Could the High-Power Laser Increase the Efficacy of Stone Lithotripsy During Retrograde Intrarenal Surgery?

To compare a high-power setting in holmium: yttrium-aluminum-garnet laser lithotripsy with the established low-power setting approach during retrograde intrarenal surgery (RIRS). Our study analyzed the data of consecutive patients managed with RIRS. The patients were divided into two groups according to the employed laser settings of power, energy, and frequency; dusting (20 W = 0.5 J × 40 Hz) (group 1) and stone self-popping (60 W = 1.5-2 J × 30-40 Hz) (group 2). Perioperative outcomes, including operative time (OT) and stone disintegration time (SDT), were compared between groups. The stone-free rate (SFR) was evaluated 1 month after the surgery. Overall, 174 patients with 179 renal units were included. The dusting mode was utilized in 98 patients (100 renal units), whereas 76 patients (79 renal units) underwent the stone self-popping technique. The SFR was 82.1% for both groups. The OT and SDT were 60.1 ± 18.6 and 32.6 ± 9.4 minutes, respectively, for group 1 and 44.9 ± 15.5 and 16.5 ± 4.7 minutes, respectively, for group 2. According to the final analysis, laser lithotripsy using the stone self-popping technique was significantly faster compared with the dusting technique with coefficient values of 14.12 minutes (95% confidence interval [CI] = 8.8-19.44) and 15.84 minutes (95% CI = 13.44-18.2) for OT and SDT, respectively. The stone self-popping technique with power at 60 W, frequency at 30 to 40 Hz, and energy at 1.5 to 2.0 J is a safe and effective modality for active treatment of renal stones. In comparison with the dusting mode, it resulted in significantly faster procedures (14.12 minutes) with similar SFRs.