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. 2023 May;49(3):198-204.
doi: 10.5152/tud.2023.22264.

Incidence of Ureteric strictures Following Ureteroscopic Laser Lithotripsy: Holmium:YAG Versus Thulium Fiber Laser

Sajad Ahmad Para  1 , Mohammad Saleem Wani  2 , Arif Hamid  1 , Sajad Ahmad Malik  1 , Abdul Rouf Khawaja  1 , Saqib Mehdi  1
Affiliations

Incidence of Ureteric strictures Following Ureteroscopic Laser Lithotripsy: Holmium:YAG Versus Thulium Fiber Laser

Sajad Ahmad Para et al. Urol Res Pract. 2023 May.

Abstract

Objective: We aimed to compare the incidence of ureteric strictures between holmium:yttrium aluminum garnet and thulium fiber laser following ureteroscopic laser lithotripsy. In the present era of miniaturization of endourologic armamentarium and better optics, how safe are lasers to fire inside ureter?

Materials and methods: It is a prospective comparative study over a period of 2 years that included patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Patients were randomly divided into 2 groups: group A underwent holmium:yttrium aluminum garnet laser lithotripsy and group B underwent thulium fiber laser lithotripsy.

Results: A total of 478 patients were analyzed after excluding patients not willing to participate and patients lost to follow-up. Two hundred forty patients underwent holmium:yttrium aluminum garnet laser lithotripsy (group A) and 238 patients underwent thulium fiber laser lithotripsy (group B). The demographic data of 2 groups were comparable. The mean age of patients in group A and group B was 36.5 ± 12.52 years and 38.62 ± 10.71 years, respectively. The mean operative time in group A and group B was 47 ± 15 and 36 ± 13 minutes, respectively, while the mean laser time in group A and group B was 13.5 ± 45 minutes and 9.25 ± 3.2 minutes, respectively. Four (1.67%) patients in group A and 11 (4.62%) patients in group B developed ureteric strictures during follow-up, and the difference was statistically significant (P <.001). The mean length of stricture was 2.67 ± 1.27 cm in group A and 4.42 ± 2.2 cm in group B, and the difference was statistically significant.

Conclusion: Thulium fiber laser, projected as safe laser previously, has a higher incidence of ureteric strictures compared to holmium:yttrium aluminum garnet laser when used for ureteroscopic laser lithotripsy.

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Figures

Figure 1.
Figure 1.
Computed tomography urography: reconstructed image showing right-sided hydroureteronephrosis due to upper ureteric stricture.
Figure 2.
Figure 2.
Antegrade and retrograde pyelography delineating the length of stricture (red arrow).
Figure 3.
Figure 3.
Left antegrade pyelography showing complete cutoff in the upper ureter.
Figure 4.
Figure 4.
Intraoperative picture of the upper ureteric stricture (black arrow).
Figure 5.
Figure 5.
Stages of our study in a Consolidated Standards of Reporting Trials diagram.
See this image and copyright information in PMC

References

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