Category: Clinical Stones: Ureteroscopy
Introduction & Objective : Moses Technology has been shown to improve the fragmentation efficiency and reduced stone retropulsion both in in vivo and in vitro studies. However, there are no randomized trials evaluating effectiveness of this new technology during laser lithotripsy. Therefore, the objective was to compare Regular and Moses modes of holmium laser lithotripsy in terms of stone fragmentation efficiency and perioperative complications
After obtaining ethics approval, a prospective double-blind randomized trial was conducted for patients undergoing holmium laser lithotripsy. Patients were randomly assigned to have holmium laser lithotripsy with either Regular or Moses modes. Both patients and surgeons were blinded to the laser mode. All procedures were performed by four experienced urologists. Lumenis 120W generator with 200 Moses D/F/L fibers were used for all cases. Demographic data, stone parameters, peri-operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero-no retropulsion to 3-maximum retropulsion.
A total of 66 patients were included in the study (33 per each arm). Both groups were comparable in terms of age, and pre-operative stone size (1.7 vs. 1.6 cm, p>0.05). When compared with the Regular mode, Moses Technology was associated with significantly lower fragmentation time (23.4 vs. 17.5 min, p < 0.05) and total procedural time (53 vs. 42.1 min, p < 0.05). However, there were no significant differences in terms of lasing time (6.5 vs. 7.1 min, p>0.05) and total energy applied to the stones (10.8 vs. 11.5 KJ, p>0.05). When compared between Regular and Moses modes, Moses technology was associated with significantly less retropulsion (mean grade was 1 vs. 0.4, p < 0.05). There was no significant difference between both modes in terms of intraoperative complications (12.1 % vs. 3%, p>0.05). Only one case from Moses group had a small ureteral perforation requiring prolonged indwelling ureteral stenting. The success rate at the end of 1 month was comparable between both groups (90.1 vs. 87.9 %, p> 0.05).
Moses technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time could be explained by the significantly lower reropulsion of the stones during laser lithotripsy; thus improving stone fragmentation efficiency.
Ahmed Ibrahim– Endourology Fellow, McGill University Health Centre, Montreal, Quebec, Canada
Nader Fahmy– McGill University Health Centre, Montreal, Quebec, Canada
Serge Carrier– McGill University Health Centre, Montreal, Quebec, Canada
Mostafa Elhilali– McGill University Health Centre, Montreal, Quebec, Canada
Sero Andonian– McGill University Health Centre, Montreal, Quebec, Canada
McGill University Health Centre
Montreal, Quebec, Canada
Dr. Ahmed Ibrahim is an Endourology clinical research fellow at McGill University Health Centre, Montreal, QC, Canada. He graduated from Al-Azhar medical school, Cairo, Egypt where he completed his urology residency training program in 2016.
His Current research interests include role of virtual reality simulators in surgical educations, minimally invasive treatment of urinary tract stones and role of different lasers in management of bladder outlet obstruction.