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<p>This prospective study evaluated the impact of normalized energy utilization on clinical outcomes and complications in endourological stone surgery. Between January 2024 and April 2025, 478 consecutive patients undergoing holmium: YAG laser lithotripsy were enrolled. Stone characteristics, energy parameters, operative outcomes, and complications were prospectively recorded. Normalized energy values (J/mm³) were calculated as total energy divided by stone volume. The primary endpoint was complication development. Mean normalized energy was 22.5 ± 13.1&#xa0;J/mm³ (range: 5.8–72.4). High-density stones (&gt; 1000 HU) and lower calyceal locations required significantly higher energy (<i>p</i> &lt; 0.001 and <i>p</i> = 0.012, respectively). ROC analysis identified 25&#xa0;J/mm³ as the optimal threshold for predicting complications (AUC = 0.792, sensitivity 75.8%, specificity 70.5%). Energy utilization above 25&#xa0;J/mm³ increased complication risk 4.25-fold (95% CI: 2.05–8.82, <i>p</i> &lt; 0.001), while energy above 30&#xa0;J/mm³ significantly increased severe papillary damage risk (68.5% vs. 25.3%, <i>p</i> &lt; 0.001). In multivariate analysis, normalized energy &gt; 25&#xa0;J/mm³ (OR: 4.25, <i>p</i> &lt; 0.001), prolonged operative time (OR: 1.02, <i>p</i> = 0.018), and high stone density (OR: 2.54, <i>p</i> = 0.017) were independent risk factors for complications. Overall stone-free rate was 83.7%. This study establishes evidence-based energy thresholds for safe laser lithotripsy, demonstrating that normalized energy monitoring can guide surgical decision-making and reduce complications in endourological stone surgery. </p>

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The impact of normalized energy utilization on clinical outcomes and complications in endourological stone surgery: a prospective study

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Mert Başaranoğlu,
  • Oktay Kuş,
  • Mesut Tek,
  • Erdem Akbay

摘要

This prospective study evaluated the impact of normalized energy utilization on clinical outcomes and complications in endourological stone surgery. Between January 2024 and April 2025, 478 consecutive patients undergoing holmium: YAG laser lithotripsy were enrolled. Stone characteristics, energy parameters, operative outcomes, and complications were prospectively recorded. Normalized energy values (J/mm³) were calculated as total energy divided by stone volume. The primary endpoint was complication development. Mean normalized energy was 22.5 ± 13.1 J/mm³ (range: 5.8–72.4). High-density stones (> 1000 HU) and lower calyceal locations required significantly higher energy (p < 0.001 and p = 0.012, respectively). ROC analysis identified 25 J/mm³ as the optimal threshold for predicting complications (AUC = 0.792, sensitivity 75.8%, specificity 70.5%). Energy utilization above 25 J/mm³ increased complication risk 4.25-fold (95% CI: 2.05–8.82, p < 0.001), while energy above 30 J/mm³ significantly increased severe papillary damage risk (68.5% vs. 25.3%, p < 0.001). In multivariate analysis, normalized energy > 25 J/mm³ (OR: 4.25, p < 0.001), prolonged operative time (OR: 1.02, p = 0.018), and high stone density (OR: 2.54, p = 0.017) were independent risk factors for complications. Overall stone-free rate was 83.7%. This study establishes evidence-based energy thresholds for safe laser lithotripsy, demonstrating that normalized energy monitoring can guide surgical decision-making and reduce complications in endourological stone surgery.