All about pulsed thulium:YAG laser: a systematic review from YAU Endourology and EAU Endourology

This review aims to comprehensively evaluate the impact of solid-state pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser technology in endourology. Special focus is given to its application in laser lithotripsy and endoscopic enucleation of the prostate (EEP), comparing it with established technologies such as holmium:YAG (Ho:YAG) and thulium fiber laser (TFL).

Recent in vitro and clinical studies suggest that p-Tm:YAG offers high ablation efficiency, low retropulsion, and versatility in both stone fragmentation and soft tissue surgery. In laser lithotripsy, p-Tm:YAG has demonstrated comparable or superior dusting and fragmentation outcomes across multiple stone compositions. Clinical studies in ureteroscopy and mini-percutaneous nephrolithotomy (mini-PCNL) have confirmed its safety, high stone-free rates (up to 95%), and reduced lasering time. For prostate enucleation, the technology enables precise tissue dissection with strong hemostatic control, as evidenced by high enucleation speed, low complication rates, and excellent functional outcomes. However, evidence in oncologic applications such as upper tract urothelial carcinoma remains limited to a single case report, with no data on long-term oncological safety.

p-Tm:YAG lasers represent a significant advancement in urological laser surgery, effectively bridging the performance gap between historical Ho:YAG and TFL. While promising results have been observed in stone and prostate surgery, high-quality randomized trials and long-term outcome data are still needed to validate its superiority and expand its clinical indications.