Laser vs. Mechanical Lithotripsy for Kidney Stones: Which Is Better?

What is it about?

This research presents a prospective multicentre study comparing perioperative outcomes, complications, and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL). The study involved 1716 adults with normal kidneys undergoing SM-PCNL across 30 international centers, with patients divided into laser (Group 1) and non-laser (Group 2) groups. After propensity score matching based on various factors, 748 patients were analyzed. The findings indicated that non-laser devices were associated with shorter lithotripsy and operative times, and higher SFRs both intraoperatively and at 30 days post-operation. However, non-laser devices also had higher rates of complications such as transfusions and pelvic perforation. The study concludes that while both laser and non-laser lithotripsy are effective in SM-PCNL, non-laser devices improve efficiency, whereas lasers are better suited for smaller access tracts.

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Why is it important?

This research investigates the comparative effectiveness of laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL) procedures, focusing on perioperative outcomes, complications, and stone-free rates (SFRs). The study's significance lies in providing real-world data on these technologies, which is crucial for optimizing SM-PCNL techniques and improving patient outcomes. By analyzing a large international cohort, the study offers valuable insights into the practical applications of different lithotripsy modalities in diverse clinical settings. Key Takeaways: 1. The study demonstrates that non-laser lithotripsy leads to shorter lithotripsy and operative times compared to laser lithotripsy, with intraoperative and 30-day SFRs being marginally higher for non-laser devices. 2. Despite the efficiency benefits observed with non-laser lithotripsy, the research reveals an increased incidence of complications such as bleeding and visceral injuries, which are more frequent in the non-laser group. 3. The findings suggest that while both lithotripsy methods are effective in achieving stone clearance, the choice between laser and non-laser devices should consider the balance between procedural efficiency and the risk of complications, especially in relation to the access tract size used in SM-PCNL.