Retrograde intrarenal surgery: laser showdown (Ho:YAG vs thulium fiber laser)

Purpose of review Retrograde intrarenal surgery (RIRS) has always been recommended for large stones > 20 mm, using the Ho:YAG laser. The introduction of a new technology in the urological market, the thulium fiber laser (TFL) has revolutionized the endourology world because of its characteristics and significantly shorter laser-on time (LOT) and operative time, without scarifying the champ vision. The aim of this review is to evaluate the most relevant findings of the last 2 years of each laser technology, confronting Ho:YAG vs TFL, analyzing who is more suitable for performing an efficient RIRS. Recent findings Five full clinical trials using TFL for RIRS were found. Median LOT was between 2.8 and 34 min. All stones were similar in terms of stone volume, >500 mm(3), and stone density, > 800 HU. Low complication rate, mostly Clavien-Dindo grade I and II and not related to the laser itself. One clinical trial only analyzed the efficacy of TFL for > 20 mm renal stones. Based on this review, TFL performs a more efficient RIRS than the Ho:YAG laser with similar safety.

Automated summary

This review evaluates the efficacy and safety of Ho:YAG laser and TFL in RIRS over the past two years. The findings suggest that TFL has a shorter laser-on time and operative time compared to Ho:YAG laser, while maintaining a similar level of safety. TFL is considered to be more efficient in performing RIRS.