Comparison of thulium fiber laser and holmium:YAG laser lithotripsy in retrograde intrarenal surgery for kidney Stone treatment: A randomized prospective study

Abstract

Objective

This study compares the clinical outcomes of Holmium:YAG (Ho:YAG) laser lithotripsy and Thulium Fiber Laser (TFL) lithotripsy in retrograde intrarenal surgery (RIRS) for kidney stones <20 mm.

Materials and methods

Patients who underwent RIRS for renal stones <20 mm between September 2022 and November 2023 were prospectively analyzed. They were randomly assigned to either the TFL or Ho:YAG laser group using a sealed-envelope method. Preoperative demographics, stone characteristics, kidney-ureter-bladder x-ray (KUB), ultrasound and noncontrast computer tomography (NCCT) scan findings were recorded. Operative time, laser usage time, postoperative stone-free rate (SFR), and complications were assessed and statistically analyzed.

Results

A total of 126 patients (mean age: 49.16 ± 15.18 years; 64.3% male, 35.7% female) were included. The TFL group (n = 64, 50.8%) had significantly shorter operative and laser usage times than the Ho:YAG laser group (n = 62, 49.2%) (operative time: 45.77 ± 15.67 min vs. 52.79 ± 18.11 min, p = 0.031; laser usage: 29.84 ± 13.32 min vs. 36.39 ± 15.75 min, p = 0.024). No significant SFR difference was found between groups (TFL group: n = 57, 91.8% vs. Ho:YAG laser group: n = 60, 93.8% ; p = 0.488).

Conclusion

In the treatment of kidney stones smaller than 20 mm using laser lithotripsy, both TFL and Ho:YAG laser are effective, safe, and associated with low complication rates. However, the use of TFL significantly reduces operative time and lithotripsy time, potentially improving surgical efficiency. Further studies with larger patient cohorts are necessary to validate these findings and provide additional insights into the advantages and limitations of each laser type.