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Comparative effectiveness of high-power holmium laser lithotripsy for pediatric patients with kidney and ureteral stones

  • William N. Harris
    Affiliations
    Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA
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  • Lusha Cao
    Affiliations
    Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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  • Gregory E. Tasian
    Correspondence
    Correspondence to: Gregory E. Tasian MD, MSc, MSCE Associate Professor of Surgery and Epidemiology, The Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19104, PA, USA Tel.: +215 590 7890.
    Affiliations
    Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA

    Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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      Summary

      Background

      The comparative effectiveness of high-power laser technology for kidney stone surgery in pediatric patients is poorly understood. We compared outcomes for the 120 W Holmium:yttrium-aluminum-garnet (Ho:YAG) laser with MOSES technology to 30 W Ho:YAG laser for pediatric patients undergoing ureteroscopy with laser lithotripsy for kidney and ureteral stones.

      Objective

      We evaluated the outcomes of the new MOSES laser technology as compared to low-power Ho:YAG lasers commonly used for kidney stone treatment in the pediatric population.

      Methods

      We performed a retrospective cohort study of 131 consecutive patients aged 1–18 years who underwent ureteroscopy and laser lithotripsy for renal and ureteric calculi at a large freestanding children's hospital between 2013 and 2020. The primary outcome was the efficiency quotient, which incorporates stone clearance, auxiliary procedures, and retreatment rates. Outcomes were compared between groups using Chi-square or Fisher's exact tests and multivariable regression. A sensitivity analysis was performed extending the age limit to ≤21 years.

      Results

      Outcomes are summarized in the table below. Median age of the cohort was 14 years with 53% of patients being female. MOSES laser had a higher efficiency quotient and was associated with a lower odds of post-operative emergency department visits (OR 0.2, 95% CI 0.0–1.0; p = 0.047). Operative time was similar. In the sensitivity analysis of patients ≤21 years, the statistical significance with fewer emergency department visits was lost and the efficiency quotient was lower.

      Discussion

      Our results show that stone clearance is similar between the 120 W MOSES and 30 W Ho:YAG lasers. However, there are indications that high-power laser lithotripsy is more efficient due to fewer auxiliary procedures and a reduction in retreatment. In addition, higher power lasers were associated with fewer emergency department visits. The benefits appear to be greater among children ≤18 years. These exploratory findings are important for pediatric patients due to the requirement for general anesthesia for each procedure and their associated impact on children and their caregivers.

      Conclusions

      High-power laser lithotripsy may be more efficient than lower power laser lithotripsy, which is driven by the fewer auxiliary procedures and reduction in retreatment particularly among youth ≤18 years old.

      Keywords

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      References

        • Turk C.
        • Petrik A.
        • Sarica K.
        • Seitz C.
        • Skolarikos A.
        • Straub M.
        • et al.
        EAU guidelines on interventional treatment for urolithiasis.
        Eur Urol. 2016; 69: 475-482
        • Assimos D.
        • Krambeck A.
        • Miller N.L.
        • Monga M.
        • Murad M.H.
        • Nelson C.P.
        • et al.
        Surgical management of stones: American urological association/endourological society guideline, PART I.
        J Urol. 2016; 196: 1153-1160
        • Zarrabi A.
        • Gross A.J.
        The evolution of lasers in urology.
        Ther Adv Urol. 2011; 3: 81-89
        • Marks A.J.
        • Teichman J.M.
        Lasers in clinical urology: state of the art and new horizons.
        World J Urol. 2007; 25: 227-233
        • Ibrahim A.
        • Badaan S.
        • Elhilali M.M.
        • Andonian S.
        Moses technology in a stone simulator.
        Can Urol Assoc J. 2018; 12: 127-130
        • Yong R.
        • Tasian G.E.
        • Kraft K.H.
        • Roberts W.W.
        • Maxwell A.
        • Ellison J.S.
        Laser access and utilization preferences for pediatric ureteroscopy: a survey of the Societies of Pediatric Urology.
        Can Urol Assoc J. 2022; 16: E155-E160
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • O'Neal L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inf. 2019; 95103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inf. 2009; 42: 377-381
        • Denstedt J.
        • Clayman R.
        • Preminger G.
        Efficiency quotient as a means of comparing lithotripters.
        J Endourol. 1990; 4: S100
        • Dunmire B.
        • Harper J.D.
        • Cunitz B.W.
        • Lee F.C.
        • Hsi R.
        • Liu Z.
        • et al.
        Use of the acoustic shadow width to determine kidney stone size with ultrasound.
        J Urol. 2016; 195: 171-177
        • Dunmire B.
        • Lee F.C.
        • Hsi R.S.
        • Cunitz B.W.
        • Paun M.
        • Bailey M.R.
        • et al.
        Tools to improve the accuracy of kidney stone sizing with ultrasound.
        J Endourol. 2015; 29: 147-152
        • Raman J.D.
        • Bagrodia A.
        • Gupta A.
        • Bensalah K.
        • Cadeddu J.A.
        • Lotan Y.
        • et al.
        Natural history of residual fragments following percutaneous nephrostolithotomy.
        J Urol. 2009; 181: 1163-1168
        • Keller E.X.
        • de Coninck V.
        • Audouin M.
        • Doizi S.
        • Bazin D.
        • Daudon M.
        • et al.
        Fragments and dust after Holmium laser lithotripsy with or without "Moses technology": how are they different?.
        J Biophot. 2019; 12e201800227
        • Elhilali M.M.
        • Badaan S.
        • Ibrahim A.
        • Andonian S.
        Use of the Moses technology to improve holmium laser lithotripsy outcomes: a preclinical study.
        J Endourol. 2017; 31: 598-604
        • Yon J.H.
        • Daniel-Johnson J.
        • Carter L.B.
        • Jevtovic-Todorovic V.
        Anesthesia induces neuronal cell death in the developing rat brain via the intrinsic and extrinsic apoptotic pathways.
        Neuroscience. 2005; 135: 815-827
        • Jevtovic-Todorovic V.
        Developmental synaptogenesis and general anesthesia: a kiss of death?.
        Curr Pharmaceut Des. 2012; 18: 6225-6231
        • Sun L.S.
        • Li G.
        • Miller T.L.
        • Salorio C.
        • Byrne M.W.
        • Bellinger D.C.
        • et al.
        Association between a single general anesthesia exposure before age 36 Months and neurocognitive outcomes in later childhood.
        JAMA. 2016; 315: 2312-2320
        • Moore G.F.
        • Audrey S.
        • Barker M.
        • Bond L.
        • Bonell C.
        • Hardeman W.
        • et al.
        Process evaluation of complex interventions: medical Research Council guidance.
        BMJ. 2015; 350: h1258