Adoption of thulium fiber laser for lithotripsy A scoping review and bibliometric analysis

While holmium:YAG for laser lithotripsy remains the gold standard, the thulium fibre laser (TFL) has gained traction as a tool in urolithiasis management. The objective of this study was to review its adoption and use as a clinically effective laser lithotrite.

We performed a scoping review for articles on TFL for lithotripsy according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Available clinical outcomes and pre-clinical processes from studies were extracted. A bibliometric analysis was performed to outline and visualize publication trends overall and between clinical vs. pre-clinical studies. The review was registered in the International Prospective Register of Systematic Review (CRD42022300788).

We identified a total of 107 studies using TFL for lithotripsy, 38 clinical and including 2803 patients, and 69 pre-clinical. Of the clinical studies, 26 (68%) were prospective and 29 (76%) involved ureteroscopic management of stones compared to 11 (29%) involving percutaneous nephrolithotomy. Complication rates remained acceptable at 0-32%, and stonefree rates varied from 61-100%. Tissue damage from TFL varied from 0-8%. Bibliometric analyses showed a rise in publications after 2020 in both clinical and pre-clinical work, with the U.S. (34%) and then Russia (12%) as the leading countries, and the Journal of Endourology (24%) and World Journal of Urology (23%) being the leading venues.

By unifying clinical outcomes and pre-clinical insights, this review showed the maturation of TFL into an effective, versatile lithotripsy modality with accelerating global uptake. Further evidence is required to better characterize the remaining clinical variability, lack of standardized outcome definitions, and cost-effectiveness.