Thulium fiber laser versus holmium:YAG laser for ureteroscopic lithotripsy: a single-center retrospective cohort study.

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.