Successful treatment of staghorn stones with flexible ureteroscopy and thulium fiber laser (TFL) lithotripsy: initial experience with 32 cases

Purpose To investigate the efficacy and safety of flexible ureteroscopy with thulium fiber laser lithotripsy for management of renal staghorn stones. Materials and methods Thirty-two patients with staghorn stones were recruited. Stone characteristics including: width, length, volume and density were analyzed. Ablation speed, laser efficacy and laser activity were recorded. The primary outcome was to assess stone free rate after the procedure using spiral CT scan. Results The median stone volume was 7339 (3183-53838) mm(3). Median operative and lasing time were 135 (70-200) and 117 (50-180) minutes, respectively. The mean total energy delivered was 63.930 KJ with a median ablation speed of 1.3 (0.5-4.9) mm(3)/sec. Mean laser efficacy was 7.5 +/- 3.6 Joules/mm(3). A total of 12 complications occurred in 8 patients (25%). The median hospital stay was 7 (3.5-48) hours and 30 patients (93.7%) were discharged on the same day of surgery. After the first session, seventeen patients (53%) were stone free with no residual fragments while six (19%) patients had residuals <= 2 mm. Nine patients (28%) had residuals>2 mm with median residual size of 4 (3-9) mm. A second intervention was required in 4 cases.The overall stone free rate after completion of treatment was 65.6%. Conclusion Flexible ureteroscopy with thulium fiber laser lithotripsy is a safe and effective treatment option for staghorn stones with stone free rate comparable to standard PCNL with advantages of minimal morbidity, minimal blood loss and shorter hospital stay.