Trilogy vs 100 W Ho: YAG Laser for Lithotripsy in Mini-Percutaneous Nephrolithotomy: Superior Stone-Free Rates in a...

To compare the clinical outcomes of lithotripsy using the 100 W Ho:YAG laser and the Trilogy lithotripter in Mini-percutaneous nephrolithotomy (PCNL), and to determine the most effective method for stone clearance through a miniaturized percutaneous tract.

This double-blind, randomized, single-center controlled trial (Clinicaltrials.gov ID: NCT04559321) enrolled patients with GUY's grade 1-2 kidney stones. Participants were randomly assigned to undergo Mini-PCNL using either the 100 W Ho:YAG laser (Lumenis Pulsed 100H) or the 1.5 mm Trilogy lithotripter (EMS-Nyon). Primary endpoints were stone lithotripsy time (SLT), lithotripsy rate (SLR), and stone-free rate (SFR). SLT was defined as the time from first activation of the lithotripter/laser until no further activations were needed. The study was terminated early in August 2023 following DSMB recommendations due to evidence of efficacy in one arm.

Eighty-three patients were analyzed (Laser, n=40; Trilogy, n=43), with comparable demographic and stone characteristics. Mean SLT was 8.02 minutes (Laser) vs 5.7 minutes (Trilogy, P=.199). SLR was 179 vs 212 mm³/min (P=.218), and operative time was 75.1±26.6 vs 85.9±28.1 minutes (P=.077). Trilogy achieved a significantly higher SFR (88.4% vs 70%, P=.038). Complication rates were low (2.3% Trilogy vs 10% laser, P=.142). Residual stone volume did not differ significantly between groups.

Trilogy lithotripsy resulted in higher SFR without increasing operative time or complications, supporting its use as an effective alternative to high-power laser lithotripsy in Mini-PCNL, especially where active suction is unavailable.