Thulium fiber laser (TFL drive) for kidney and ureteral stones: prospective outcomes from a university teaching hospital

BACKGROUND: Kidney stone disease (KSD) is a growing healthcare challenge. Thulium fiber laser (TFL) laser has emerged as an alternative to holmium lasers due to its improved dusting capabilities and reduced retropulsion. However, some concerns remain regarding its safety, especially within the ureter. We present prospective outcomes from a tertiary centre using TFL laser over a 24-month period.METHODS: This was a prospective audit (Ref: 8056) of consecutive patients, undergoing ureteroscopy and laser lithotripsy (URSL), for ureteral and renal stones, using the Coloplast TFL Drive. Data on patient demographics, stone parameters, laser settings, intraoperative and postoperative outcomes were collected. Complications were recorded using the Clavien-Dindo (CD) Classification.RESULTS: One hundred procedures were performed between September 2023 and August 2024, with a median age of 61 years and a male:female ratio of 54:46. ASA grades were I/II/III in 15/53/32% respectively. Stone location was in the ureter, kidney or both in renal in 23%, 57%, and 20% respectively. The median largest and cumulative stone diameter was 9 and 10 mm respectively. The pre-stenting, access sheath use, and post-operative stent rates were 45%, 47% and 83% respectively. Laser settings used were 0.5-1.0J at 20-40Hz. The SFR was 95% with 84% done as a day case procedure. Complications occurred in 9% (1% CD I, 8% CD II), mainly related to urinary tract infections.CONCLUSIONS: TFL lasertripsy is a safe and effective modality for managing ureteric and renal stones, with good outcomes, a high SFR, low complication rates, and feasibility as a day-case procedure. While these real-world outcomes support broader adoption of TFL in routine endourological practice, high quality randomized studies are needed to validate our findings.