ReviewCureus2025
Thulium Fibre Laser Versus Pulse-Modulated Holmium:Yttrium Aluminum Garnet (Ho:YAG) Laser for Endoscopic Lithotripsy: A Systematic Review of Clinical Outcomes, Efficiency, and Safety.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Holmium:Yttrium Aluminum Garnet (Ho:YAG) laser has been the standard energy source for endoscopic lithotripsy for over two decades; however, limitations such as inefficient energy transmission, strong retropulsion, and large fiber diameters have prompted the development of newer laser technologies. Pulse-modulated Ho:YAG platforms (e.g., Moses™ (Boston Scientific, Marlborough, USA), Virtual Basket™ (Quanta System, Milan, Italy), Magneto™ (Quanta System, Milan, Italy)) and the Thulium Fibre Laser (TFL) were introduced to improve energy coupling, fragmentation efficiency, and surgical precision. This systematic review aims to evaluate and compare the clinical efficacy and safety of TFL and pulse-modulated Ho:YAG systems in the management of urolithiasis. A systematic search of PubMed, Cochrane Library, and Embase was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing TFL and pulse-modulated Ho:YAG lasers in ureteroscopy (URS), retrograde intrarenal surgery (RIRS), or mini-percutaneous nephrolithotomy (mini-PCNL) were included. Data on stone-free rate (SFR), operative and lasering times, retropulsion, visibility, complications, and safety were extracted. Due to heterogeneity in definitions and study design, a qualitative synthesis without meta-analysis (SWiM) was performed. Risk of bias was assessed using the Risk of Bias (RoB) 2.0 (The Cochrane Collaboration, London, UK) and ROBINS-I (The Cochrane Collaboration, London, UK), and evidence certainty was graded with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eight studies, including two randomized controlled trials and six observational studies, were included in the review. Across most studies, TFL achieved similar or slightly higher SFRs (82-98%) compared with pulse-modulated Ho:YAG (56-95%). Operative and lasering times were comparable, while TFL demonstrated less retropulsion, superior endoscopic visibility, and an equivalent complication profile. No clinically significant differences in thermal safety or re-hospitalization were observed. In summary, TFL provides comparable or marginally superior performance to pulse-modulated Ho:YAG lasers for endoscopic stone surgery. It offers consistent safety and improved intraoperative control, suggesting an emerging role as a preferred next-generation lithotripsy platform pending further multicenter randomized trials.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.