Skip to main content
SpringerLink
Log in

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

  • Invited Review
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Enikeev D, Shariat SF, Taratkin M, Glybochko P (2020) The changing role of lasers in urologic surgery. Curr Opin Urol 30(1):24–29

    Article  Google Scholar 

  2. Mullerad M, Aguinaga JRA, Aro T, Kastin A, Goldin O, Kravtsov A, Assadi A, Badaan S, Amiel GE (2017) Initial clinical experience with a modulated holmium laser pulse-moses technology: does it enhance laser lithotripsy efficacy? Rambam Maimonides Med J. https://doi.org/10.5041/RMMJ.10315

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ventimiglia E, Traxer O (2019) What is moses effect: a historical perspective. J Endourol 33(5):353–357

    Article  Google Scholar 

  4. Glybochko P, Altshuler G, Yaroslavsky I, Vinarov A, Rapoport L, Enikeev D, Sorokin N, Dymov A, Vinnichenko V (2017) Comparative in vitro study of Ho: Yag and Tm fiber laser lithotripters in dusting mode of operation. J Urol 197(4):E815–E815

    Google Scholar 

  5. Nazif OA, Teichman JM, Glickman RD, Welch AJ (2004) Review of laser fibers: a practical guide for urologists. J Endourol 18(9):818–829

    Article  Google Scholar 

  6. Jackson SD, Lauto A (2002) Diode-pumped fiber lasers: a new clinical tool? Lasers Surg Med 30(3):184–190

    Article  Google Scholar 

  7. Enikeev D, Okhunov Z, Rapoport L, Taratkin M, Enikeev M, Snurnitsyna O, Capretz T, Inoyatov J, Glybochko P (2019) Novel thulium fiber laser for enucleation of prostate: a retrospective comparison with open simple prostatectomy. J Endourol 33(1):16–21

    Article  Google Scholar 

  8. Enikeev D, Glybochko P, Rapoport L, Snurnitsyna O, Potoldykova N, Novoselova T, Laukhtina E, Taratkin M, Margulis V (2018) Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate. Int Urol Nephrol 50(12):2173–2177

    Article  CAS  Google Scholar 

  9. Glybochko PV, Rapoport LM, Enikeev ME, Enikeev DV (2017) Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks. Urologia 84(3):169–173. https://doi.org/10.5301/uj.5000232

    Article  PubMed  Google Scholar 

  10. Fried NM (2018) Recent advances in infrared laser lithotripsy [Invited]. Biomed Opt Express 9(9):4552–4568

    Article  CAS  Google Scholar 

  11. Traxer O, Keller EX (2019) Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium: YAG laser. World J Urol. https://doi.org/10.1007/s00345-019-02654-5

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rapoport LM, Vinarov AZ, Sorokin NI, Dymov AM, Enikeev DV, Tsarichenko DG, Lekarev VY, Klimov RE, Andreeva VA, Kovalenko AA (2018) Experimental verification of thulium lithotripsy. Urologiia 5:74–80

    Article  Google Scholar 

  13. Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV, Wolf JS Jr, Grabe M, Gravas S, Group CPS (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62(2):246–255

    Article  Google Scholar 

  14. Andreeva V, Vinarov A, Yaroslavsky I, Kovalenko A, Vybornov A, Rapoport L, Enikeev D, Sorokin N, Dymov A, Tsarichenko D et al (2019) Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 38:497–503

    Article  Google Scholar 

  15. Dymov A, Glybochko P, Alyaev Y, Vinarov A, Altshuler G, Zamyatina V, Sorokin N, Enikeev D, Lekarev V, Proskura A et al (2017) Thulium lithotripsy: from experiment to clinical practice. J Urol 197(4):E1285–E1285

    Google Scholar 

  16. Blackmon RL, Irby PB, Fried NM (2011) Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. J Biomed Opt 16(7):071403

    Article  Google Scholar 

  17. Kronenberg P, Traxer O (2019) The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 8(Suppl 4):S398–S417

    Article  Google Scholar 

  18. Isner JM, Lucas AR, Fields CD (1988) Laser therapy in the treatment of cardiovascular disease. Br J Hosp Med 40(3):172–178

    CAS  PubMed  Google Scholar 

  19. Winship B, Wollin D, Carlos E, Li J, Peters C, Simmons WN, Preminger GM, Lipkin M (2018) Dusting efficiency of the moses holmium laser: an automated in vitro assessment. J Endourol 32(12):1131–1135

    Article  Google Scholar 

  20. Elhilali MM, Badaan S, Ibrahim A, Andonian S (2017) Use of the moses technology to improve holmium laser lithotripsy outcomes: a preclinical study. J Endourol 31(6):598–604

    Article  Google Scholar 

  21. Gross A, Becker B, Taratkin M, Enikeev D, Rapoport L, Netsch C (2018) Wavelength and pulse shape effects on stone fragmentation of laser lithotripters. J Urol 199(4):E293–E294

    Google Scholar 

  22. Hardy LA, Kennedy JD, Wilson CR, Irby PB, Fried NM (2017) Analysis of thulium fiber laser induced bubble dynamics for ablation of kidney stones. J Biophoton 10(10):1240–1249

    Article  CAS  Google Scholar 

  23. Wilson CR, Hardy LA, Irby PB, Fried NM (2015) Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy. Lasers Surg Med 47(5):403–410

    Article  Google Scholar 

  24. Fried NM, Murray KE (2005) High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russian Federation

    Dmitry Enikeev, Mark Taratkin, Roman Klimov, Yuriy Alyaev, Leonid Rapoport, Magomed Gazimiev, Dmitry Korolev, Stanislav Ali, Gagik Akopyan, Dmitry Tsarichenko & Petr Glybochko

  2. Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia

    Irina Markovina & Francis A. Jefferson

  3. GRC #20 Lithiase Urinaire, Hôpital Tenon, Sorbonne University, Paris, France

    Eugenio Ventimiglia & Olivier Traxer

  4. Department of Internal Diseases, Sechenov University, Moscow, Russia

    Evgenia Goryacheva

  5. Department of Urology, University of California, Irvine, USA

    Zhamshid Okhunov

Authors
  1. Dmitry Enikeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Taratkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roman Klimov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuriy Alyaev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leonid Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Magomed Gazimiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dmitry Korolev
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stanislav Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gagik Akopyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dmitry Tsarichenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Irina Markovina
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Eugenio Ventimiglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Evgenia Goryacheva
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Zhamshid Okhunov
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Francis A. Jefferson
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Petr Glybochko
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Olivier Traxer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DE—manuscript writting/editing; protocol development. MT—manuscript writting; protocol development; data analysis. RK—data collection; protocol development; data analysis. YA—manuscript editing; protocol development. LR—manuscript editing; protocol development. MG—manuscript editing; protocol development. DK—data collection; protocol development. SA—data collection; protocol development. GA—data collection; protocol development; DT—data collection; protocol development; IM—manuscript editing. EV—manuscript editing. EG—manuscript editing. ZO—manuscript editing; protocol development. FAJ—manuscript editing; data analysis. PG—manuscript editing; protocol development. OT—manuscript writting/editing; protocol development.

Corresponding author

Correspondence to Dmitry Enikeev.

Ethics declarations

Conflict of interest

No potential conflict of interest was reported by the authors.

Ethical approval

Study was approved by the Sechenov University (Moscow, Russia) institutional review board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Enikeev, D., Taratkin, M., Klimov, R. et al. Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy. World J Urol 38, 3069–3074 (2020). https://doi.org/10.1007/s00345-020-03134-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03134-x

Keywords

Search

Navigation