Pulsed solid-state thulium: YAG laser compared to holmium: YAG laser during mini-PCNL

Benedikt Becker^1,2, Sophia Hook¹, Carla Dapper¹, Julius Bergmann¹, Christopher Netsch¹, Simon Filmar^1,*
1 Department of Urology, Asklepios Hospital Barmbek, Hamburg, 22307, Germany
2 Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, 23538, Germany
* Corresponding Author: Simon Filmar. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.072386

Received 26 August 2025; Accepted 12 November 2025; Published online 08 December 2025

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Abstract

Background: Holmium: yttrium-aluminum-garnet (Ho: YAG) laser technology has long been employed for urinary stone fragmentation; however, its limitations have prompted the exploration of alternative systems such as thulium lasers. This study aims to compare a novel pulsed solid-state Thulium: YAG (Tm: YAG) laser to the standard Ho: YAG laser in Mini-percutaneous nephrolithotomy (Mini-PCNL) lithotripsy for renal calculi. Methods: In total, 100 patients undergoing Mini-PCNL were enrolled in this clinical trial. Fifty patients treated with a holmium laser were selected from a retrospective database. These patients were compared to fifty patients who were prospectively enrolled and treated with a new thulium laser. Patient characteristics, stone parameters, operative details, and complications were recorded and analyzed statistically. Results: Both groups were comparable in demographics and stone characteristics. The Tm: YAG group demonstrated significantly shorter laser-on-time (7.20 vs. 10.46 min; p < 0.05) and operative time (32.6 vs. 41.2 min; p < 0.05) compared to the Ho: YAG group. There was no difference regarding stone-free rates (SFR) at 24 h, which were 90% in the Ho: YAG group and 92% in the Tm: YAG group (p > 0.999). Intraoperative complications did not significantly differ between groups. Conclusion: The novel pulsed solid-state Tm: YAG laser demonstrates advantages over the Ho: YAG laser in terms of laser-on-time and operation time, while showing comparable results for stone-free rate and complications. Further clinical trials are needed to compare Tm: YAG and Ho: YAG lasers in various contexts and to evaluate the Tm: YAG laser against the thulium fiber laser (TFL) for a comprehensive understanding of each technology’s advantages.