PD47-08 A RANDOMIZED TRIAL ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) IV (PD47)1 May 2024PD47-08 A RANDOMIZED TRIAL ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY Alan Yaghoubian, Kavita Gupta, Chris Connors, Anna Ricapito, Raymond Khargi, Blair Gallante, William Atallah, and Mantu Gupta Alan YaghoubianAlan Yaghoubian , Kavita GuptaKavita Gupta , Chris ConnorsChris Connors , Anna RicapitoAnna Ricapito , Raymond KhargiRaymond Khargi , Blair GallanteBlair Gallante , William AtallahWilliam Atallah , and Mantu GuptaMantu Gupta View All Author Informationhttps://doi.org/10.1097/01.JU.0001008652.62443.0a.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been hypothesized that high-power Holmium (Ho:YAG) and thulium fiber lasers (TFL) can induce renal cellular damage due to heat generation. However, no human studies have confirmed or quantified this damage. Our objective was to establish a timeline and quantify evidence of such damage in patients undergoing RIRS with TFL and Ho:YAG lasers, using established kidney injury biomarkers. METHODS: Patients were randomized with unilateral non-obstructing renal stones undergoing RIRS to receive lithotripsy with either TFL or Ho:YAG lasers. A control group of patients undergoing diagnostic ureteroscopy or bladder procedures was included. Urine samples were collected at 3 time points: pre-op (V1), 1 hour post-op (V2), and 10 days post-op (V3). Samples were analyzed using ELISA for key biomarkers—Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), and β2-microglobulin (β2M)—normalized to urine creatinine. Primary outcome was the extent of renal injury based on changes in urinary biomarkers. RESULTS: 91 patients were randomized (46 TFL, 45 Ho:YAG) with similar baseline patient and stone characteristics. Both lasers led to significant increases in biomarkers immediately postoperatively, which trended to baseline by postoperative day 10 (Figure 1). Notably, the Ho:YAG laser resulted in a sustained increase in NGAL at 10 days. Multivariate analysis highlighted that NGAL is particularly sensitive to high-energy laser settings (p<0.001), while KIM-1 and β2M are influenced more by total laser energy (p<0.001, p=0.05) (Table 1). CONCLUSIONS: There is notable laser-induced renal parenchymal damage for both TFL and Ho:YAG. NGAL is more sensitive to high laser settings, consistent with NGAL being a marker of distal tubular damage. β2M and Kim-1 are more sensitive to total laser energy consistent with proximal tubular injury biomarkers. Renal damage safety profile appears similar for both lasers. Further studies evaluating the connection of heat damage from high energy lasers and kidney damage are needed. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e983 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alan Yaghoubian More articles by this author Kavita Gupta More articles by this author Chris Connors More articles by this author Anna Ricapito More articles by this author Raymond Khargi More articles by this author Blair Gallante More articles by this author William Atallah More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...