Which Laser System Is Optimal for Cystolithotripsy of Large Bladder Calculi?

Mohammad Hajiha; Ala'a Farkouh; Akin S Amasyali; Matthew I Buell; Rose Leu; Jason Groegler; John Smith; Arthur Goyne; D Daniel Baldwin; Reihaneh Moghisi; D Duane Baldwin

doi:10.1089/end.2023.0078

Which Laser System Is Optimal for Cystolithotripsy of Large Bladder Calculi?

J Endourol. 2023 Nov;37(11):1221-1227. doi: 10.1089/end.2023.0078.

Authors

Affiliations

¹ Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
² Department of Urology, Loma Linda University Health, Loma Linda, California, USA.
³ Department of Analytics, Georgia State University, J. Mack Robinson School of Business, Atlanta, Georgia, USA.

PMID: 37698888
DOI: 10.1089/end.2023.0078

Abstract

Introduction and Objective: A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. Materials and Methods: In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 μm fiber. Lasers compared were as follows: 60 W TFL, 120 W HL with MOSES, and conventional 120, 100, and 30 W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost-effectiveness was modeled using laser purchase price, fiber, and operating room (OR) time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. Results: The laser and total operating times were significantly different between the five systems (p < 0.001). The 120 W HL with MOSES was the fastest with 60.9 minutes of laser and 68.3 minutes of procedure times, while the 30 W HL was the slowest with 281.2 minutes of laser and 297.5 minutes of procedure times. The 60 W TFL was faster than the 30 W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (R_s = -0.98; p = 0.002). When estimating cost per procedure, the MOSES HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared with the 100 W HL. Conclusions: When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume.

Keywords: holmium; laser lithotripsy; solid-state lasers; thulium; urinary bladder calculi.

MeSH terms

Calcium Oxalate
Holmium
Humans
Lasers, Solid-State* / therapeutic use
Lithotripsy, Laser* / methods
Thulium
Urinary Bladder Calculi* / surgery

Substances

Thulium
Calcium Oxalate
Holmium