Thulium fiber laser versus high-power holmium laser for renal stones: a systematic review and meta-analysis of high-quality studies.

IF 3.5 4区医学 Q2 UROLOGY & NEPHROLOGY

Therapeutic Advances in Urology Pub Date : 2026-08-20 eCollection Date: 2026-01-01 DOI:10.1177/17562872261467267

Khi Yung Fong, Han Jie Lee, Pierre Yeap, Jingzeng Du, Alvin Wei Xiang Low, Tsung Wen Chong, Palaniappan Sundaram

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引用次数: 0

Abstract

Background: Thulium fiber laser (TFL) and high-power Holmium:Yttrium-Aluminum-Garnet laser (HPHL) are common laser modalities used in flexible ureteroscopy (F-URS). Existing comparisons are imperfect due to lack of randomization, use of obsolete low-power settings, and the recent advent of technologies such as flexible and navigable ureteral access sheaths (FANS).

Objectives: To compare the safety and efficacy of TFL versus HPHL for F-URS in renal stones.

Design: A PRISMA-compliant literature review was conducted on PubMed, EMBASE, Scopus and for randomized trials or propensity score-matched studies comparing TFL to HPHL in renal stones.

Data sources and methods: Primary outcomes were study-defined stone-free rate (SFR), as well as 100% SFR (zero residual fragments). Secondary outcomes were total operation time, all complications, bleeding complications, postoperative fever, and reintervention. Random-effects meta-analyses were performed to generate risk ratios (RRs) or mean differences (MDs).

Results: Eight studies (1290 patients) were shortlisted for analysis. Only one utilized FANS; three did not routinely use ureteral access sheaths. Between TFL and HPHL, there was no significant difference in study-reported SFR (RR = 1.17, 95% CI = 0.98-1.40, p = 0.07), 100% SFR (RR = 1.16, 95% CI = 0.90-1.50, p = 0.19), total operation time (MD -1.0 min, 95% CI = -8.8 to 6.8 min, p = 0.75), all complications (RR = 1.01, 95% CI = 0.54-1.87, p = 0.97), bleeding complications (RR = 0.59, 95%CI = 0.01-23.3, p = 0.60), postoperative fever (RR = 1.23, 95% CI = 0.68-2.24, p = 0.27), and reintervention (RR = 0.72, 95% CI = 0.38-1.34, p = 0.15).

Conclusion: This meta-analysis of high-quality studies found no significant differences between HPHL and TFL in the trifecta of outcomes-SFR, complications, and reintervention-in F-URS for renal stones. Continued re-evaluation of this field remains a necessity as technological advancements such as FANS and novel lasers continue to emerge.

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铥光纤激光与高功率钬激光治疗肾结石：高质量研究的系统回顾和荟萃分析。

背景：铥光纤激光器（TFL）和高功率钬钇铝石榴石激光器（HPHL）是柔性输尿管镜（F-URS）中常用的激光形式。由于缺乏随机化，使用过时的低功率设置，以及最近出现的灵活和可导航输尿管导管（FANS）等技术，现有的比较并不完善。目的：比较TFL与HPHL治疗肾结石F-URS的安全性和有效性。设计：对PubMed、EMBASE、Scopus以及比较TFL和HPHL在肾结石中的随机试验或倾向评分匹配研究进行了一项符合prisma标准的文献综述。数据来源和方法：主要结局是研究定义的结石清除率（SFR）和100% SFR（零残留碎片）。次要结果为总手术时间、所有并发症、出血并发症、术后发热和再干预。随机效应荟萃分析产生风险比（rr）或平均差异（MDs）。结果：8项研究（1290例患者）入围分析。只有一个使用了FANS；其中3例未常规使用输尿管导管。伦敦交通局和HPHL之间没有显著差异研究报告SFR (RR = 1.17, 95% CI -1.40 = 0.98, p = 0.07), 100% SFR (RR = 1.16, 95% CI -1.50 = 0.90, p = 0.19),总操作时间(MD -1.0分钟,95% CI = -8.8到6.8分钟,p = 0.75),所有并发症(RR = 1.01, 95% CI -1.87 = 0.54, p = 0.97),出血并发症(RR = 0.59, 95% CI -23.3 = 0.01, p = 0.60),术后发热(RR = 1.23, 95% CI -2.24 = 0.68, p = 0.27),和reintervention (RR = 0.72, 95% CI -1.34 = 0.38, p = 0.15)。结论：这项高质量研究的荟萃分析发现，HPHL和TFL在肾结石F-URS的三联结局——sfr、并发症和再干预方面没有显著差异。随着fan和新型激光器等技术的不断进步，对这一领域的持续重新评估仍然是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Urology Medicine-Urology

CiteScore

3.70

自引率

0.00%

发文量

审稿时长

10 weeks

期刊介绍： Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.