ArticleTherapeutic advances in urology
Thulium fiber laser versus high-power holmium laser for renal stones: a systematic review and meta-analysis of high-quality studies.
Article in Therapeutic advances in 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Background: Thulium fiber laser (TFL) and high-power Holmium:Yttrium-Aluminum-Garnet laser (HPHL) are common laser modalities used in flexible ureteroscopy (F-URS). Existing comparisons are imperfect due to lack of randomization, use of obsolete low-power settings, and the recent advent of technologies such as flexible and navigable ureteral access sheaths (FANS). Objectives: To compare the safety and efficacy of TFL versus HPHL for F-URS in renal stones. Design: A PRISMA-compliant literature review was conducted on PubMed, EMBASE, Scopus and for randomized trials or propensity score-matched studies comparing TFL to HPHL in renal stones. Data sources and methods: Primary outcomes were study-defined stone-free rate (SFR), as well as 100% SFR (zero residual fragments). Secondary outcomes were total operation time, all complications, bleeding complications, postoperative fever, and reintervention. Random-effects meta-analyses were performed to generate risk ratios (RRs) or mean differences (MDs). Results: Eight studies (1290 patients) were shortlisted for analysis. Only one utilized FANS; three did not routinely use ureteral access sheaths. Between TFL and HPHL, there was no significant difference in study-reported SFR (RR = 1.17, 95% CI = 0.98-1.40, Conclusion: This meta-analysis of high-quality studies found no significant differences between HPHL and TFL in the trifecta of outcomes-SFR, complications, and reintervention-in F-URS for renal stones. Continued re-evaluation of this field remains a necessity as technological advancements such as FANS and novel lasers continue to emerge.
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