Technique-stratified whole-stone laser energy consumption during RIRS using a 150-W Ho: YAG laser

To determine whether technique-stratified whole-stone laser energy consumption (LEC) provides interpretable benchmarking during retrograde intrarenal surgery (RIRS) performed with a 150-W holmium: YAG platform. This retrospective single-center cohort identified 350 procedures performed from January 2023 to January 2025 and included all 300 eligible procedures (100 per technique). Total energy was reconstructed from case-level pulse energy, frequency, and laser-on time. Whole-stone LEC was energy divided by preoperative computed-tomography stone volume. Strict zero-residual stone-free rate (SFR) and < 2 mm clinical success were assessed by computed tomography at 3 months. Median whole-stone LEC was 19.3 [17.1-22.0] J/mm³ for dusting, 11.7 [10.4-13.3] for fragmentation, and 24.1 [21.3-27.6] for pop-dusting (p < 0.001). Fragmentation used the least total energy but had the longest operation time. Strict SFR was 71.0%, 80.0%, and 67.0% (p = 0.107), whereas clinical success was 93.0%, 93.0%, and 94.0% (p = 0.948). After adjustment for comorbidity, stone volume, density, and lower-calyx location predicted strict SFR; technique and LEC did not. Adding technique and LEC did not improve repeated cross-validated discrimination and produced modest overfitting. Technique-specific whole-stone LEC is best interpreted as a benchmarking measure alongside operative time and CT outcomes, not as an independent preoperative predictor.