Comparative outcomes of thulium fibre laser and Holmium:YAG laser lithotripsy: A matched analysis from a single centre

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Objective: 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; p = 0.617). Radiological SFR was higher in the thulium fibre laser group for all patients (85.1% vs 91.5%; p = 0.06) and also for patients with single stones (80% vs 97.8%; p = 0.014). Holmium:YAG was associated with a higher mean number of procedures (1.6 vs 1.1; p < 0.001) and longer stent indwelling time (24.6 vs 19.0 days; p = 0.010). Complication rates were low and did not differ significantly. 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

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