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Updated: May 14, 2026

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser
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Which is the best laser for ureteroscopy? A Comprehensive Review.

Vinícius Ravena Lourenço1,2, João Pedro Leal Puppin1,2, Fábio Carvalho Vicentini1,2

  • 1Departamento de Urologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP, SP, São Paulo, Brasil.

International Braz J Urol : Official Journal of the Brazilian Society of Urology
|May 12, 2026
PubMed
Summary

Choosing the right ureteroscopy laser depends on your specific needs. Thulium Fiber Laser (TFL) offers efficiency, while Holmium:YAG (Ho:YAG) excels in complex cases, guiding clinical decisions.

Keywords:
UreterUreteral CalculiUreteroscopy

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Area of Science:

  • Urology
  • Laser Technology
  • Nephrolithotripsy

Background:

  • Ureteroscopy laser technology has rapidly evolved, introducing new options beyond standard Holmium:YAG (Ho:YAG) lasers.
  • Thulium Fiber Laser (TFL) and hybrid systems (Magneto/Tm:YAG) present new choices, causing uncertainty in clinical decision-making.

Purpose of the Study:

  • To analyze the physical principles, safety, and clinical outcomes of various ureteroscopy lasers.
  • To propose a framework for selecting the appropriate laser technology based on clinical context.

Main Methods:

  • A comprehensive literature review of PubMed and Embase databases from 2014-2025.
  • Selection of 14 high-quality studies focusing on ablation efficiency, stone-free rates (SFR), complications, and cost-effectiveness.

Main Results:

  • Thulium Fiber Laser (TFL) shows faster ablation and better dusting than standard Ho:YAG, with similar safety profiles.
  • High-Power Ho:YAG remains versatile for complex stones, while emerging hybrid lasers require further validation.
  • TFL and High-Power systems involve higher initial costs compared to Low-Power lasers.

Conclusions:

  • No single laser is universally superior; selection should be context-dependent.
  • A framework is proposed: Low-Power Ho:YAG for cost-sensitive centers, High-Power Ho:YAG for complex cases, TFL for efficiency, and hybrid technologies for innovation.
  • Standardized reporting in future studies is crucial for robust evidence.