Abstract
Purpose
To compare the clinical efficacy and safety between the FURL with 365 μm and 200 μm holmium laser for treating nephrolithiasis.
Materials and methods
A prospective randomized controlled trial was performed including analysis of data from 200 patients with nephrolithiasis. A total of 180 patients were randomized into two groups according to 1:1 ratio. In the 365 μm holmium laser group, kidney stones were disintegrated into less than 2 mm fragments with a 365 µm holmium laser fiber with the settings of 30–45 W under direct visualization; in the control group, the conventional 200 μm holmium laser was used. Descriptive statistics and logistic regression analyses tested the association among operation time, stone-free rate (SFR) and incidence of complications.
Results
Operation time in the FURL with 365 μm laser was significantly shortened and no significance was observed in the complication rate. Stone size and location were identified as two major confounding factors for the operation time and SFR. Moreover, the FURL using 365 μm laser showed less operation time for renal stones with the diameter between 1 and 2 cm, stones located in lower calyx and multiple calculi; stones larger than 2 cm and/or located in lower pole inclined to present better SFR using the FURL with 365 μm laser.
Conclusions
The FURL combined with 365 μm holmium laser is safer and highly efficacious for the management of nephrolithiasis when compared to conventional FURL procedures, especially for those located in lower pole and larger than 2 cm.
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Acknowledgements
This work was supported by the National Natural Science Foundation of China (Grant Numbers 81570676), the Science and Education Health Project of Jiangsu Province for Important Talent (Grant Number RC2011055), the “333 High Level Talents Project” in Jiangsu Province, China (Grant Numbers BRA2017532, BRA2015469), the Standardized Diagnosis and Treatment Research Program of Key Diseases in Jiangsu Province, China (Grant Number BE2016791), the Open Project Program of Health Department of Jiangsu Province, China (Grant Number JSY-2-2016-099), the Jiangsu Province Six Talents Peak from Department of Human Resources, Social Security Office of Jiangsu Province, China (Grant Numbers 2010WSN-56), the General Program of Health Department of Jiangsu Province, China (Grant Number H2009907), and the Priority Academic Program Development of Jiangsu Higher Education Institutions (Grant Number JX10231801).
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PL: Protocol development and data management; KC: Data collection and management; ZW: Data analysis and manuscript writing; RS: Data analysis; JZ: Data management; BL: Data collection; GZ: Data collection and protocol development; ZW: Data management and funding; WZ: Protocol development and manuscript writing; MG: Protocol development and funding.
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The protocols followed in this study were in accordance with the ethical standards of the Declarations of Helsinki and Istanbul, and approved by the local ethics committee of the First Affiliated Hospital of Nanjing Medical University (2017-SR-196).
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Written informed consents from all enrolled patients were obtained. The selection of operation ways strictly conformed to the diagnosis and treatment guideline of urology and obtained the consent and recognition of the patients.
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Lu, P., Chen, K., Wang, Z. et al. Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 μm holmium laser for nephrolithiasis: a prospective, randomized, controlled trial. World J Urol 38, 481–487 (2020). https://doi.org/10.1007/s00345-019-02776-w
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DOI: https://doi.org/10.1007/s00345-019-02776-w