
| | - Riccardo Scalia
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
| | - Stefano Gisone
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
| | | | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Franco Gaboardi
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raaffaele Hospital, Milan, Italy
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Sierra A, Solano C, Corrales M, Ventimiglia E, Panthier F, Kwok JL, Chicaud M, Keller EX, Traxer O. Steady-state versus burst lasing techniques for thulium fiber laser. World J Urol 2024; 42:487. [PMID: 39158747 PMCID: PMC11333515 DOI: 10.1007/s00345-024-05102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/01/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE To evaluate the stone ablation rate and direct thermal damage from thulium fiber laser (TFL) lithotripsy using continuous (C) and burst (B) lasing techniques on an in vitro ureteral model. METHODS The TFL Drive (Coloplast, Humlebaek, Denmark) was used in an in vitro saline-submerged ureteral model. Ten participants, including five junior and five experienced urologists, conducted the experimental setup with 7 different settings comparing two lasing techniques: steady-state lasing (0.5 J/10 Hz = 5W for 300 s and 0.5 J/20 Hz = 10W for 150 s) and burst, intermittent 5 s on/off lasing (0.5 J/20 Hz, 0.5 J/30 Hz, 0.5 J/60 Hz, 0.1 J/200 Hz, and 0.05 J/400 Hz) with a target cumulative energy of 1500 J using cubic 125 mm3 phantom BegoStonesTM. Ureteral damage was graded 1-3 based on the severity of burns and holes observed on the surface of the ureteral model. RESULTS The were no significant differences in stone ablation mass neither between C and B lasing techniques, nor between expertise levels. At C lasing technique had only mild ureteral lesions with no significant differences between expertise levels (p: 0.97) or laser settings (p: 0.71). At B lasing technique, different types of thermal lesions were found with no expertise (p: 0.11) or setting (p: 0.83) differences. However, B laser setting had higher grade direct thermal lesions than C (p: 0.048). CONCLUSION Regarding efficacy, C and B lasing techniques achieve comparable stone ablation rates. Safety-wise, B lasing mode showed higher grade of direct thermal lesions. These results should be further investigated to verify which of the lasing mode is the safest in vivo. Until then and unless proven otherwise, a C mode with low frequency should be recommended to avoid ureteral wall lesions.
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Affiliation(s)
- Alba Sierra
- Urology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France.
| | - Catalina Solano
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Uroclin, Medellín, Colombia
| | - Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
| | - Eugenio Ventimiglia
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Frederic Panthier
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
| | - Jia-Lun Kwok
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Departament of Urology, University Hospital Zürich, Zurich, Switzerland
- Departament of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Marie Chicaud
- Department of Urology, Limoges University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Etienne Xavier Keller
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
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Keller EX, Kwok JL, Panthier F, Ventimiglia E, Traxer O. Planning my ureteroscopic laser lithotripsy: how much energy and time should I reasonably expect? Integrating the concept of laser energy consumption (J/mm 3). World J Urol 2024; 42:100. [PMID: 38400855 DOI: 10.1007/s00345-024-04790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands.
| | - Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
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Panthier F, Berthe L, Ghnatios C, Smith D, Traxer O. From laser-on time to lithotripsy duration: how neural networks can refine "KIDNEY STONE CALCULATOR" predictions for ureteroscopic lithotripsy duration: preliminary results. World J Urol 2024; 42:99. [PMID: 38400928 DOI: 10.1007/s00345-024-04882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Frédéric Panthier
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de L'Hôpital, 75013, Paris, France
- Department of Urology, Westmoreland Street Hospital, and Clinical Microbiology, UCLH NHS Foundation Trust, London, UK
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de L'Hôpital, 75013, Paris, France
| | - Chady Ghnatios
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de L'Hôpital, 75013, Paris, France
| | - Daron Smith
- Department of Urology, Westmoreland Street Hospital, and Clinical Microbiology, UCLH NHS Foundation Trust, London, UK
| | - Olivier Traxer
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de L'Hôpital, 75013, Paris, France
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