Comparison of Thulium Fibre Laser and Holmium:YAG Laser in Flexible Ureteroscopic Lithotripsy for 1-2 cm Lower Pole Kidney Stones.

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.