Holmium laser for RIRS. Watts are we doing?

Area of Science:

• Urology
• Laser Lithotripsy
• Endourology

Background:

• Holmium:YAG (Ho:YAG) lasers are crucial for kidney stone lithotripsy during retrograde intrarenal surgery (RIRS).
• High-power (HPL) and low-power (LPL) lasers differ in settings like pulse energy and frequency, impacting stone fragmentation and retropulsion.

Purpose of the Study:

• To review current information on HPL and LPL Ho:YAG lasers in RIRS for lithotripsy.
• To analyze laser settings, lithotripsy techniques (dusting vs. fragmenting), and their clinical implications.

Main Methods:

• A comprehensive literature search was performed using PubMed and Embase.
• Relevant recent studies on Ho:YAG laser applications in RIRS were systematically reviewed.

Main Results:

• Both HPL and LPL Ho:YAG lasers demonstrate comparable effectiveness in lithotripsy.
• Higher pulse energy in HPL may increase fragment size and retropulsion, while LPL has limitations in pulse frequency.
• Dusting and fragmenting techniques are complementary; dusting avoids retrieval tools but may not always be feasible, necessitating fragmenting techniques.

Conclusions:

• HPL and LPL Ho:YAG lasers offer similar stone treatment efficacy, but long-term cost-effectiveness remains understudied.
• Emerging technologies like thulium fiber lasers require comparison with HPL.
• Determining the optimal power for Ho:YAG lasers necessitates further comparative studies, especially against mid-power laser options.