A Comparative Evaluation of Holmium:YAG and Thulium Fiber Lasers in Urinary Stone Treatment

Laser lithotripsy has transformed the management of urinary stone disease, with Holmium:YAG (Ho:YAG) long regarded as the standard of care. However, the emergence of the thulium fiber laser (TFL) has introduced a novel alternative with potential technical and clinical benefits. This review synthesizes data from randomized controlled trials and cohort studies published between 2019 and 2025 comparing Ho:YAG and TFL for urinary stone lithotripsy. A total of 13 peer-reviewed studies were included, with outcomes assessed across stone-free rates (SFRs), operative time, ablation efficiency, complication rates, and overall safety. While both lasers achieve comparable SFRs, several studies reported significantly higher clearance rates and shorter operative times with TFL. TFL was also associated with improved dusting performance, reduced retropulsion, and enhanced ergonomics due to its higher frequency and smaller fiber compatibility. Safety outcomes were similar, though some studies noted fewer bleeding events and greater fiber durability with TFL. These findings suggest that TFL may offer advantages over Ho:YAG in selected clinical settings. Although Ho:YAG remains the globally established modality, accumulating evidence supports the growing role of TFL in contemporary endourology, pending further long-term and cost-effectiveness data.