Comparison of Ho:YAG and pTm:YAG lasers in mini-percutaneous nephrolithotomy: safety, efficiency, and efficacy for lithotripsy

BACKGROUND: While several in-vitro studies have compared the performance of Holmium:YAG and pulsed Thulium:YAG lasers, no studies to date have directly compared the performance of these lasers during mini- PCNL. Herein, we aimed to compare the clinical effectiveness and stone-free rates of Ho:YAG and pThulium:YAG lasers in patients undergoing mini-PCNL.METHODS: This prospective, non-randomized study included 264 patients who underwent mini-PCNL: 170 patients in the Ho:YAG group and 94 patients in the pTm:YAG group. Demographic characteristics, stone-related variables, and intraoperative and postoperative parameters were systematically recorded.RESULTS: Demographic characteristics and stone-related variables, including stone diameter, volume (mm3), and Hounsfield units, were similar between the groups; a significant difference was observed only in the GUYS score (P=0.013). Median total energy and energy consumption were significantly lower in the Ho:YAG group than in the pTm:YAG group (3954 J [1932-8630] vs. 9887 J [3961.25-21,972.75], and 1.52 J/mm3 [0.80-3.17] vs 5.03 J/mm3 [1.94-9.08], respectively; both P<0.001). Laser ablation efficiency was higher in the Ho:YAG group (0.66 mm3/J [0.31-1.24] vs. 0.20 mm3/J [0.11-0.51]; P<0.001), whereas laser efficacy was comparable between groups (61.15 vs. 55.92 mm3/min; P=0.738). Postoperative complication and stone-free rates were similar (P=0.468 and P=0.418, respectively).CONCLUSIONS: Ho:YAG was associated with lower total energy use and shorter lasing times than pTm:YAG in mini-PCNL. However, overall efficacy, stone-free rates, and safety outcomes in mini-PCNL were comparable between the two laser systems.