TOPLINE

For dusting kidney stones in patients undergoing retrograde intrarenal surgery, the Holmium:YAG (Ho:YAG) laser and thulium fiber laser (TFL) achieved comparable stone-free rates. Patients in the two laser-treatment groups experienced significant improvement in health-related quality of life after surgery.

METHODOLOGY

• Researchers conducted a randomized controlled trial across five tertiary care centers in the US to compare the efficacy of the pulse-modulated Ho:YAG laser and TFL during retrograde intrarenal surgery for dusting kidney stones.
• They included 178 adults with kidney stones ranging from 5 mm to 20 mm between 2023 and 2025.
• Patients were randomly assigned to receive treatment using either the pulse-modulated Ho:YAG laser (n = 89) or TFL (n = 89). Surgeons utilized a flexible ureteroscope and a 200-µm laser.
• The primary outcome was the stone-free rate, confirmed by CT imaging performed 6-12 weeks after surgery. This analysis included 133 patients who completed CT imaging after surgery, with 68 from the Ho:YAG group and 65 from the TFL group.
• Data were collected for the duration of the procedure, laser energy utilized, stent placement, and health-related quality of life. The mean follow-up duration was 1.7 months in the Ho:YAG arm and 1.5 months in the TFL arm.

TAKEAWAY

• Stone-free rates were similar between the laser groups (52.9% in the Ho:YAG group and 52.3% in the TFL group).
• The duration of the procedure, time for stone treatment, total laser energy used, and laser ablation efficiency did not differ significantly between the laser groups.
• Overall complication rates did not differ significantly between the two laser groups. All complications observed were minor, with most involving pain after surgery that required an emergency department visit.
• Health-related quality of life improved significantly in both groups after surgery (P < .001), with no significant between-group differences.

IN PRACTICE

"Both lasers are effective and efficient at dusting renal stones with minimal complications. Surgeon and institutional preferences can dictate which laser to use," the authors wrote.

SOURCE

The study was led by Margaret A. Knoedler of the Department of Urology at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. It was published online on September 24, 2026, in The Journal of Urology.

LIMITATIONS

Laser settings were not standardized. The study considered a specific stone size, possibly affecting the applicability of the findings to larger stones. Only 75% of the patients completed CT imaging after surgery.

DISCLOSURES

The authors disclosed receiving no funding for the study and having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.