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<article xlink="http://www.w3.org/1999/xlink" dtd-version="1.0" article-type="urology" lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher">JOHS</journal-id>
<journal-id journal-id-type="nlm-ta">Journ of Health Scien</journal-id>
<journal-title-group>
<journal-title>Journal of HealthCare Sciences</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Journ of Health Scien</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">2231-2196</issn>
<issn pub-type="opub">0975-5241</issn>
<publisher>
<publisher-name>Radiance Research Academy</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">508</article-id>
<article-id pub-id-type="doi">http://dx.doi.org/10.52533/JOHS.2026.60113</article-id>
<article-id pub-id-type="doi-url"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Urology</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Safety and Efficiency of Thulium Fiber Laser Versus Holmium: YAG in Stone Fragmentation Procedures: A Systematic Review
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Azzuz</surname>
<given-names>Shahirah</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alghamdi</surname>
<given-names>Ahmed</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alkhaldi</surname>
<given-names>Mohammed</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alqunais</surname>
<given-names>Mahmood</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Binsaleh</surname>
<given-names>Abdulrahman</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Busaleh</surname>
<given-names>Hassan</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Al-Otaibi</surname>
<given-names>Emad</given-names>
</name>
</contrib>
</contrib-group>
<pub-date pub-type="ppub">
<day>16</day>
<month>01</month>
<year>2026</year>
</pub-date>
<volume>6</volume>
<issue>1</issue>
<fpage>94</fpage>
<lpage>107</lpage>
<permissions>
<copyright-statement>This article is copyright of Popeye Publishing, 2009</copyright-statement>
<copyright-year>2009</copyright-year>
<license license-type="open-access" href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract>
<p>Background: Laser lithotripsy has revolutionized the treatment of urinary stone disease, with Holmium: Yttrium-Aluminum-Garnet (Ho: YAG) consistently recognized as the gold standard. The advent of the thulium fiber laser (TFL) has presented a new alternative with possible technological and therapeutic advantages. This systematic review aimed to compare the safety and efficacy outcomes of Thulium Fiber Laser (TFL) versus Ho: YAG laser in urinary stone fragmentation procedures. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and ScienceDirect to identify English-language studies reporting outcomes related to operative time, stone-free rates, ablation efficiency, retropulsion, and endoscopic visibility in endourological stone management. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) for non-randomized studies and the Cochrane risk of bias tool assessment for randomized trials. TFL requires less operative time when treating stones of moderate size. Nevertheless, several studies found no statistically meaningful difference between techniques, indicating that the benefit may vary according to stone size. Lasing times varied across studies, indicating that laser-on time alone may not fully reflect procedural efficiency. Stone-free rates were comparable or higher with TFL, with significant improvements observed for stones measuring 1–2 cm, while outcomes were similar for smaller stones or cohorts with high baseline clearance. Safety profiles were largely equivalent, with comparable overall complication rates. TFL was often associated with improved intraoperative visibility and reduced stone retropulsion, while isolated reports of infectious complications were inconsistent. TFL appears to be a safe and effective alternative to Ho: YAG for stone fragmentation, offering potential advantages in operative efficiency, stone clearance, retropulsion control, and energy utilization, particularly in selected patients with small to medium-sized stones. Both laser technologies demonstrated comparable safety, supporting their continued use in endourological practice.
</p>
</abstract>
<kwd-group>
<kwd>Thulium Fiber Laser (TFL)</kwd>
<kwd> Holmium: YAG laser (Ho:YAG)</kwd>
<kwd> Stone fragmentation</kwd>
<kwd> Stone-free rate</kwd>
<kwd> Complications</kwd>
<kwd> Ablation efficiency</kwd>
<kwd> Operative time</kwd>
</kwd-group>
</article-meta>
</front>
</article>