Comparing Super Pulse Fiber Thulium Laser and Holmium Laser for Ureteral Stone Fragmentation During Ureteroscopy
Comparison of Super Pulse Fiber Thulium Laser and Holmium Laser Lithotripsy Under Ureteroscopy
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
136 participants
Jan 20, 2025
OBSERVATIONAL
Conditions
Summary
The goal of this prospective, multicenter, randomized controlled trial is to objectively evaluate the clinical efficacy and safety differences between superpulse thulium fiber laser (sTFL) and holmium:YAG laser (Ho:YAG) in flexible ureteroscopy (FURS) lithotripsy in adult patients aged 18-70 years with kidney stones and/or upper ureteral stones (6-20mm). The main questions it aims to answer are: Does sTFL yield a higher stone-free rate (SFR) compared to Ho:YAG at 3 months post-FURS? Is sTFL superior to Ho:YAG in terms of operation time, complication rate, and surgeon's visual experience during FURS? Researchers will compare the experimental group receiving sTFL treatment to the control group receiving Ho:YAG laser treatment to see if sTFL demonstrates better lithotripsy efficiency, safety, and ease of operation. Participants aged 18-70 years will: Undergo FURS lithotripsy under general anesthesia using either sTFL (experimental group) or Ho:YAG laser (control group) based on randomization Have CT scans at 3 months post-operation to assess stone-free status Be monitored for intraoperative and postoperative complications Have surgeons rate their visual experience during the procedure in terms of visual clarity, lithotripsy efficiency, stone movement and tissue injury
Eligibility
Inclusion Criteria6
- Age ≥18 years old
- Diagnosis of kidney stones and/or upper ureteral stones with stone diameter ≥6mm and ≤20mm
- Plan to undergo fURS lithotripsy
- General anesthesia to complete the operation
- The latest urine culture before surgery is negative
- Signed and dated informed consent indicating that the patient or his or her legal representative has been fully informed about the study and has consented to participate
Exclusion Criteria13
- Isolated kidney
- Previous history of kidney transplantation or urinary diversion surgery
- Congenital malformations of urinary system
- Abnormal coagulation mechanism due to blood system diseases, liver diseases, etc.
- Severe heart or lung disease, malignancy and immune deficiency status
- Neurogenic bladder
- Failure to provide informed consent
- Have an untreated urinary tract infection
- The presence of known anatomic abnormalities (such as ureteral stenosis), urothelial tumors, or stones that can be removed directly without the use of laser lithotripsy
- Pregnant women
- In cases where the stone cannot be reached with a bendable negative pressure suction sheath, or in cases where the stone cannot be reached with a conventional sheath or the pyeloureteral junction
- Surgical completion under epidural anesthesia or lumbar anesthesia
- Recurrent stones due to genetic metabolic diseases
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Interventions
The superpulse thulium fiber laser (sTFL) was used as a minimally invasive surgical treatment for kidney and upper ureteral stones. All procedures were performed by experienced urologists using standard techniques for laser lithotripsy. Laser settings, such as pulse energy and frequency, were adjusted according to stone characteristics and the surgeon's judgment to optimize treatment efficacy and safety.
The holmium:YAG laser (Ho:YAG) was used as a minimally invasive surgical treatment for kidney and upper ureteral stones. All procedures were performed by experienced urologists using standard techniques for laser lithotripsy. Laser settings, such as pulse energy and frequency, were adjusted according to stone characteristics and the surgeon's judgment to optimize treatment efficacy and safety.
Locations(1)
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NCT06667557