Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy

Purpose To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL). Methods Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire. Results A total of 120 patients were included in the study with a mean age of 52 (+/- 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (+/- 8.8) mm with a mean density of 1019 (+/- 375) HU. Mean operative time was 23.4 (+/- 17.9) min and mean LOT was 5.0 (+/- 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (+/- 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases. Conclusions TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.