Comparative study on the efficacy of Moses holmium laser versus traditional holmium laser in the treatment of renal calculi under flexible ureteroscopic lithotripsy
Objective To compare the effectiveness of the Moses holmium laser and the traditional holmium laser in the treatment of kidney stones using flexible ureteroscopy.Methods The data of 425 patients with kidney stones treated with flexible ureteroscopic holmium laser lithotripsy at Hebei University Affiliated Hospital from January 2017 to January 2023 were retrospectively analysed.Among them,136 cases were treated with traditional holmium laser(traditional group),and 289 cases were treated with Moses holmium laser(Moses group).To minimize selection bias due to non-random allocation,1:1 propensity score matching(PSM)was employed,ensuring comparability between the two groups in baseline characteristics(age,gender)and stone characteristics(stone location,number,diameter,CT value,and stone composition).The differences in operation time,laser action time,stone clearance rate(SFR),postoperative complications and secondary treatment rate were compared between the two groups after matching.The risk factors affecting SFR were analyzed by multivariate logistic regression.The efficacy of Moses group and traditional group in treating kidney stones with diameter ≥ 20 mm was also compared.Results After PSM,108 patients were selected from each group for data analysis.Traditional group and Moses group demonstrated good consistency in baseline characteristics,including age[57.0(49.0,65.0)years old vs.58.5(51.8,66.0)years old],male gender[58.3％(63/108)vs.60.2％(65/108)],stone location(upper calyx/mid calyx/lower calyx/pelvis:33/35/38/42 cases vs.35/33/40/42 cases),multiple stones[33.3％(36/108)vs.35.2％(38/108)],diameter[14.0(11.0,16.0)mm vs.14.0(12.0,17.0)mm],CT value[1 115.5(993.2,1 228.2)HU vs.1 114.5(1 000.2,1 216.5)HU],and the presence of calcium stones[83.3％(90/108)vs.79.6％(86/108)],and all showing absolute standardized mean difference(ASMD)＜0.1.The Moses group had shorter operation time[48.5(36.0,56.0)min vs.60.0(48.8,68.0)min,P＜0.01],higher post-operative stone-free rate(SFR)[88.9％(96/108)vs.67.6(73/108),P＜0.01],and lower rate of secondary surgery[1.8％(2/108)vs.9.3％(10/108),P=0.04],indicating advantages in surgical efficiency and post-operative outcomes.Multivariable logistic regression analysis revealed that using Moses holmium laser(OR=0.029,P＜0.01),stone diameter(OR=1.492,P＜0.01),stone CT value(OR=1.007,P＜0.01),presence of calcium stones(OR=1.551,P＜0.01),holmium laser application time(OR=0.863,P＜0.01),preoperative placement of a double-J stent(OR=0.193,P＜0.01),and preoperative moderate to severe hydronephrosis(OR=1.651,P＜0.01)were significant factors affecting SFR.In treating stones with a diameter of 20-30 mm,the surgery time of Moses group was shorter than that of traditional group[50.5(43.8,58.3)min vs.72.0(68.0,78.0)min,P＜0.05],and the laser application time of Moses group was also shorter[29.5(22.8,36.0)min vs.36.0(32.0,41.0)min,P＜0.05].The post-operative SFR of Moses group was higher than that of traditional group[65.6％(42/64)vs.35.3％(6/17),P＜0.05],and the rate of secondary surgery was lower[7.8％(5/64)vs.29.4(5/17),P＜0.05].Conclusions Flexible ureteroscopy combined with Moses holmium laser lithotripsy demonstrated significant advantages over traditional holmium laser in enhancing stone clearance rate,reducing operation time,and lowering the need for secondary surgeries in the treatment of kidney stones.Flexible ureteroscopy combined with Moses holmium laser lithotripsy also proves its efficacy and clinical value in managing complex kidney stone cases.
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