Ureteroscopic Performance of High Power Super Pulse Thulium Fiber Laser for the Treatment of Urolithiasis: Results of the First Case Series in North America

OBJECTIVE To report the first case series of ureterorenoscopy in North America using the High Power Super Pulse Thulium Fiber Laser for the treatment of upper urinary tract stones. METHODS After Institutional Review Board approval, a multicentric retrospective chart review of patients treated with the High Power Super Pulse Thulium Fiber Laser from October 2019 to March 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. RESULTS Seventy-six patients were included with a mean age of 60.9 +/- 13.3 years. 118 stones were treated including 32 within the ureter, 49 in the lower pole, 37 in mid or upper poles. Dusting technique was commonly used (67.1%) with pulse frequencies up to 2400 Hz. Mean operative time was 59.4 +/- 31.5 minutes. Mean laser time and total laser energy were 10.8 +/- 14.1 minutes and 12.5 +/- 19.1 KJ, respectively. Intraoperative complications were limited to 7 grade 1, 3 grade 2, and 1 grade 3 ureteral injuries and one case of renal collecting system bleeding that was adequately managed with laser coagulation settings (1J-20Hz). CONCLUSION This initial case series in North America of the High Power Super Pulse Thulium Fiber Laser is promising for the treatment of urolithiasis. Sub-200 mm fibers and dusting settings up to 2400 Hz were utilized successfully. No specific complications related to use of the laser were seen. (C) 2021 Elsevier Inc.