Thulium oder Holmium-Laser oder beides: wo geht die Reise hin?

Zusammenfassung

Der Holmium:YAG-Laser war in den letzten drei Jahrzehnten der Goldstandard für die Laserlithotripsie und seit Ende der 1990er Jahre auch für die Enukleation der Prostata. Nachdem die gepulsten Thulium-Faserlaser (TFL) ihre Wirksamkeit in in-vitro Experimenten demonstriert haben, wurden sie vor einigen Jahren auf dem Markt eingeführt. Die ersten klinischen Ergebnisse zu dem TFL für die Lithotripsie und die Enukleation sind sehr erfolgsversprechend. Neben dem TFL wurde auch ein gepulster Thulium:YAG-Festkörperlaser eingeführt, zu dem allerdings noch wenige klinische Daten vorliegen. Dieser Artikel zielt darauf ab, die wichtigsten technologischen Unterschiede zwischen dem Ho:YAG-Laser und den gepulsten Thuliumlaser zu überprüfen und die ersten klinischen Ergebnisse zur Steinlithotripsie und zur Laserenukleation gegenüberzustellen bzw. zu diskutieren.

In-vitro-Studien zeigen eine technische Überlegenheit des TFL im Vergleich zum Ho:YAG-Laser. Da der TFL jedoch noch eine neue Technologie ist, stehen derzeit nur begrenzte Studien zur Verfügung und die optimalen Einstellungen für die Lithotripsie sind noch nicht festgelegt. Bei der Enukleation scheinen die Unterschiede des TFL zu einem Hochleistungs-Ho:YAG-Laser klinisch nicht relevant zu sein. Erste Studien zum gepulsten Tm:YAG-Laser zeigen zwar vielversprechende Ergebnisse, jedoch liegen noch keine vergleichenden Studien vor.

Die gepulsten Thuliumlaser haben das Potenzial, eine Alternative zum Ho:YAG-Laser zu sein. Es sind jedoch noch weitere Studien erforderlich, um den optimalen Laser für die Enukleation und die Lithotripsie von Harnsteinen unter Berücksichtigung aller Parameter, einschließlich Wirksamkeit, Sicherheit und Kosten, zu bestimmen.

Abstract

The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.

In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.

Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.

Schlüsselwörter

Holmium Laser - Thulium Laser - Enukleation - Lithotripsy - Thulium YAG Laser

Keywords

holmium laser - thulium laser - lithotripsy - enucleation - thulium yag laser

Publication History

Received: 09 February 2024

Accepted: 04 March 2024

Article published online:
11 April 2024

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