2. UroToday Home
  3. Recent Abstracts
  4. Urologic Oncology
  5. Renal Cancer

Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser - Beyond the Abstract

The laser technology used for ureteroscopy and laser stone fragmentation (URSL) has shifted away from traditional low-power lasers to higher-power, higher-frequency lasers that use Moses pulse modulation technology. The higher-power Moses lasers permit surgeons to use newer fragmentation techniques, including dusting and pop-dusting of stones.


In the June issue of the Journal of Clinical Medicine, my colleagues and I shared the results of a study comparing the outcomes of URSL with these two types of lasers.1

In the study, a single surgeon treated patients with flexible ureteroscopy (Storz FlexX2) and a Moses 60W laser (Lumenis VersaPulse PowerSuite 60W) (group A). Historical control data were drawn from the same surgeon’s previous cases using a standard 20W holmium laser (group B). Apart from the laser, all equipment and techniques were exactly the same, as were pre- and postoperative regimens. Each group included 38 patients, matched for stone locations and cumulative stone sizes. When we compared data, a few clear conclusions emerged:

  • The 60W Moses laser significantly reduces operative time. Operative time with the 60W Moses laser was about 37% shorter, with a mean operative time of 51.6 minutes (± 17.1) in group A and 82.1 minutes (± 27.0) in group B.
  • With 60W Moses laser treatment, more patients were stone-free, and fewer required retreatment. After surgery, the stone-free rates were 97.3% for group A and 81.6% for group B. One group A patient and 7 group B patients needed a second procedure.
  • Complications were low in both groups. Groups A and B had 2 and 5 Clavien I/II complications, respectively. No patients in group A had any complication related to infection.

This study, one of the first to use a 60W Moses holmium laser in the clinical setting, provides support for the emergence of the laser as a new benchmark for treating stones. Future studies should look at outcomes for both costs and quality of life, including whether reductions in time and secondary procedures rates result in savings when weighed against the cost of the laser, as well as how improved stone-free rates affect patients’ lives.

Written by: Bhaskar Somani, MD, Professor, University Hospital Southampton NHS Trust

References:

  1. Pietropaolo A, Hughes T, Mani M, Somani B. Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser. J Clin Med. 2021 Jun 22;10(13):2742. Accessed online August 10, 2021 https://www.mdpi.com/2077-0383/10/13/2742/htm

Read the Abstract