Efficacy of thulium fiber laser litothripsy on large renal stones (> 1000 mm³) according to Hounsfield units: a prospective single-center study

İngilizce (OpenAlex)

BACKGROUND: This study evaluated the efficacy and safety of Thulium Fiber Laser (TFL) lithotripsy based on stone density and factors affecting success in retrograde intrarenal surgery (RIRS) for renal calculi > 1000 mm3. METHODS: Eighty-one patients who underwent RIRS with TFL for renal calculi > 1000 mm3 were evaluated prospectively and categorized into two groups based on stone density [Group 1:<1000 Hounsfield Units (HU); Group 2:≥1000 HU]. Demographic data, stone-free rates (SFRs), need for second RIRS, and complications were also recorded. Laser parameters, including lasing time, energy usage, ablation speed, efficiency, and energy consumption, were calculated. RESULTS: Mean HU values differed significantly between groups (731.65 ± 220.54 vs. 1207.92 ± 147.75,p = 0.001). Laser energy consumption was lower in group 2 (14.83 ± 10.15 vs. 18.01 ± 16.02 J/mm3,p = 0.045).No significant differences were observed in the other laser parameters (ablation efficiency, ablation speed, total energy used). Need for second RIRS rates were similar (26.83% vs. 30.00%,p = 0.752). SFRs after first and second RIRS were comparable between the groups (53.66% vs. 40.00%,p = 0.218; 70.73% vs. 57.50%,p = 0.214).Laser ablation efficiency (p = 0.004), ablation speed (p = 0.036), and operative time (p < 0.001) positively correlated with SFR in univariate analysis, but not in multivariate analysis.Stone location, and preoperative double J stent presence did not affect SFRs. The complication rate was 12.35%, with most complications being mild (Clavien I and II). CONCLUSION: TFL is effective and safe for treating large kidney stones using RIRS. Stone density did not significantly affect the outcomes, suggesting TFL’s versatility across different stone compositions. TFL lithotripsy is a promising option for the treatment of large renal calculi. TRIAL REGISTRATION: NCT07153978.