High-power holmium laser versus pulsed thulium laser for ureteroscopic lithotripsy: Results of a randomized prospective study

Introduction: Current evidence indicates that the outcomes obtained with the holmium laser (Ho:YAG) and the thulium fiber laser (TFL) in the endoscopic treatment of upper urinary tract stones are at least equivalent. The recent introduction of the pulsed thulium laser (p-Tm:YAG) could result, due to its characteristics, in the ideal combination of its predecessors. The aim of this study was to compare the performance and outcomes between high-power Ho:YAG and p-Tm:YAG. Material and methods: This prospective randomized clinical study included patients with a single renal or ureteral stone, who underwent retrograde endoscopic surgery. Results: for Ho:YAG; p = 0.48). Conclusions: Intracorporeal lithotripsy with p-Tm:YAG shows non-inferior results in terms of stone-free rates compared to high-power Ho:YAG. There is a trend in favor of p-Tm:YAG regarding the total energy required and a lower need for a subsequent double-J catheter, which should be corroborated by further studies in this field of urology.