to Compare the Effectiveness of Thulium Fiber Laser and Holmium YAG Laser for Ureteroscopic Lithotripsy

Not Applicable

Completed

Brief Summary: This prospective randomized clinical trial aimed to compare the difference in stone ablation rates of TFL and Ho:YAG laser in a clinical setting. Patients are randomized to receive URS with lithotripsy (URSL) either with TFL or Ho:YAG with an allocation ratio of 1:1. Primary outcome is the efficiency of stone ablation in terms of the stone ablation rate

Detailed Description: Having the advantages of being minimally invasive and simple, ureteroscopic lithotripsy is one of the treatment options for ureteric stone less than 1.5 cm. While many energy systems has been used for stone fragmentation during ureteroscopy, laser energy is the most commonly used approach for stone fragmentation. Currently, Holmium-YAG laser is the main laser platform being used due to its preciseness and safety. Unfortunately, Holmium-YAG laser system has some intrinsic problems, such as lower energy conversion ratio, excessive heat generation in machines, noise etc. Therefore, newer laser systems are being developed to overcome the problem. Thulium-fiber Laser (TFL) is the latest available laser system in the market with promising results. The advantages of TFL included better energy conversion ratio, less heat energy generation, more portable size, allow the generation of higher laser frequency for better stone dusting etc. Therefore, its uses are increasing popular. However, there are not many studies comparing the efficacy and stone free results of the Holmium-YAG laser and TFL systems in the literature. Therefore, investigators would like to perform a formal study to compare the two systems.

.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patients on anti-coagulation
Patients with condition that increases the risk of urolithiasis (e.g. cystinuria, hyperparathyroidism, previous intestinal resection)
Patients with abnormal urinary tract (e.g. ileal conduit, neobladder, ureteric stricture)
Patients with stones > 15 mm

Arm && Interventions

Group	Intervention	Description
Thulium-fibre laser (TFL)	Ureteroscopic lithotripsy	The laser used in this group for surgical procedure ureteroscopic lithotripsy will be the Olympus SOLTIVETM Premium SuperPulsed laser system with a 365micron laser fibre. The laser pulse setting will be 1J x 10Hz, short pulse duration (adjusted up to 600microseconds).
Holmium: yttrium-aluminum-garnet (Ho: YAG)	Ureteroscopic lithotripsy	The laser used in this group for surgical procedure ureteroscopic lithotripsy will be the Lumenis VersaPulse® PowerSuiteTM 100W laser system with a 365micron laser fibre. The laser pulse setting will be 1J x 10Hz. Pulse duration is not adjustable in this machine (up to 600microseconds).

Primary Outcome Measures

Name	Time	Method
The efficiency of stone ablation	Intraoperation	Measured by stone ablation rate(pre-operative stone volume/ laser time)

Secondary Outcome Measures

Name	Time	Method
Laser time	Intra-operation	Duration of laser use
Operation time	Intra-operation	Duration of operation
Length of hospital stay	The total number of days of hospitalization for this surgical procedure up to day 30 after the procedure	Total number of days of hospitalization for the surgical procedure
Number of patient with Complications after surgical procedure	30 days post-operation	Complications of treatment using Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Stone free rate	3 months post-operation	Defined by no detectable stone on post-operative 3-month NCCT
Number of patients require auxiliary procedure after the intervention	3 months post-operation	Defined by any additional procedure

Receive instant email notifications about changes in this clinical trial

Receive instant email notifications about changes in this clinical trial