Frontiers in surgery · 2026
Thulium fiber laser versus holmium:YAG laser for ureteroscopic lithotripsy: a single-center retrospective cohort study.
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Yang Longfei, Lou Yangfeng, Li Ruipeng, Li Junhua, Tang Chenhao, Wang Yanbin, Zhou Peng, Song Chen
Аннотация
OBJECTIVE: To evaluate and compare the clinical efficacy of thulium fiber laser (TFL) versus holmium:YAG laser (Ho:YAG) in the treatment of ureteral stones in a retrospective, non-randomized setting.
METHODS: We conducted a single-center retrospective cohort study of 132 patients with ureteral stones who underwent ureteroscopic laser lithotripsy between September 2023 to June 2025. Patients were stratified into TFL (n = 54) and Ho:YAG (n = 60) groups after applying exclusion criteria. Baseline demographics, stone characteristics (size, location, density), and preoperative hydronephrosis were recorded. Primary outcomes included operative time, laser time, and stone-free rate (SFR) assessed by non-contrast computed tomography (NCCT) at 12 weeks. Secondary outcomes encompassed intraoperative stone retropulsion, visual quality, complication rates, and hospital stay.
RESULTS: Baseline characteristics were comparable between groups. The TFL group showed better intraoperative visual quality (p = 0.045), shorter operative time (median 23.5 vs. 33.5 min, p = 0.001), shorter laser time (median 5 vs. 11.5 min, p < 0.001), and less stone retropulsion (p = 0.027). Intraoperative complications, including bleeding (7.4% vs. 20.0%, p = 0.043) and ureteral injury (1.9% vs. 11.7%, p = 0.028), were lower in the TFL group. Hospital stay and overall postoperative complication rates were similar. The 12-week SFR as assessed by NCCT was 96.3% in the TFL group versus 86.7% in the Ho:YAG group (p = 0.026).
CONCLUSION: In this retrospective, non-randomized cohort study, our findings suggest that thulium fiber laser (TFL) may be associated with shorter operative and laser time, better intraoperative visualization, fewer intraoperative complications, and a higher stone-free rate (SFR) confirmed by non-contrast computed tomography (NCCT) at 12 weeks postoperatively. However, limited by the retrospective, non-randomized study design and short follow-up duration, well-designed prospective randomized controlled trials with extended safety surveillance periods are warranted to confirm these findings.
METHODS: We conducted a single-center retrospective cohort study of 132 patients with ureteral stones who underwent ureteroscopic laser lithotripsy between September 2023 to June 2025. Patients were stratified into TFL (n = 54) and Ho:YAG (n = 60) groups after applying exclusion criteria. Baseline demographics, stone characteristics (size, location, density), and preoperative hydronephrosis were recorded. Primary outcomes included operative time, laser time, and stone-free rate (SFR) assessed by non-contrast computed tomography (NCCT) at 12 weeks. Secondary outcomes encompassed intraoperative stone retropulsion, visual quality, complication rates, and hospital stay.
RESULTS: Baseline characteristics were comparable between groups. The TFL group showed better intraoperative visual quality (p = 0.045), shorter operative time (median 23.5 vs. 33.5 min, p = 0.001), shorter laser time (median 5 vs. 11.5 min, p < 0.001), and less stone retropulsion (p = 0.027). Intraoperative complications, including bleeding (7.4% vs. 20.0%, p = 0.043) and ureteral injury (1.9% vs. 11.7%, p = 0.028), were lower in the TFL group. Hospital stay and overall postoperative complication rates were similar. The 12-week SFR as assessed by NCCT was 96.3% in the TFL group versus 86.7% in the Ho:YAG group (p = 0.026).
CONCLUSION: In this retrospective, non-randomized cohort study, our findings suggest that thulium fiber laser (TFL) may be associated with shorter operative and laser time, better intraoperative visualization, fewer intraoperative complications, and a higher stone-free rate (SFR) confirmed by non-contrast computed tomography (NCCT) at 12 weeks postoperatively. However, limited by the retrospective, non-randomized study design and short follow-up duration, well-designed prospective randomized controlled trials with extended safety surveillance periods are warranted to confirm these findings.