Power is not performance: Analysis of laser‐use metrics from a randomised clinical trial comparing low‐ and high‐power ureteroscopic lithotripsy

Objective: Thulium fibre laser (TFL) offers a wide range of power settings during ureteroscopic (URS) lithotripsy, yet the impact of power selection on intraoperative laser-use dynamics remains unclear. The objective of this study was to characterise differences in laser activation patterns between low-power (LP) and high-power (HP) TFL during sheathless URS. Materials and Methods: values. Results: < 0.001). Conclusion: LP and HP TFL lithotripsy result in distinctly different laser-use dynamics during sheathless URS. LP supported sustained, continuous lasing, whereas HP yielded fragmented activation requiring frequent pauses. Coupled with superior stone-free outcomes in the parent trial, these findings suggest that preserving clear endoscopic visibility and more active lasing may be more impactful than increasing laser power.