International urology and nephrology · 2026
Clinical outcomes of thulium fiber laser versus holmium:YAG laser during pediatric retrograde ıntrarenal surgery: a multicenter cohort study.
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Özçift Burak, Miçoogulları Uygar
Аннотация
OBJECTIVE: The thulium fiber laser (TFL) is a new-generation laser technology that has been increasingly used in endourology in recent years. However, data on the use of TFL in the treatment of pediatric kidney stones are limited. The aim of this study was to compare the efficacy and safety of thulium fiber laser (TFL) and Holmium: Yttrium Aluminum Garnet (Ho:YAG) laser in children undergoing retrograde intrarenal surgery (RIRS) for a solitary renal stone measuring 10-20 mm.
MATERIALS AND METHODS: Pediatric patients (< 18 years) with a solitary renal stone measuring 10-20 mm who underwent RIRS at two tertiary referral centers between January 2020 and March 2026 were retrospectively reviewed. Patients were divided into two groups based on the laser technology used: Ho:YAG and TFL. Ho:YAG lithotripsy was predominantly performed using fragmentation strategy, whereas TFL was mainly used in dusting mode. The primary endpoint was the stone-free rate (SFR), as assessed by ultrasound at the third postoperative month. Secondary endpoints included operative time, fluoroscopy time, intraoperative stone retropulsion, the need for reintervention, length of hospital stay, and complications according to the Clavien-Dindo classification.
RESULTS: A total of 74 patients were included in the study. Forty-eight patients were treated with Ho:YAG, and 26 with TFL. The groups were comparable in terms of age, sex, body mass index, stone size, stone density, and stone location. Operative time was significantly shorter in the TFL group than in the Ho:YAG group (64.0 ± 28.35 vs. 80.0 ± 30.17 min, p = 0.028). Intraoperative stone retropulsion occurred significantly less frequently in the TFL group (11.5% vs. 35.4%, p = 0.031). The 3-month stone-free rate was 92.3% in the TFL group and 85.4% in the Ho:YAG group, with no significant difference between the groups (p = 0.486). No significant differences were found between the groups in terms of fluoroscopy time, reintervention rate, and length of hospital stay. Complication rates were similar, and no Clavien-Dindo grade IV or V complications were observed in either group.
CONCLUSION: These findings suggest that TFL may represent a safe and effective alternative to the Ho:YAG laser in pediatric RIRS. However, further prospective multicenter studies using standardized laser settings are warranted to validate these findings.
MATERIALS AND METHODS: Pediatric patients (< 18 years) with a solitary renal stone measuring 10-20 mm who underwent RIRS at two tertiary referral centers between January 2020 and March 2026 were retrospectively reviewed. Patients were divided into two groups based on the laser technology used: Ho:YAG and TFL. Ho:YAG lithotripsy was predominantly performed using fragmentation strategy, whereas TFL was mainly used in dusting mode. The primary endpoint was the stone-free rate (SFR), as assessed by ultrasound at the third postoperative month. Secondary endpoints included operative time, fluoroscopy time, intraoperative stone retropulsion, the need for reintervention, length of hospital stay, and complications according to the Clavien-Dindo classification.
RESULTS: A total of 74 patients were included in the study. Forty-eight patients were treated with Ho:YAG, and 26 with TFL. The groups were comparable in terms of age, sex, body mass index, stone size, stone density, and stone location. Operative time was significantly shorter in the TFL group than in the Ho:YAG group (64.0 ± 28.35 vs. 80.0 ± 30.17 min, p = 0.028). Intraoperative stone retropulsion occurred significantly less frequently in the TFL group (11.5% vs. 35.4%, p = 0.031). The 3-month stone-free rate was 92.3% in the TFL group and 85.4% in the Ho:YAG group, with no significant difference between the groups (p = 0.486). No significant differences were found between the groups in terms of fluoroscopy time, reintervention rate, and length of hospital stay. Complication rates were similar, and no Clavien-Dindo grade IV or V complications were observed in either group.
CONCLUSION: These findings suggest that TFL may represent a safe and effective alternative to the Ho:YAG laser in pediatric RIRS. However, further prospective multicenter studies using standardized laser settings are warranted to validate these findings.