Description:

The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has become the gold-standard intracorporeal lithotripsy device since it was first introduced in the 1980’s. More recently, the Thulium Fiber Laser (TFL) was introduced into the clinical setting, with the potential to address some of the inherent limitations with Ho:YAG devices. In particular, early experience suggested the TFL provided enhanced dusting and fragmenting capabilities, less retropulsion and better stone free rates compared to the Ho:YAG laser.

Relevance:

Should the initial claims of the TFL’s better dusting properties be confirmed, this would be a significant advancement in the field. The ability to dust larger stones more rapidly could enhance the role of ureteroscopy and reduce the need for more invasive procedures.

Conclusion:

The initial experience with the TFL is promising and suggests an advantage over Ho:YAG laser lithotripsy. Properly conducted prospective randomized trials are required to further delineate the advantages, disadvantages and to optimize patient outcomes.

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