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A prospective comparative study of mini-PCNL using Trilogy™ or thulium fibre laser with suction

World Journal of Urology volume 40, pages 539–543 (2022)Cite this article

Abstract

Introduction

There has been recent introduction of novel lithotripters and high-power lasers for stone disintegration. With miniaturization of PCNL, there is need of effective disintegration and faster stone-clearance. This study aimed to evaluate efficiency of Trilogy™ and Thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (mini-PCNL).

Methods

This is prospective study comparing efficiency and outcomes of Trilogy™ and TFL in mini-PCNL between January 2019 and February 2020. Primary objective was to compare stone fragmentation rates, with secondary objectives beings stone-free rates and complications.

Results

There were 60 mini-PCNL with suction using either Trilogy™ or TFL energy source. Mean stone size and density were 27.60 ± 10.17 mm, 22.04 ± 9.69 mm (p = 0.05) and 1172.9 ± 313.5HU, 1308.9 ± 333.9HU (p = 0.10) for Trilogy™ and TFL, respectively. Using 3D doctor imaging software from CT images, mean stone volumes were 3718.9 ± 3038.7mm3 for Trilogy™ and 3425.9 ± 3096.1mm3 for TFL(p = 0.77). Using probe-activation time or lasing time, stone-fragmentation rate was 5.98 ± 4.25mm3/sec for Trilogy™ and 3.95 ± 1.00mm3/sec for TFL(p = 0.015). Treatment time (puncture to complete clearance) was 32.48 ± 15.39 min for Trilogy™ and 28.63 ± 18.56 min for TFL(p = 0.38). Haemoglobin drop was 1.19 ± 0.76gm/dl for Trilogy™ and 0.99 ± 0.74gm/dl for TFL (p = 0.30). Trilogy™ arm had 96.6% complete clearance and TFL had 76.6% in TFL at 48 h. One patient in Trilogy™ arm required auxiliary RIRS for residual stone. Both arms had complete stone clearance at 1 month follow-up. Trilogy™ arm had 3 Clavien–Dindo grade-II complications while TFL had 2 Clavien–Dindo grade-II complications (UTI requiring antibiotics). There was no blood transfusion in either of arm.

Conclusion

Trilogy™ had significantly better stone fragmentation rate than TFL in managing renal stones. However, stone-free rates and complications were comparable for Trilogy™ and TFL.

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Authors and Affiliations

  1. Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India

    Abhijit Patil, Rohan Sharma, Darshit Shah, Ankit Gupta, Abhishek Singh, Arvind Ganpule, Ravindra Sabnis & Mahesh Desai

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  1. Abhijit Patil
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  2. Rohan Sharma
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  3. Darshit Shah
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  4. Ankit Gupta
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  5. Abhishek Singh
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  6. Arvind Ganpule
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  7. Ravindra Sabnis
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  8. Mahesh Desai
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Contributions

APP: protocol/project development, data analysis, manuscript writing/editing. RS: data collection or management. DS: data collection or management. AG: data collection or management. AGS: data analysis, manuscript writing/editing. APG: data analysis, manuscript writing/editing. RBS: protocol/project development, operating surgeon, data analysis, manuscript writing/editing. MRD: protocol/project development, operating surgeon, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Ravindra Sabnis.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Muljibhai Patel Society for Research in Nephro-Urology (MPSRNU).

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Informed consent was obtained from all individual participants included in the study.

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Patil, A., Sharma, R., Shah, D. et al. A prospective comparative study of mini-PCNL using Trilogy™ or thulium fibre laser with suction. World J Urol 40, 539–543 (2022). https://doi.org/10.1007/s00345-021-03881-5

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  • DOI: https://doi.org/10.1007/s00345-021-03881-5

Keywords

  • Trilogy
  • Mini-PCNL
  • Thulium fibre laser
  • TFL
  • Suction