The Journal of urology · 2026
Multicenter Randomized Controlled Trial Comparing Pulse-Modulated Holmium:YAG Laser and Thulium Fiber Laser in Retrograde Intrarenal Surgery for Dusting Kidney Stones.
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Knoedler Margaret A, Serrell Emily C, Gupta Kavita, Chehroudi Cyrus, Zampini Anna, Lee Matthew, Antar Ali, Sourial Michael, Khargi Raymond, Atallah William, Li Shuang, Yaghoubian Alan, Savin Ziv, Scotland Kymora, Knudsen Bodo, Sivalingam Sri, Nakada Stephen Y, Gupta Mantu
Аннотация
PURPOSE: High-power lasers have revolutionized the treatment of stones during retrograde intrarenal surgery, but single center and retrospective studies comparing stone-free rates and efficiency of the two most commonly used modalities, pulse modulated Holmium:YAG and Thulium Fiber Laser, have had conflicting results. We designed a multicenter randomized controlled trial to address these discrepancies.
MATERIALS AND METHODS: After IRB approval, 5 U.S. centers recruited and prospectively randomized adults aged 18-89 with intrarenal stones ≥5 mm to ≤20 mm to receive retrograde intrarenal surgery with a Holmium:YAG or Thulium Fiber Laser with the goal to dust all stones. The primary outcome was stone free rates on computed tomography at 6-12 weeks. Secondary outcomes included procedure time, laser efficiency parameters, and complications.
RESULTS: Demographics and pre-operative stone parameters of the 178 enrolled patients were similar between treatment arms. Zero fragment stone free rates were 36/68 (52.9%) for Holmium:YAG and 34/65 (52.3%) for Thulium Fiber Laser and were nearly identical (p=0.942). Procedure time, laser time, laser efficiency, and complication rates also did not show any statistical difference between groups.
CONCLUSIONS: This multi-center randomized controlled trial found no statistically significant difference in stone free rate, complications, or efficiency between high-power pulse-modulated Holmium:YAG and Thulium Fiber Laser. They are both effective at treating intrarenal stones ≤ 2 cm. Surgeon and institutional preferences can dictate which laser to use.
MATERIALS AND METHODS: After IRB approval, 5 U.S. centers recruited and prospectively randomized adults aged 18-89 with intrarenal stones ≥5 mm to ≤20 mm to receive retrograde intrarenal surgery with a Holmium:YAG or Thulium Fiber Laser with the goal to dust all stones. The primary outcome was stone free rates on computed tomography at 6-12 weeks. Secondary outcomes included procedure time, laser efficiency parameters, and complications.
RESULTS: Demographics and pre-operative stone parameters of the 178 enrolled patients were similar between treatment arms. Zero fragment stone free rates were 36/68 (52.9%) for Holmium:YAG and 34/65 (52.3%) for Thulium Fiber Laser and were nearly identical (p=0.942). Procedure time, laser time, laser efficiency, and complication rates also did not show any statistical difference between groups.
CONCLUSIONS: This multi-center randomized controlled trial found no statistically significant difference in stone free rate, complications, or efficiency between high-power pulse-modulated Holmium:YAG and Thulium Fiber Laser. They are both effective at treating intrarenal stones ≤ 2 cm. Surgeon and institutional preferences can dictate which laser to use.