ReviewInternational braz j urol : official journal of the Brazilian Society of Urology
Energy sources in percutaneous surgery. Are lasers ready to become the gold standard? A narrative review.
Review in International braz j urol : official journal of the Brazilian Society of Urology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
introductionNephrolithiasis is a prevalent and recurrent condition affecting approximately 10-11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL. MATERIALS AND
methodsA narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed.
resultsDifferences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance.
conclusionUltrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.
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