Successful treatment of staghorn stones with flexible ureteroscopy and thulium fiber laser (TFL) lithotripsy: initial experience with 32 cases

<h3>Purpose</h3><p dir="ltr">To investigate the efficacy and safety of flexible ureteroscopy with thulium fiber laser lithotripsy for management of renal staghorn stones.</p><h3>Materials and Methods</h3><p dir="ltr">Thirty-two patients with staghorn stones were recruited. Stone characteristics including: width, length, volume and density were analyzed. Ablation speed, laser efficacy and laser activity were recorded. The primary outcome was to assess stone free rate after the procedure using spiral CT scan.</p><h3>Results</h3><p dir="ltr">The median stone volume was 7339 (3183–53838) mm³. Median operative and lasing time were 135 (70–200) and 117 (50–180) minutes, respectively. The mean total energy delivered was 63.9 ± 30 KJ with a median ablation speed of 1.3 (0.5–4.9) mm³/sec. Mean laser efficacy was 7.5 ± 3.6 Joules/mm³. A total of 12 complications occurred in 8 patients (25%). The median hospital stay was 7 (3.5–48) hours and 30 patients (93.7%) were discharged on the same day of surgery. After the first session, seventeen patients (53%) were stone free with no residual fragments while six (19%) patients had residuals £ 2 mm. Nine patients (28%) had residuals > 2 mm with median residual size of 4 (3–9) mm. A second intervention was required in 4 cases.The overall stone free rate after completion of treatment was 65.6%.</p><h3>Conclusion</h3><p dir="ltr">Flexible ureteroscopy with thulium fiber laser lithotripsy is a safe and effective treatment option for staghorn stones with stone free rate comparable to standard PCNL with advantages of minimal morbidity, minimal blood loss and shorter hospital stay.</p><h2>Other Information</h2><p dir="ltr">Published in: Urolithiasis<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s00240-024-01598-9" target="_blank">https://dx.doi.org/10.1007/s00240-024-01598-9</a></p>