Comparison of ureteoroscopy and laser stone fragmentation between Holmium: YAG laser with MOSES versus non-MOSES technology: a prospective single-center propensity score-matched analysis using similar laser settings.

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY Therapeutic Advances in Urology Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI:10.1177/17562872241272974

Victoria Jahrreiss, Francesco Ripa, Clara Cerrato, Carlotta Nedbal, Amelia Pietropaolo, Bhaskar Somani

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Abstract

Background: In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies.

Methods: Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4-1 J, 20-40 Hz) with dusting and pop-dusting technique. The independent t-test, Mann-Whitney U test, and Chi-squared test were used, with a p-value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis.

Results: A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, p = 0.42), pre-stenting (37% and 35%, p = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, p = 0.73), and ureteral access sheath use (37% and 35%, p = 0.77) respectively.While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%.

Conclusion: While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes.

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采用 MOSES 和非 MOSES 技术的钬：YAG 激光与激光碎石术的比较：采用相似激光设置的前瞻性单中心倾向得分匹配分析。

背景：体外研究表明，钬调制光学增强系统（MOSES）技术可提高碎石疗效并减少反推，但将其与非MOSES技术进行比较的临床证据仍然很少。我们对采用 MOSES 技术的钬：YAG 激光与非 MOSES 技术的尿道镜检查和激光碎石术（URSL）进行了比较：方法：前瞻性地收集并分析了患者数据和结果，包括患者人口统计学、结石参数和临床结果。采用相同的临床激光设置（0.4-1 J，20-40 Hz）、除尘和爆破除尘技术，将使用不含 MOSES 技术的标准钬激光进行 URSL 的患者（第 1 组）与使用 MOSES 的钬激光进行 URSL 的患者（第 2 组）进行比较。采用独立 t 检验、曼-惠特尼 U 检验和卡方检验，P 值为结果：共分析了 206 名患者（1:1 匹配），男女比例为 94:112，中位年龄为 56 岁（范围：39-68）。第 1 组和第 2 组在输尿管结石（27.7% 和 22.3%，p = 0.42）、支架植入前（37% 和 35%，p = 0.66）、结石平均数量（1.76 ± 1.3）和（1.82 ± 1.4，p = 0.73）以及输尿管通道鞘的使用（37% 和 35%，p = 0.77）方面分别匹配。虽然在临床结果上没有明显的统计学差异，但第2组的结石大小略大，为14.8±10.8毫米对11.7±8.0毫米，手术时间为42.7±30.6分钟对48.5±25分钟，围手术期并发症发生率为3.9%对4.9%，无结石率为90.3%对87.4%：虽然从临床结果来看，使用 MOSES 技术对治疗结石略有益处，但在统计学上并不显著。由于这一争论仍在继续，因此有必要进行高质量的随机研究，以显示这些结果是否存在真正的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Urology Medicine-Urology

CiteScore

3.70

自引率

0.00%

发文量

审稿时长

10 weeks

期刊介绍： Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.