A Comparison of the Thulium Fiber Laser versus Holmium:YAG Laser Lithotripsy of Upper Urinary Tract Calculi: Preliminary Results of a Randomized Prospective Clinical Trial
Abstract
The Holmium:yttrium-aluminium-garnet (Ho:YAG) laser has become an indispensable tool in Endourology since its introduction in 1995, due to its safe and efficient urinary stone fragmentation capabilities. The Thulium Fiber Laser (TFL), is the latest innovation with early clinical experience suggesting improvements over the Ho:YAG. This prospective, randomized controlled study aims to compare clinical outcomes of Ho:YAG versus TFL lithotripsy for upper urinary tract calculi. Patients undergoing ureteroscopy for renal stones (size 8-20mm, density >600 HU) from a single institution were prospectively recruited.
Thirty-eight patients have been recruited (Ho:YAG=20, TFL=18). The laser-on time (p=.330), total operative time (p=.849), total laser energy (p=.745), ablation speed (p=.745) and ablation efficiency (p=.745) were not statistically different between groups. Multiple trends in favor the TFL were documented, including shorter laser-on time and total operative time, improved ablation efficiency and ablation speed.
Preliminary results suggest similar outcomes for both technologies. Several parameters are trending in favor of the TFL being more efficient; however, recruitment fulfillment will be necessary to determine if there are significant differences.