Indian Journal of Urology Users online:917  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
LETTERS TO EDITOR
Year : 2022  |  Volume : 38  |  Issue : 2  |  Page : 160-161
 

Author reply Re: Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial. Indian J Urol 2022;38:42-7


Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra, India

Date of Submission30-Jan-2022
Date of Acceptance03-Mar-2022
Date of Web Publication1-Apr-2022

Correspondence Address:
Sumeeta Abhay Mahajan
Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_42_22

Rights and Permissions

 

How to cite this article:
Mahajan AD, Mahajan SA. Author reply Re: Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial. Indian J Urol 2022;38:42-7. Indian J Urol 2022;38:160-1

How to cite this URL:
Mahajan AD, Mahajan SA. Author reply Re: Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial. Indian J Urol 2022;38:42-7. Indian J Urol [serial online] 2022 [cited 2022 May 26];38:160-1. Available from: https://www.indianjurol.com/text.asp?2022/38/2/160/342459


We thank the readers for their comments.

The study was conducted from May 2020 to May 2021. To our knowledge, there was no study published that compared thulium fiber laser (TFL) with holmium: yttrium aluminum garnet (Ho:YAG) laser lithotripsy in the Mini-Perc procedure for urolithiasis at the time of initiation of our study. The proposed sample size was estimated based on previously published paper by Enikeev et al.,[1] in which 120 patients were included in a proof-of-concept study with no comparison group. We could enroll 66 and 59 patients in Ho:YAG and TFL groups, respectively, due to COVID-19 situation, and based on recommendation from the statistician, we decided to discontinue the patient enrollment and presented the interim analysis.

The stone disintegration time is affected by various factors such as size, location, density, and number of stones. We agree that the proportion of stones was larger in the thulium fiber group as compared to the Ho:YAG laser group, but the average size of the stones was comparable in both, 15.6 mm in the Ho:YAG group and 17 mm in the TFL group. Similarly, the stone volume also was comparable in both the groups, 3410 cubic mm in the Ho:YAG group and 3710 cubic mm in the TFL group. The mean stone hardness (Ho:YAG – 1035 HU and TFL – 1160 HU) were comparable in both the groups. As the difference in the size of the stone, volume of the stone, and stone density/hardness was not statistically significant in both the groups, it is indicative that there was no bias in the randomization of the study. Randomization was done using online research randomizer tool (https://www.randomizer.org/). Randomized allotted numbers in both the sets were strictly followed.

Multiple stones were observed in 11/66 patients in the Ho:YAG group and in 16/59 patients in the TFL group. All the patients required single puncture for stone removal. Operative time was calculated from the successful puncture in the calyx till the exit policy.

We observed that the incidence of hematuria was higher in the TFL group as compared to the Ho:YAG group. We were not able to ascertain the exact cause for this but probably attributed to the heat generation in TFL. Although most of the in vitro studies[2] suggest that the heat generation is same as in Ho:YAG laser, further clinical studies will be required to know the exact effect of TFL on the mucosa of the pelvicalyceal system during percutaneous stone procedures.

CTRI registration was not obtained, but hospital ethics committee approval was taken prior to the initiation of the study (ECRHS/2020/04/01, dated April 15, 2020).

We apologize for the error in the Guy's stone score classification. It was a typographical error in Table 1, and hence subsequently appeared in the text.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Enikeev D, Taratkin M, Klimov R, Alyaev Y, Rapoport L, Gazimiev M, et al. Thulium-fiber laser for lithotripsy: First clinical experience in percutaneous nephrolithotomy. World J Urol 2020;38:3069-74.  Back to cited text no. 1
    
2.
Taratkin M, Laukhtina E, Singla N, Kozlov V, Abdusalamov A, Ali S, et al. Temperature changes during laser lithotripsy with Ho: YAG laser and novel Tm-fiber laser: A comparative in-vitro study. World J Urol 2020;38:3261-6.  Back to cited text no. 2
    




 

Top
Print this article  Email this article
 

    

 
   Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (281 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed314    
    Printed10    
    Emailed0    
    PDF Downloaded33    
    Comments [Add]    

Recommend this journal