Outcomes of holmium: YAG laser vs. Thulium fiber laser for ureteric stones during ureterorenoscopic lithotripsy - a prospective, randomized single-centre study.

Background: The use of lasers has created a major impact in the management of stones. The aim of our study is to evaluate and compare the effectiveness and safety profile of Thulium fiber laser (TFL) and Holmium: YAG (Ho: YAG) laser in ureteric stones.

Methods: It is a prospective randomized single-centre study carried out from December 2022 to December 2023. About 110 patients were subjected to the study with 55 randomized to each group. All underwent ureterorenoscopic lithotripsy either with TFL or Ho: YAG laser. Patient demographic data, stone-related factors, and complications were analyzed in both groups and compared.

Results: Mean stone volume was comparable in the Ho: YAG laser and TFL group (578.62 [SD 296.48] mm3 vs. 556.64 [SD 246.18] mm3; P = 0.67). Mean total operative time was significantly different between the two groups (Ho: YAG - 27.3 (SD 2.77) vs. TFL - 24.8 (SD 2.58) minutes, P = 0.005). Mean lasing time was also found to be significantly different (Ho: YAG - 15.16 (SD 3.97) vs. TFL - 13.13 (SD 3.21) minutes, P = 0.004). Ablation speed was also significantly different (Ho: YAG mean 35.67 (SD 9.13) vs. TFL mean 40.48 (SD 10.60) mm3/min, P = 0.012). Stone-free rates (SFR) at 3 months follow-up were similar in TFL and Ho: YAG laser group.

Conclusions: Shorter lasing time, decreased overall operative time, and higher ablation speed are a few selective advantages of TFL over Ho: YAG laser. The SFR and complication rates remained almost the same in both.