Margaret Knoedler, MD, on Ho:YAG vs thulium fiber laser for ureteroscopy

Data presented at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada showed no difference in stone-free rate between pulse-modulated Holmium:YAG (Ho:YAG) or the thulium fiber laser (TFL) for laser lithotripsy.

Presenting author Margaret A. Knoedler, MD, connected with Urology Times® to share her insights on the trial results.

Overall, data showed a stone-free rate of 53.6% with Ho:YAG compared with 52.9% with TFL (P = .948). Residual fragments of 2 mm or less were reported in 58.9% of patients with Ho:YAG vs 64.7% of patients with TFL (P = .539). Additionally, residual fragments of 4 mm or less were reported in 78.6% of patients with Ho:YAG vs 88.2% of patients with TFL (P = .182).

The authors also reported, “Preoperative stone size, procedure time, laser time, ablation speed and complication rates also did not differ between the two groups.”

Knoedler is a urologist at University of Wisconsin Health and an assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health.

In total, the study included 152 patients, of whom 46.7% were women. The average BMI was 29.9 ± 6.9.

Knoedler concluded, "The decision for which laser to use in your institution should be left up to the urologist and the hospital system. They both have slightly different benefits and risks associated with them, but they're both good lasers for uteroscopy."