Related Experiment Video
Updated: Aug 8, 2025
Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser
Published on: May 9, 2018
Comparison of Low-Power vs High-Power Holmium Lasers in Pediatric Retrograde Intrarenal Surgery Outcomes
Esther García Rojo1, Olivier Traxer2, Diana María Vallejo Arzayús3
1Department of Urology, HM Hospitales and ROC Clinic, Hospital Universitario HM Sanchinarro, Madrid, Spain.
Insights
High-power holmium lasers significantly improve stone-free rates in pediatric retrograde intrarenal surgery (RIRS) compared to low-power lasers. This multicenter study confirms high-power laser efficacy and safety for treating pediatric kidney stones.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Background:
- Retrograde intrarenal surgery (RIRS) is a key treatment for pediatric kidney stones.
- The optimal holmium laser power for RIRS in children remains debated.
- Understanding laser parameters is crucial for improving surgical outcomes in pediatric patients.
Purpose of the Study:
- To compare outcomes of low-power (≤30 W) versus high-power (≤120 W) holmium lasers in pediatric RIRS.
- To evaluate the influence of lasering techniques and access sheath use on RIRS outcomes in children.
- To assess the safety and efficacy of different holmium laser power settings for pediatric kidney stone treatment.
Main Methods:
- Retrospective analysis of 314 pediatric RIRS cases across 9 centers (January 2015 - December 2020).
- Patients divided into high-power and low-power holmium laser groups.
- Comparison of clinical, perioperative variables, and complications using statistical tests (t-test, Chi-square, Fisher's exact, logistic regression).
Main Results:
- High-power laser group showed reduced surgical time (64.29 vs 75.27 min, p=0.018) and significantly higher stone-free rates (SFR) (81.4% vs 59%, p<0.001).
- Low-power group treated larger stones (11.11 vs 9.70 mm, p=0.018).
- Multivariable analysis indicated lower SFR with low-power lasers, particularly for larger and multiple stones (p=0.011, p<0.001); complication rates were similar between groups.
Conclusions:
- High-power holmium laser (up to 120 W) is favored in pediatric RIRS due to improved efficacy and reduced operative time.
- High-power holmium laser demonstrates safety and effectiveness in treating pediatric kidney stones.
- This multicenter study supports the use of high-power lasers for optimizing RIRS outcomes in children.
Abstract:
To compare the outcomes of using low-power (up to 30 W) vs high-power (up to 120 W) holmium lasers in retrograde intrarenal surgery (RIRS) in children and to analyze if lasering techniques and the use of access sheath have any influence on the outcomes. We retrospectively reviewed data from 9 centers of children who underwent RIRS with holmium laser for the treatment of kidney stones between January 2015 and December 2020. Patients were divided into two groups: high-power and low-power holmium laser. Clinical, perioperative variables and complications were analyzed. Outcomes were compared between groups using Student's t-test for continuous variables, and Chi-square and Fisher's exact test for categorical variables. A multivariable logistic regression analysis model was also performed. A total of 314 patients were included. A high-power and low-power holmium laser was used in 97 and 217 patients, respectively. Clinical and demographic variables were comparable between both groups, except for stone size where the low-power group treated larger stones (mean 11.11 vs 9.70 mm, p = 0.018). In the high-power laser group, a reduction in surgical time was found (mean 64.29 vs 75.27 minutes, p = 0.018) with a significantly higher stone-free rate (SFR) (mean 81.4% vs 59%, p < 0.001). We found no statistical differences in complication rates. The multivariate logistic regression model showed lower SFR in the low-power holmium group, especially with larger (p = 0.011) and multiple stones (p < 0.001). Our real-world pediatric multicenter study favors high-power holmium laser and establishes its safety and efficacy in children.
