Which Is the Best Laser for Lithotripsy? Holmium Laser

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

“…12 Despite a recent single-center randomized clinical trial demonstrating no significant clinical advantage of one technology over the other, 13 no direct comparison has been published comparing HLM with TFL in F-URS for renal stones in real-world practice, and much controversy continues to exist among experts in the field. 14,15…”

“…12 Despite a recent singlecenter randomized clinical trial demonstrating no significant clinical advantage of one technology over the other, 13 no direct comparison has been published comparing HLM with TFL in F-URS for renal stones in real-world practice, and much controversy continues to exist among experts in the field. 14,15 The purpose of the present study was to evaluate outcomes and complications after F-URS for renal stones, comparing patients who were operated on using HLM vs TFL.…”

“…There was no significant difference in gender distribution. Patients in the TFL group had larger median stone diameters(12 [10-17] vs 11[8][9][10][11][12][13][14][15] mm, ASMD[0.385), with a higher prevalence of single stone (66% vs 43%, ASMD[0.475) and stones located in the pelvis (46% vs 17%, ASMD[0.662). Conversely, median Propensity Scoreematched Cohort After PSM, 284 patients from each group were included.…”

Which Is the Best Laser for Lithotripsy? The Referee Point of View

“…In this debate, sides led by Olivier Traxer [2] and Kurshid Ghani [3] , both highly internationally regarded scientists in the field, share their convictions regarding TFL and Ho:YAG lasers. Several laboratory studies have shown superiority of TFL over Ho:YAG lasers in terms of being more efficient and faster for stone ablation [4] .…”

“…Absorption by water is four times greater for TFL than for Ho:YAG [4] , defining TFL as a contact laser. It is likely, as postulated by Hyung and Ghani [3] , that TFL experiments were performed in an ideal setting for its physical features, with the fiber always in contact with phantom stones owing to the presence of a robotic arm and with the laser continuously activated. This is completely different from the clinical scenario.…”