ArticleWorld journal of urology2026
When long pulse is not enough: inferior dusting efficiency of pulsed thulium:YAG compared with Ho:YAG and thulium fiber laser in a standardized in vitro renal model.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Pulsed thulium: YAG (p-Tm: YAG) and thulium fiber laser (TFL) differ in pulse architecture despite similar wavelengths. We asked whether long-pulse p-Tm: YAG achieves ablation efficiency and thermal behaviour comparable to holmium: YAG (Ho: YAG) and TFL under standardized low-power dusting settings. Fifty-four BegoStone phantoms were treated in an in vitro renal collecting system model, 18 per platform, at 0.8 J and 25 Hz through a 7.5 Fr single-use flexible ureteroscope with gravity irrigation and no access sheath. Pulse duration was not standardized: Ho: YAG and p-Tm: YAG were long-pulse, TFL short-pulse. Ablated dry mass, laser-on time, delivered energy, temperature every 10 s and thermal dose (CEM43, per run) were recorded. p-Tm: YAG ablated 0.099 g versus 0.138 g (Ho: YAG) and 0.140 g (TFL) (p = 0.005), a 29% reduction, despite delivered energy indistinguishable from Ho: YAG (5.61 versus 5.62 kJ; p = 1.000). Energy efficiency was 0.0176 versus 0.0248 and 0.0242 g·kJ⁻¹ (p = 0.007). Both thulium platforms heated more than Ho: YAG (ΔT 18.8 and 18.9 versus 12.8 °C; p = 0.001) but did not differ from each other. Temperature exceeded 43 °C in 17 of 36 thulium runs (peak 51.7 °C); mean per-run CEM43 was 24.4 and 14.5 min. For equivalent delivered energy, long-pulse p-Tm: YAG was associated with lower ablation efficiency than Ho: YAG or short-pulse TFL. Because pulse duration was confounded with platform, these findings implicate pulse architecture rather than intrinsic inferiority. Frequent excursions above 43 °C with both thulium platforms warrant attention.
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