Skip to main content
SpringerLink
Log in

Low-energy high-frequency Ho-YAG lithotripsy: is RIRS going forward? A case–control study

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

Retrograde Intra-Renal Surgery (RIRS) plays a primary role in renal stone treatment context. Energy, frequency and width of laser impulse can be modulated by surgeons to achieve better outcomes. In our study, patients with single renal stone sized 10–20 mm were retrospectively divided into two groups. Patients of Group 1 underwent RIRS with Low-Energy (LE) High-Frequency (HF) settings using Lumenis® 120-W high-power Ho:YAG laser. Patients of Group 2 (control) underwent RIRS using “standard” settings by means of Sphinx® Jr 30 W Ho:YAG system. Follow-up was conducted with a CT scan at 3 months after RIRS in both groups. Procedure success was defined as stone-free or presence of ≤ 4 mm fragments (Clinical Insignificant Residual Fragments—CIRF). A total number of 199 patients were included: 86 LE/HF RIRS (Group 1) vs 113 “conventional” RIRS (Group 2). Mean operative time was 56.6 (± 19.4) min in Group 1 vs 65.2 (± 25.2) min in Group 2 (p = 0.01). Mean hospitalization time was 2.5 ± 1.7 days for Group 1 vs 2.9 ± 3.2 days for Group 2 (p = 0.2). Peri-operative complications were counted: eight in Group 1 and 11 in Group 2 (p > 0.05). At 3-month control, stone-free rate was 69% (59/86 patients) in Group 1 vs 65% (73/113 patients) in Group 2 (p = 0.6). Success rate was 93% (80/86) in Group 1 in comparison to 82% (93/113) in Group 2 (p = 0.03). In conclusion, LE/HF RIRS seems to be a feasible and effective technique with a reduction of operative time and optimal results in terms of “stone-free” and “success” rates. Further studies are needed to ensure the validity of our results and to give evidence-based statements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

Available if necessary.

References

  1. Türk C, Skolarikos A, Neisius A, Petrik A, Seitz C, Thomas K, et al (2019) EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2

  2. Fiori C, Autorino R (2018) Flexible ureteroscopy for kidney stones in the third millennium: lights and shadows. Minerva Urol e Nefrol 70:543–545. https://doi.org/10.23736/S0393-2249.18.03354-4

    Article  Google Scholar 

  3. Ulker V, Cakmak O, Yucel C et al (2019) The efficacy and safety of bilateral same-session ureteroscopy with holmium laser lithotripsy in the treatment of bilateral ureteral stones. Minerva Urol Nefrol 71(2):174–180

    Article  Google Scholar 

  4. Ahmed I, Mostafa ME, Nader F, Serge C, Sero A (2018) Double-blinded prospective randomized clinical trial comparing regular and moses modes of holmium laser lithotripsy: Preliminary results. Eur Urol Suppl. https://doi.org/10.1016/S1569-9056(18)31815-3

  5. Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 8:S398-417. https://doi.org/10.21037/tau.2019.08.01

    Article  PubMed  PubMed Central  Google Scholar 

  6. Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O (2019) What is the exact definition of stone dust? An in vitro evaluation. Eur Urol Suppl 18:e484. https://doi.org/10.1016/s1569-9056(19)30363-x

    Article  Google Scholar 

  7. Peng G, Song L, Xie D, Huang J, Zhong Y, Tan W et al (2018) Suctioning flexible ureteroscopic lithotripsy in the oblique supine lithotomy position and supine lithotomy position: a comparative retrospective study. Minerva Urol e Nefrol 70:612–616. https://doi.org/10.23736/S0393-2249.18.03144-2

    Article  Google Scholar 

  8. Dindo D, Demartines N, Claiven PA (2004) Classification of surgical complications. Ann Surg 2:205–213

    Article  Google Scholar 

  9. Bosio A, Dalmasso E, Alessandria E, Agosti S, Pizzuto G, Peretti D et al (2018) Retrograde intra-renal surgery under spinal anesthesia: the first large series. Minerva Urol e Nefrol 70:333–339. https://doi.org/10.23736/S0393-2249.18.02926-0

    Article  Google Scholar 

  10. Çakici Ç, Özok HU et al (2019) Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. Minerva Urol Nefrol 71(6):636–643

    Article  Google Scholar 

  11. Carobbio F, Zamboni S et al (2020) Role of cultural analysis in patients with indwelling ureteral stent submitted to ureteroscopy for stones. Minerva Urol Nefrol 72(6):755–762

    Article  Google Scholar 

  12. Aldoukhi AH, Roberts WW, Hall TL, Ghani KR (2017) Holmium laser lithotripsy in the new stone age: dust or bust? Front Surg 4:57. https://doi.org/10.3389/fsurg.2017.00057

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tracey J, Gagin G, Morhardt D, Hollingsworth J, Ghani KR (2018) Ureteroscopic high-frequency dusting utilizing a 120-W holmium laser. J Endourol 32:290–295. https://doi.org/10.1089/end.2017.0220

    Article  PubMed  Google Scholar 

  14. Pietropaolo A, Jones P et al (2019) Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months. Urolithiasis 47:391–394

    Article  Google Scholar 

  15. Kronenberg P, Somani B (2018) Advances in lasers for the treatment of stones—a systematic review. Curr Urol Rep 19:45

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy

    D. Peretti, A. Pecoraro, C. Fiori & F. Porpiglia

  2. ASO S. Croce e Carle Cuneo, Cuneo, Italy

    E. Dalmasso, C. Ambruosi, F. Venzano & O. Maugeri

Authors
  1. D. Peretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Dalmasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Pecoraro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Ambruosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Venzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Fiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Porpiglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O. Maugeri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Peretti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peretti, D., Dalmasso, E., Pecoraro, A. et al. Low-energy high-frequency Ho-YAG lithotripsy: is RIRS going forward? A case–control study. Urolithiasis 50, 79–85 (2022). https://doi.org/10.1007/s00240-021-01282-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-021-01282-2

Keywords

Search

Navigation