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Asian Journal of Urology, 2023, 10(3): 289-297    doi: 10.1016/j.ajur.2022.11.003
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Thulium fiber laser lithotripsy: Is it living up to the hype?
John Denstedt(),Fernanda C. Gabrigna Berto
Division of Urology, Department of Surgery, Western University, Schulich School of Medicine and Dentistry, London Canada
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Abstract: 

ObjectiveThe holmium:yttrium-aluminium-garnet laser (Ho:YAG) has been the gold standard for laser lithotripsy over the last three decades. After demonstrating good in vitro efficacy, the thulium fiber laser (TFL) has been recently released in the market and the initial clinical results are encouraging. This article aims to review the main technology differences between the Ho:YAG laser and the TFL, discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.
MethodsWe reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.
ResultsIn vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice. However, as TFL is a new technology, limited studies are currently available, and the optimal settings for lithotripsy are not yet established.
ConclusionTFL has the potential to be an alternative to the Ho:YAG laser, but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness, safety, and costs.
Key words:  Urolithiasis    Thulium fiber laser    Holmium:yttrium-aluminium-garnet laser    Laser lithotripsy
收稿日期:  2022-10-20           接受日期:  2022-11-20           发布日期:  2023-08-11      整期出版日期:  2023-07-20
引用本文:    
. [J]. Asian Journal of Urology, 2023, 10(3): 289-297.
John Denstedt,Fernanda C. Gabrigna Berto. Thulium fiber laser lithotripsy: Is it living up to the hype?. Asian Journal of Urology, 2023, 10(3): 289-297.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2022.11.003  或          http://www.ajurology.com/CN/Y2023/V10/I3/289
Characteristics Thulium fiber laser High-power Ho:YAG laser
Light source Laser diodes Flash lamp
Wavelength, nm 1940 2120
Water penetration depth, mm 0.077 0.314
Pulse energy range, J 0.025-6.0 0.2-6.0
Maximum frequency, Hz 2400 80
Maximum average power, W 50 120
Pulse width Short and long pulse Short and long pulse
Beam profile Similar to Gaussian curve Faster spike and slower descendant
Cooling system Air Water
Power outlet Regular power outlet Dedicated high voltage
  
Characteristic Thulium fiber laser High-power Ho:YAG laser
Machine size and weight Smaller and lighter Bigger and heavier
Particle size Smaller dust and fragments Dust and fragments
Fiber size Minimum 50 μm Minimum 200 μm
Retropulsion and burnback Less burnback and retropulsion More burnback and retropulsion
Ablation speed Faster Slower
Energy efficiency Higher efficiency Lower efficiency
  
Procedure Thulium fiber laser Ho:YAG laser
PCNL ·?
Kronenberg et al., 2021 [60];
·Fragmentation: 1.5 J and 15-30 Hz,
·Dusting: 0.1-0.3 J and 50-100 Hz
·?
Shah et al., 2021 [68];
·Stones <1000 HU: 0.2 J and 125-150 Hz,
·Stones 1000-1400 HU: 0.2 J and 150-200 Hz,
·Stones >1400 HU: 0.2 J and 200 Hz		 ·?
Tzelves et al., 2021 [11];
·Fragmentation: 0.8-1.4 J and 6-10 Hz
RIRS and ureteroscopy ·?
Enikeev et al., 2021 [52];
·Fragmentation: 0.5 J and 30 Hz,
·Dusting: 0.15 J and 100 Hz
·?
Kronenberg et al., 2021 [60];
·Renal stones: 0.1-0.2 J with 15-30 W,
·Ureteric calculi: 0.1-0.2 J with 10-15 W
·?
Sierra et al., 2022 [73];
·Fragmentation: 0.1-1.5 J and 5-60 Hz (7.5-60 W),
·Dusting: 0.05-0.5 J and 20-400 Hz (7.5-45 W)		 ·?
Tzelves et al., 2021 [11];
·Dusting: 0.2-0.5 J and 10-70 Hz,
·Pop corning: 1.0-1.5 J and 15-40 Hz
Cystolitholapaxy ·?
Kronenberg et al., 2021 [60];
·2-5 J and 5-10 Hz		 ·?
Tzelves et al., 2021 [11];
·0.8-1.4 J and 6-10 Hz
  
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Asian Journal of Urology, ISSN 2214-3882 (Print), ISSN 2214-3890 (Online), CN 31-2124/R
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