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Navigating urolithiasis treatment: assessing the practicality and performance of thulium fiber laser, holmium YAG, and thulium YAG in real-world scenarios

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Abstract

Background

The management of urolithiasis has undergone significant advancements with the introduction of pulsed lasers, particularly the holmium:yttrium–aluminum-garnet (Ho:YAG) laser, which is currently considered the gold standard in endourology. However, the Ho:YAG laser has certain limitations, such as the inability to support small laser fibers (150 μm) and the requirement of a heavy water cooling system, making it challenging to transfer between operating rooms. These limitations have led to the emergence of new laser technologies, including the thulium fiber laser (TFL) and the thulium:yttrium–aluminum-garnet laser (Tm:YAG), as potential alternatives to the Ho:YAG laser.

Methods

In this review, we aimed to evaluate the effectiveness and safety of TFL, Ho:YAG, and Tm:YAG lasers in real-life scenarios by comparing clinical trial data with laboratory findings. A literature review was conducted, and relevant in vitro studies and clinical trials until March 2023 were analyzed.

Results

The findings indicate that TFL has demonstrated high ablation efficiency for stones of any composition, size, and location, superior the capabilities of Ho:YAG lasers. TFL has shown superior dusting and fragmentation abilities, lower retropulsion, and increased patient safety. The laser parameters, such as ablation efficiency, speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes.

Conclusion

Although the number of studies on TFL is limited, the available evidence suggests that TFL represents a significant advancement in laser technology for lithotripsy. However, further research is needed to fully explore the implications and limitations of TFL and Tm:YAG lasers.

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Data availability statement

Data are available by contacting authors.

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Funding

This is an independent study and is not funded by any external body.

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Authors and Affiliations

  1. GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France

    Catalina Solano, Mariela Corrales, Frederic Panthier, Luigi Candela, Steeve Doizi & Olivier Traxer

  2. Department of Endourology, Uroclin S.A.S, Medellín, Colombia

    Catalina Solano

  3. Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, Milan, Italy

    Luigi Candela

  4. Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France

    Olivier Traxer

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All authors have contributed to the study conception and design. OT: conceptualization and the idea for the article; methodology: CS, MC, and LC; formal analysis and investigation: CS; writing—original draft preparation: CS; writing—review and editing: MC, LC, FP, SD, and OT; Supervision: OT.

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Correspondence to Olivier Traxer.

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Olivier Traxer is a consultant is a consultant for Coloplast, Rocamed, Karl Storz, Medical, AMBU, and Quanta System. The other authors have no conflict of interest to declare.

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Solano, C., Corrales, M., Panthier, F. et al. Navigating urolithiasis treatment: assessing the practicality and performance of thulium fiber laser, holmium YAG, and thulium YAG in real-world scenarios. World J Urol 41, 2627–2636 (2023). https://doi.org/10.1007/s00345-023-04487-9

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