Comparative outcomes of thulium fibre laser and Holmium:YAG laser lithotripsy: A matched analysis from a single centre
Erfan Masiha, Sohani N. Dassanayake, Shriya N. Fernandes, Amelia Pietropaolo, Maria F. Frascheri, Nico C. Grossmann, Bhaskar K. SomaniObjective:
Thulium fibre laser has emerged as an alternative to Holmium:YAG laser lithotripsy for ureteroscopic management of kidney stone disease. However, real-world comparative data from the United Kingdom remain limited. This study compared outcomes following thulium fibre laser and Holmium:YAG laser lithotripsy during ureteroscopy.
Methods:
A retrospective matched analysis was performed of adult patients undergoing ureteroscopy with laser lithotripsy for kidney stone disease at a single tertiary centre between September 2023 and July 2025. The co-primary outcomes were endoscopic stone-free rate and radiological SFR at follow-up. Secondary outcomes included operative time, number of procedures, length of stay, stent indwelling time, and complications.
Results:
Following matching, 47 patients were included in each group. Baseline characteristics were comparable, although bilateral stones and ureteral access sheath use were more common in the Holmium:YAG group. Endoscopic stone-free rate was similar between groups (93.6% Holmium:YAG vs 97.9% thulium fibre laser;
Conclusion:
Both thulium fibre laser and Holmium:YAG achieved comparable endoscopic stone-free rates following ureteroscopy. Thulium fibre laser was associated with higher stone clearance at radiological follow-up, required fewer procedures per patient and was associated with shorter stent dwell times. Further prospective multicentre studies are needed to confirm these findings and evaluate their cost-effectiveness.
Level of evidence:
3