Thulium laser-based hemostasis during percutaneous nephrolithotomy: a prospective observational multicentric study

Purpose: Percutaneous nephrolithotomy (PNL) is a controlled grade IV renal trauma and intraoperative bleeding is the most crucial complication. Contemporarily, pulsed mode thulium laser has been reported to confer adequate hemostasis. Therefore, the primary outcome of this study was to assess safety and efficacy of thulium laser-based hemostasis during PNL.

Methods: This was a prospective observational study including all patients, aged ≥ 18 years old with renal stone(s) ≥ 20 mm in the maximal dimension, candidate for PNL. Pregnant patients or those with uncorrected coagulopathy were excluded. All procedures were performed in the prone position and in case of a well-defined active blood spurter, and hemostasis was deployed by thulium laser. Hence, the patients were further classified into group (A): required thulium laser-based hemostasis and group (B): did not require hemostasis. A comparison was made between the groups regarding patients' history, PNL outcomes and complications.

Results: Seven hundred and thirty three patients underwent the procedure and abided by the follow-up regimen. Eighty-eight patients required hemostasis (12%) for tract spurters (51 patients, 58% of group A), renal unit spurters (18 patients, 20.5% of group A) and spurters of both (19 patients, 21.5% of group A). Twenty-two patients (3.1%) received blood transfusion during the study and there was no statistically significant difference between both groups regarding the outcomes and complications. Additionally, there was no statistically significant difference between the preoperative and postoperative value of the mean glomerular filtration rate.

Conclusion: Thulium laser-based hemostasis is safe and effective for controlling the intraoperative bleeding during PNL.