Both kidney stone lasers get the job done — surgeons can pick their favorite

Choosing between two leading laser systems for kidney stone surgery just got a lot simpler. A randomized controlled trial across five US tertiary care centers compared the pulse-modulated Holmium:YAG (Ho:YAG) laser and the thulium fiber laser (TFL) in 178 adults undergoing retrograde intrarenal surgery for kidney stones sized 5–20 mm. The verdict? They're essentially equivalent.

Stone-free rates, procedure duration, laser energy used, and complication rates were all statistically similar between the two groups. Importantly, patients in both groups reported significant improvements in health-related quality of life after surgery — a win no matter which laser was used. All observed complications were minor, with most involving post-operative pain requiring an ED visit.

By the Numbers

• Stone-free rate: 52.9% (Ho:YAG) vs. 52.3% (TFL)
• 178 patients enrolled; 133 completed post-op CT imaging
• Quality-of-life improvement: significant in both groups (P < .001)
• Mean follow-up: ~1.7 months (Ho:YAG) and ~1.5 months (TFL)

Why it matters: With both lasers performing equally well, hospitals and surgeons don't need to overhaul their equipment or training. Institutional preference and surgeon familiarity can safely guide the choice — simplifying decision-making without compromising patient outcomes.