Safety and efficacy of thulium fiber laser in ureteric calculi - Prospective study

Objectives:The objective of the study was to analyze the efficacy and safety of superpulsed thulium fiber laser (TFL) lithotripsy and to identify the ideal laser settings.Methodology:Patients with ureteric stones were included prospectively. We performed Lithotripsy by superpulsed TFL 400 micron laser fiber, UROLASE SP+ (60W), IPG IRE POLUS Russia. Semirigid ureteroscope 6/7.5 Ch (Scholly, Denzlingen, Germany) was used. Demographic data and stone parameters such as stone size, volume, density, position, and laterality were recorded. The efficacy of lithotripsy was analyzed by measuring total energy, laser time, ablation efficacy, ablation speed, and energy consumption. Stone retropulsion and visibility were assessed using a three-point Likert scale. Complications were assessed using the Clavien-Dindo classification system.Results:Ninety-one patients underwent URSL for ureteric calculi. The mean stone size was 9.5 mm. The mean stone volume was 268.3 mm3. The mean stone density was 839.5HU. The stone-free rate at 3 months was 92.3% (84/91). The complication rate was 12% (11 patients).Conclusion:The SuperPulsed thulium-fiber laser provides safe and effective lithotripsy in Ureteric calculi. Ideal laser settings for ureteric stone are 0.9J x 10 Hz for fragmentation and 0.2J x 20 Hz for dusting.