Archivos espanoles de urologia · 2026
Comparison of Thulium Fibre Laser and Holmium:YAG Laser in Flexible Ureteroscopic Lithotripsy for 1-2 cm Lower Pole Kidney Stones.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Zhang Jiacheng, Xiong Jinguo, Zhao Zhonghao, Cao Zhihua
Аннотация
OBJECTIVE: To compare the efficacy and safety of thulium fibre laser (TFL) and holmium:yttrium aluminum garnet (Ho:YAG) laser in flexible ureteroscopic lithotripsy for 1-2 cm lower pole kidney stones.
METHODS: This retrospective analysis included 160 patients with 1-2 cm lower pole stones (LPSs) admitted to our hospital between January 2024 and December 2025. Patients were assigned to a TFL group and a Ho:YAG group according to the surgical technique used. After applying propensity score matching (PSM), two matched groups with 60 cases each were obtained. Outcome variables included surgery-related indicators, postoperative recovery indicators, stone-free rate (SFR), and postoperative complications.
RESULTS: The operation time, lithotripsy time, hospital stay, first ambulation time, and urethral catheter indwelling time in the TFL group were significantly shorter than those in the Ho:YAG group (all p < 0.05). The incidence of intraoperative stone retropulsion and the visual analogue scale (VAS) score at 24 h postoperatively were significantly lower in the TFL group than in the Ho:YAG group (both p < 0.05). At 4 weeks postoperatively, the SFR was significantly higher in the TFL group than in the Ho:YAG group (93.33% vs. 80.00%; p < 0.05), and the overall complication rate was significantly lower in the TFL group than in the Ho:YAG group (6.67% vs. 20.00%; p < 0.05). Stratified analysis showed that TFL was associated with shorter operation time and lithotripsy time across different stone sizes and densities. Furthermore, in patients with a diameter ≥1.5 cm, the SFR was higher in the TFL group than in the Ho:YAG group. The SFR in the Ho:YAG group was significantly lower in large-diameter stones than in small-diameter stones, whereas the TFL group showed consistently high SFR (>90%) across all subgroups.
CONCLUSIONS: Compared with Ho:YAG laser, TFL was associated with better efficiency and perioperative outcomes in flexible ureteroscopic lithotripsy for 1-2 cm LPSs. TFL may provide more consistent fragmentation efficacy in larger stones and may reduce the risk of stone retropulsion and postoperative complications.
METHODS: This retrospective analysis included 160 patients with 1-2 cm lower pole stones (LPSs) admitted to our hospital between January 2024 and December 2025. Patients were assigned to a TFL group and a Ho:YAG group according to the surgical technique used. After applying propensity score matching (PSM), two matched groups with 60 cases each were obtained. Outcome variables included surgery-related indicators, postoperative recovery indicators, stone-free rate (SFR), and postoperative complications.
RESULTS: The operation time, lithotripsy time, hospital stay, first ambulation time, and urethral catheter indwelling time in the TFL group were significantly shorter than those in the Ho:YAG group (all p < 0.05). The incidence of intraoperative stone retropulsion and the visual analogue scale (VAS) score at 24 h postoperatively were significantly lower in the TFL group than in the Ho:YAG group (both p < 0.05). At 4 weeks postoperatively, the SFR was significantly higher in the TFL group than in the Ho:YAG group (93.33% vs. 80.00%; p < 0.05), and the overall complication rate was significantly lower in the TFL group than in the Ho:YAG group (6.67% vs. 20.00%; p < 0.05). Stratified analysis showed that TFL was associated with shorter operation time and lithotripsy time across different stone sizes and densities. Furthermore, in patients with a diameter ≥1.5 cm, the SFR was higher in the TFL group than in the Ho:YAG group. The SFR in the Ho:YAG group was significantly lower in large-diameter stones than in small-diameter stones, whereas the TFL group showed consistently high SFR (>90%) across all subgroups.
CONCLUSIONS: Compared with Ho:YAG laser, TFL was associated with better efficiency and perioperative outcomes in flexible ureteroscopic lithotripsy for 1-2 cm LPSs. TFL may provide more consistent fragmentation efficacy in larger stones and may reduce the risk of stone retropulsion and postoperative complications.