Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis

Area of Science:

• Urology
• Medical Technology
• Laser Surgery

Background:

• Renal stone treatment often involves lasers, with varying outcomes reported for different laser types.
• High-Power Laser (HPL) and Low-Power Laser (LPL) are two such technologies used in retrograde intrarenal surgery (RIRS).

Purpose of the Study:

• To compare the efficacy and safety of HPL versus LPL in patients undergoing RIRS for kidney stones under 2 cm.
• To evaluate the impact of HPL and LPL on key surgical parameters including stone-free rates, operation duration, hospitalization, and fluoroscopy time.

Main Methods:

• An observational, retrospective, comparative, multicentric study was conducted on a prospectively organized database.
• A total of 217 patients undergoing RIRS for kidney stones < 2 cm were initially included.
• Propensity score matching was performed, resulting in a final analysis of 192 patients (96 in each group: LPL vs. HPL).

Main Results:

• No significant difference was observed in stone-free rates between the LPL and HPL groups at day 1 (80.3% vs. 78.1%) and month 3 (90.7% vs. 87.5%).
• Hospitalization duration (2.35 ± 2.27 days vs. 1.42 ± 1.10 days), operation duration (88.70 ± 29.72 min vs. 66.17 ± 41.02 min), and fluoroscopy time (90.73 ± 4.79 s vs. 50.78 ± 5.64 s) were significantly lower in the HPL group (p < 0.001 for all).
• Complication rates, classified by Clavien Classification, were similar between the two groups (p > 0.05).

Conclusions:

• Both HPL and LPL achieve comparable stone-free rates and complication profiles in RIRS for kidney stones.
• HPL offers significant advantages by reducing operation time, hospitalization duration, and fluoroscopy time.
• Despite higher initial costs, HPL's versatility in energy and frequency settings enhances its utility for urologists.