Thulium Fiber Laser Versus Holmium:YAG for Urological Stone Lithotripsy: A Systematic Review and Meta-Analysis

To systematically evaluate the clinical efficacy, safety, and procedural outcomes of thulium fiber laser (TFL) compared to Holmium:YAG (Ho:YAG) in laser lithotripsy for urinary stones, based on a synthesis of randomized and comparative studies.

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Scopus were searched for studies published between January 2010 and March 2025. Eligible studies included randomized controlled trials and cohort studies directly comparing TFL and Ho:YAG in ureteroscopy or retrograde intrarenal surgery (RIRS). Primary outcomes were stone-free rate (SFR), operative time, complication rate, and retreatment rate. Meta-analyses were performed using a random-effects model; heterogeneity was assessed using the I² statistic.

Twenty-eight studies were included (7 RCTs, 21 cohort studies), encompassing a total of 3672 patients. TFL was associated with a significantly higher SFR (93.5% vs. 87.2%, p < 0.01), shorter operative time (43.2 vs. 52.8 min, p < 0.001), and lower retreatment rates (4.2% vs. 7.6%, p < 0.01). Complication rates were comparable between groups. Heterogeneity among studies was moderate (I² = 62%); subgroup analysis and sensitivity testing were used to explore sources of variability.

TFL demonstrates superior procedural outcomes compared to Ho:YAG in endourological management of urinary stones. Further research into next-generation systems-such as the Cyber Ho Magneto, which integrates high-power Ho:YAG output with TFL-like pulse modulation-may provide additional procedural benefits and warrants formal clinical evaluation.