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Objective/background <p>To evaluate the safety and efficacy of TFL and Ho: YAG laser in URL for Ureteral Stones.</p> Methods <p>An electronic search of randomized controlled trials (RCTs) of TFL and Ho: YAG under URL for ureteral stones was conducted in PubMed, Embase, Web of Science (WOS), and Cochrane Library to retrieve relevant studies published from inception to March 21, 2025. Meta-analysis was conducted with software RevMan 5.4.1. The Protocol number is CRD420251021727 (<a href="http://www.crd.york.ac.uk/PROSPERO">www.crd.york.ac.uk/PROSPERO</a>).</p> Results <p>5 RCTs comprised of 441 patients were included. The TFL group had a higher Stone-free rate (SFR) (RR = 1.03, 95% CI 1.01 to 1.06, <i>P</i> = 0.02, analyzed with fixed-effects model) with acceptable heterogeneity (I<sup>2</sup> = 47%), higher laser efficacy (MD=-5.38, 95% CI -5.83 to -4.93, <i>P</i> &lt; 0.00001), shorter lasering time (MD=-5.06, 95% CI -6.53 to -3.59, <i>P</i> &lt; 0.00001), and shorter operation time (MD=-7.16, 95% CI -11.11 to -3.20, <i>P</i>=0.0001) compared to the group of Ho: YAG. No statistical significance was shown regarding the hospital stay, endoscopic view quality, ablation speed, and energy consumption (<i>P</i> &gt; 0.05). Nonetheless, the TFL group had a lower incidence of severe retropulsion (grade 2, Likert scale) (RR = 0.05, 95%CI 0.01 to 0.33, <i>P</i> = 0.002), and a lower risk of mucosal injury (RR = 2.42, 95%CI 1.30 to 4.51, <i>P</i> = 0.006). The incidence of other complications and adverse reactions was insignificant (<i>P</i> ＞0.05).</p> Conclusion <p>TFL with URL showed significantly higher SFR and shorter operative times than Ho: YAG without increasing complications (Clavien I–III), it also reduced severe retropulsion (grade 2, Likert scale). Nonetheless, these conclusions should be validated through high-quality RCTs with a large sample.</p>

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Thulium fiber laser versus holmium: YAG laser for ureteroscopic lithotripsy of ureteral stones: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Yiwei Zhang,
  • Lifeng Liu,
  • Xiaoyu Tang,
  • Ziqi He,
  • Zhilong Li,
  • Du Wang,
  • Lin Zhang,
  • Sheng Li

摘要

Objective/background

To evaluate the safety and efficacy of TFL and Ho: YAG laser in URL for Ureteral Stones.

Methods

An electronic search of randomized controlled trials (RCTs) of TFL and Ho: YAG under URL for ureteral stones was conducted in PubMed, Embase, Web of Science (WOS), and Cochrane Library to retrieve relevant studies published from inception to March 21, 2025. Meta-analysis was conducted with software RevMan 5.4.1. The Protocol number is CRD420251021727 (www.crd.york.ac.uk/PROSPERO).

Results

5 RCTs comprised of 441 patients were included. The TFL group had a higher Stone-free rate (SFR) (RR = 1.03, 95% CI 1.01 to 1.06, P = 0.02, analyzed with fixed-effects model) with acceptable heterogeneity (I2 = 47%), higher laser efficacy (MD=-5.38, 95% CI -5.83 to -4.93, P < 0.00001), shorter lasering time (MD=-5.06, 95% CI -6.53 to -3.59, P < 0.00001), and shorter operation time (MD=-7.16, 95% CI -11.11 to -3.20, P=0.0001) compared to the group of Ho: YAG. No statistical significance was shown regarding the hospital stay, endoscopic view quality, ablation speed, and energy consumption (P > 0.05). Nonetheless, the TFL group had a lower incidence of severe retropulsion (grade 2, Likert scale) (RR = 0.05, 95%CI 0.01 to 0.33, P = 0.002), and a lower risk of mucosal injury (RR = 2.42, 95%CI 1.30 to 4.51, P = 0.006). The incidence of other complications and adverse reactions was insignificant (P ＞0.05).

Conclusion

TFL with URL showed significantly higher SFR and shorter operative times than Ho: YAG without increasing complications (Clavien I–III), it also reduced severe retropulsion (grade 2, Likert scale). Nonetheless, these conclusions should be validated through high-quality RCTs with a large sample.