Akademik Veri Yönetim Sistemi
LASERS IN MEDICAL SCIENCE, cilt.40, sa.1, 2025 (SCI-Expanded, Scopus)
Laser lithotripsy, which is widely applied in treating urinary system stones, presents difficulties such as stone migration due to retropulsion, especially in upper ureteral stones. This study aims to compare the stone migration rates of conventional Holmium:YAG (Ho:YAG), pulse modulated Ho:YAG, and Thulium Fiber Laser (TFL) in patients undergoing laser lithotripsy. A retrospective analysis of 455 patients who underwent laser lithotripsy for upper ureteral stones between 01.01.2021 and 01.06.2025 at a tertiary hospital was conducted. The cohort was divided into three groups based on the laser used: conventional 30 W Ho:YAG (Group A), pulse-modulated 65 W Ho:YAG (Group B), and TFL (Group C). Data on stone migration, operation time, laser-on time, and stone-free rates (SFR) were collected and analyzed. Significant differences in stone migration rates were observed, with Group C showing the lowest migration rate (7.8%) compared to Groups A (28.9%) and B (16.8%) (p < 0.001). TFL also resulted in significantly higher SFRs (97.1%) compared to conventional Ho:YAG laser (86.8%) (p = 0.002). Additionally, TFL reduced the need for auxiliary procedures, with only 2.9% of patients requiring flexible ureteroscopy, compared to 12.2% in Group A and 9.7% in Group B (p = 0.032). TFL significantly reduces stone migration and improves stone-free rates compared to conventional and pulse-modulated Ho:YAG lasers. Its clinical and economic benefits, including reduced need for auxiliary procedures and shorter operation times, suggest TFL as a promising alternative for upper ureteral stone treatment. Further large-scale, prospective studies are needed to validate these findings.