Abstract and Introduction
Abstract
Purpose: The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages.
Recent Findings: New Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points.
TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy.
Summary: Several new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.
Introduction
In the past 5 years many developments on laser lithotripsy have been established. New lasers as the pulsed thulium:yttrium-aluminium-garnet (YAG) and the (not so new) thulium laser fiber are now gaining increasing evidence to compete with the long lasting gold standard holmium:YAG.
Increasing evidence has supported one laser over the other in different areas as stone free rates, speed, lithotripsy efficiency or complications. Also, with the increasing number of lasers, setting ranges and pulsed modulations, some confusion has raised on the urological community to select to best generator and setting combination to be effective.
A literature review was performed searching bibliographic databases PubMed, EMBASE, and Cochrane library. Duplicate articles were eliminated and a total of 361 titles were screened. After screening, a total of 81 papers were included in the review in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines.
A narrative review of the literature was made in search of all articles regarding the three technologies from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages and to look for the right indication for each laser. A summary of the findings can be seen is Table 1.
Curr Opin Urol. 2023;33(4):302-307. © 2023 Wolters Kluwer Health, Inc.
