Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review


Peter Kronenberg(a), BM Zeeshan Hameed(b) and Bhaskar K. Somani(c)

Purpose of review

Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes.

Recent findings

Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible.


Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.


Holmium laser, Kidney calculi, Laser, Thulium Fibre laser, Ureteroscopy


In the last few years, many rumours and hype has surrounded a new laser technology, the thulium fibre laser (TFL). Many claims of better performance in comparison to the Holmium:Yttrium-Aluminumgarnet (Ho:YAG) laser, the current gold-standard in endoscopic laser lithotripsy have been made in several papers, congress presentations or scientific news outlets [1–6].

Additionally, some reviews of the technology have been made [2,7&,8&,9], however, the technology has not been readily available till recently. Despite being a promising technology, until recently only one single Russian manufacturer had this kind of lasers available and approved for clinical use in Russia [10], and consequently, the first studies were also done mostly by Russian colleagues [11,12]. With the recent FDA approval in 2019 and the European CE mark approval in 2020, Thulium fibre laser technology has become more widely available, but is still a rarity in most urological departments in the US, Europe and worldwide. Despite its rarity, new studies, including basic science and clinical studies are being reported more frequently.

Thus, we decided to evaluate the latest data available to date, helping the readers to create an objective and evidence-based opinion about this new technology and associated clinical outcomes.


  • TFL technology has a promising role in the future of laser lithotripsy.
  • The advantages of the TFL over the Ho:YAG laser are numerous and ubiquitous, including significant improvements in ablation efficiency, retropulsion, lithotripsy settings, laser fibres, safety and machine form-factor.
  • TFL technology is capable of reducing operating room time, expanding the role of RIRS in the treatment of larger kidney stones and changing the current guidelines on stone management.
  • The TFL has potential to compete or even replace the Ho:YAG laser, but more clinical studies are needed to determine if it will become the new gold standard.


A PubMed search was performed (October 2020) for papers including the terms ‘thulium’ in association  with any of the following terms ‘lithotripsy’, ‘lithiasis’, ‘stone(s)’, ‘calculus’, ‘calculi’, ‘lithotripter(s)’, ‘lithotrite(s)’, ‘kidney’, ‘ureter’, ‘fiber(s)’, ‘fibre(s)’, ‘(endo)urology’, ‘(endo)urologic(al)’, or ‘intrarenal’. The search covered articles published between the years 2019 and 2020, as well as articles already accepted in 2020 but not yet published. Grey literature including the medical sections of ScienceDirect, Wiley, SpringerLink, and Mary Ann Liebert publishers as well as Google Scholar were also searched for peer-reviewed abstract presentations published within the previously stated time frame that were not indexed on PubMed. The authors adhered to PRISMA guidelines for this review [13]. All relevant data was identified and selected, and is summarized below.


The PubMed search returned 260 articles and the medical sections of ScienceDirect, Wiley, Springer-Link, Mary Ann Liebert, and Google Scholar returned 39 additional papers, some of them in duplicate. After duplicate removal, the abstracts of the remaining 220 records were read. 144 (65%) of these records related to basic technical laser research, to the use of lasers in nonurological medical specialities or the use of lasers in a nonlithotripsy- related urological setting, such as Ho:YAG or 

FIGURE 1. Flow chart documenting the source of information selection process through the different phases, according to PRISMA guidelines [13].

Table 1. Main features and advantages of the TFL according to different topics (in comparison to Ho:YAG laser technology) based on the bibliography of the current review, including in-vivo and in-vitro studies

TFL enucleation of the prostate. After the exclusion of additional 16 records, 60 full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review (Fig. 1). Yet, as with any new technology, most of the references pertain to clinical abstracts, with very little fully published studies, being a limitation of the current review.

Despite the majority of the initial laboratory and clinical studies were from Russian researchers, many more recent studies were done by researchers all around the world, showing promising results [14&&,15–18]. Still, after evaluating our bibliographic search results, more than 40% of the recent published research on TFL is from Russian origin or has Russian researchers participating in it. And considering exclusively recent clinical studies, over 75% come from Russian investigators. This only highlights the leading position that Russian urologists and researchers have as one of the primary users concerning this ground breaking and innovative technology.

The relevant data retrieved from the bibliographic search has been categorized and summarized into the following sections: TFL machine specifications, Ablation efficiency, Dust issues, Retropulsion, Optimal settings, Laser fibres, Safety, and Ongoing and future research. Table 1 summarizes the main results of this review.


Previous reports about TFL have been lab-based studies, but they were skewed because the TFL prototypes had low peak powers. However now there are new Super pulsed TFL machines that use electronically modulated laser diodes (instead of using flash lamps as in Ho:YAG lasers) and are capable of higher and constant peak power, thereby offering wider range of laser parameters, thus turning the TFL into one of the most awaited innovations in endourology [14&&,19,20].

The TFL is called a fibre laser because the laser beam is generated inside a very small core laser fibre (the gain medium) within the laser generator, whereas Ho:YAG lasers use laser rods inside resonance chambers with complex optical systems and precision alignment [7&,8&]. Although Ho:YAG Lasers use laser radiation at 2100nm wavelength, the TFL uses 1940nm wavelength and its radiation absorption is four times higher in water, which is probably the reason for its higher ablation efficiency of any type of urinary calculi (see below) [21,22&&]. Although Ho:YAG lasers are big, heavy, power-hungry machines that need dedicated high-power outlets and use noisy water cooling, TFL machines are several times lighter, smaller, use quiet air cooling mechanisms, that consume less energy and can be run from a standard power outlet [8&,10,23–26].

Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules [14&&]. But what makes the TFL stand out in comparison to the Ho:YAG laser are its frequency capabilities. Although the current top of the line Ho:YAG laser machines are capable of achieving 120 Hz of pulse frequency, the TFL is capable to have frequency over 2000Hz [7&,8&], and the latest commercially available TFL goes even up to 2400 Hz [23]. Another innovation concerns pulse duration, since the TFL can be operated in both using very low pulse energies and very long pulse durations (up to 50 milliseconds) [14&&]. The very low pulse energies, the higher frequencies and the longer pulse durations, are features that Ho:YAG lasers do not have, thus giving the TFL a significant advantage.


Several papers conclude that the TFL is more efficient for urinary calculus lithotripsy than the Ho:YAG laser [27], even at equivalent lithotripsy settings using the same pulse energy and the same pulse frequency [28–30]. With fragmentation settings, the TFL ablates twice as fast, and with dusting settings it ablates 4 to 5 times faster than the best Ho:YAG lasers [28,31,32].

Even comparisons with high-power Ho:YAG lasers equipped with pulse modulating Moses technology from Lumenis [26] showed the superior lithotripsy performance of the TFL technology, sometimes by a factor of 3 [20,33– 36]. One of the reasons for this improved performance is the steady and prolonged peak power levels that the TFL is capable of delivering associated with its four times higher wavelength absorption in water, thereby causing explosive thermomechanical interactions in addition to the already known photothermal effects [14&&,20,21,22&&]. Still, there are some debatable results such as accrediting solely the higher frequencies of the TFLs for its increased ablation speeds, less retropulsion or operating room time reduction [37], in spite of the use of lower pulse energies together with higher frequencies or the higher ablation performance per Joule of TFL energy.

However, most authors are unanimous in accrediting the TFL with time-saving properties and reducing operating room time [27,32,35–37].


Interestingly, it is not only the four to fivefold higher dusting rate of the primary stones that makes the TFL so attractive [28,30,31]. The resulting stone particles and fragments are also significantly different from those resulting with Ho:YAG lasers. Not only is the TFL able to produce stone dust from all prevailing stone types [22&&], but it also produces at least twice as much dust even when compared to Moses technology [35]. The resulting mean stone particle sizes are also significantly smaller in all size categories of less than 1mm or 0.5mm [14&&,36,37].

One study even analyzed the mean maximal remaining stone fragments with the TFL, and depending on stone composition, the largest residual fragments had 116 to 254 mm sizes [22&&]. Another advantage of small particles means less basketing passes [36], which further reduces complications and operating room times. Regardless of the current controversial definition of dust one thing is clear that the TFL produces not only a larger quantity of dust, but also a finer quality of dust.


Another issue that many studies refer to is the reduced or even absent retropulsion with the TFL. This was not only objectively evaluated in in vitro studies, but also subjectively perceived in several clinical studies including (flexible) ureteroscopy and percutaneous nephrolithotomy (PCNL) procedures [27,31,37–40]. At equal pulse energies, stone retropulsion threshold is up to four times higher with the TFL [20,29]. With Ho:YAG lasers, retropulsion becomes already evident at 0.2J pulse energies, while with the TFL retropulsion begins at around 1 J pulse energy, being clinically insignificant in many cases [29,41].

The reason for this reduced retropulsion in comparison to the Ho:YAG lays not only in the lower peak power of the TFL, but also in the more constant and prolonged peak power with longer pulse duration, thus delivering more energy to the stone without sacrificing ablation efficiency [20,42]. Yet, there is still some controversy with some authors claiming that the TFL has significantly less retropulsion than  Moses technology [34], whereas other authors do not [43]. Another aspect mentioned by authors was the better visibility using the TFL which was optimal in up to 95% of clinical cases [38,40,41,44,45]. At very high frequencies, however (200Hz) some deterioration in visibility was noticed due to the snowstorm effect [37].


With the TFL’s improved performance on several levels and the wide range of adjustable parameters, some authors have attempted to clinically determine the best lithotripsy settings for (flexible) ureteroscopy, PCNL or cystolithotripsy. Settings such as, 1–1.5 J and 15–30Hz for fragmentation and 0.1–0.3 J and 50 100Hz for dusting in (micro-) PCNL, 0.1–0.2J with 15–30W for dusting in the kidney, 0.2–0.5J with 10–15W for dusting and fragmentation in the ureter, and 2–5J and 5–10 Hz for bladder stones treatment [38,41,46]. However, there are even reports of some authors using up to 500 Hz in the upper tract [15]. Yet, this is very preliminary data and the optimal laser settings are far from being established, needing future studies on it [8&,47].


TFL laser fibres are smaller (150 mm), more flexible, resistant to bending and suffering less burnback in comparison to Ho:YAG laser fibres or even special Moses fibres [43,48,49]. One study using exclusively Ho:YAG laser fibres with a Ho:YAG laser and comparing it with a TFL using exactly the same fragmentation and dusting parameters at 7.5W total power levels, showed up to 90% fibre breakages at extreme 9mm bending diameters with the Ho:YAG laser but none with the TFL. Furthermore, the same authors even tested 50W settings with the TFL at 9mm bending diameter with the same 200 mm Ho:YAG laser fibres, and still none of the fibres broke [50&&]. This irrefutably shows that it is the quality of the laser beam generation within the TFL that protects the laser fibres, even protecting native Ho:YAG laser fibres.

The smaller diameter of the TFL laser fibres has also been shown to contribute to produce smaller stone fragments [49], and despite their diameter, they still produce higher ablation volumes than their larger Ho:YAG counterparts [28,30]. By using smaller core diameters the energy density delivered by these fibres is also significantly higher [7&], as well as allowing better instrument deflection and offering future miniaturization possibilities [8&,51,52]. The better and speedier performance of the TFL enabled the tackling of larger stone through retrograde intrarenal surgery (RIRS), like demonstrated by several clinical studies [53–55].

Thus, TFL technology is capable of expanding the role of RIRS in the treatment of larger kidney stones with shorter operating times and in changing the current guidelines on stone management [53,56].


Concerning the safety of this new technology, the clinical and prospective data from several patient cohorts is coherent in deeming the TFL safe to use, in any anatomical location, and regardless of its endoscopic surgical approach [15 17,27,38–40,45,46,51,55,57,58]. One of the safety features of the TFL is its laser fibres higher resistance to extreme bending diameters, even using high power, thereby avoiding their breakage with consequent laser emission inside the fragile flexible scopes [50&&,59]. The ability of the TFL to ablate urinary stones into finer particles and smaller residual fragments implies less basketing passes and complicated endoscope manoeuvres that can cause additional wear and tear to our instruments [36].

Moreover, the optimal and clear visibility reported with the TFL use [27,37,38,40,41,44,45] represents an additional safety feature, allowing the surgeon to better judge its fibre tip position in relation to other structures, reducing unintentional firing against soft tissues or instruments. However, there is a controversial safety issue that comes up again and again in the social media and literature with the alleged high-temperature rise with the TFL. Urologists are afraid of heating the fluid medium too much, potentially causing damage or ureteral stenosis [59].

Claims have been made that the TFL’s higher absorption coefficient in water equals higher water temperature [60] or that the heat production of 1 Joule of TFL energy is four times that of the Ho:YAG laser [29]. Perceptions like these with TFL continue being repeated and some authors even name it the ‘thermal effect of the TFL’ [61]. Yet there are plenty of papers showing that with similar energy and frequency settings, both the Ho:YAG and the TFL cause precisely the same temperature changes [29,62&&,63&&]. Only using high power settings and reduced or absent irrigation, there is dangerous temperature rises with the Ho:YAG as with the TFL (with exactly similar temperature variations) [64,65].

Thus urologists should be aware of this problem and implement variety of techniques, if needed, such as higher irrigation flow rates, intermittent laser activation, cooled irrigation fluid or avoidance of high power settings to limit thermal lesions during laser lithotripsy, regardless of the laser technology employed [60,64,66&]. One paper even evaluated strictures or stenosis at 3-month follow-up of a TFL procedure and found none [40]. The authors of the present systematic review can’t state enough that 1 Joule of energy originating from whatever energy source, will always heat a certain medium to the same degree, regardless of the energy source (1 Joule of TFL energy ¼1 Joule of Ho:YAG energy¼1 Joule of candle energy), a statement which is by itself similar to the definition of the thermodynamical calorie [67].

Recently, other researchers are also trying to eradicate this misbelief regarding the TFL [63&&].


Other technological developments and lines of research are underway for the TFL. These include vibrating laser fibre tips [52], or detailed research on vapour bubble formation and surfactant supplementation of irrigation fluids or tweaking of the energy pulse shape to increase working distance if desired [42,68,69], as well as to associate TFL lithotripsy with suction [70].

All of these features are to further enhance TFL efficiency. Because of the smaller laser fibres that one can use with this technology, there are also future miniaturization possibilities of instruments, making an already minimally invasive technique even less invasive [8&].


Based on the review, we consider that the TFL is a game changer and has a promising role in the future. Considering its additional versatility for soft tissue applications, the TFL has the potential to compete or even replace the Ho:YAG laser and becoming the new gold standard [4,59,71,72]. The evidence supporting the TFL seems very promising, but we have to be careful before fully embracing the TFL as an alternative to the Ho:YAG laser [8&,19,73].

Considering the current rarity and absence of TFL machines throughout the world, most studies regarding the TFL have relative small sample size and almost no clinical comparative studies exist in relation to the Ho:YAG laser. Thus, large multicentric prospective studies and randomized clinical trials with Ho:YAG comparison (control arm) are needed, with long-term follow-up to irrefutably confirm all the aforementioned observations and conclusions. Only then canwe consider to replace our 30-year-old Ho:YAG technology with the apparently safer and more efficacious TFL technology.




Financial support and sponsorship


Conflicts of interest

Peter Kronenberg has participated in advisory board meetings for Olympus and in industry breakout session for Lumenis. Bhaskar Somani has participated in industry session for Lumenis.


Papers of particular interest, published within the annual period of review, have been highlighted as:

  • & of special interest
  • && of outstanding interest

1. Kronenberg P, Somani B. Advances in lasers for the treatment of stones-a systematic review. Curr Urol Rep 2018; 19:45.

2. Fried NM, Irby PB. Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 2018; 15:563–573.

3. Traxer O, Rapoport L, Tsarichenko D, et al. V03-02 first clinical study on superpulse thulium fiber laser for lithotripsy. J Urol 2018; 199(4 Supplement): e321–e322.

4. Kronenberg P. AUA Live: Thulium fiber laser may become the new lithotripsy gold standard; 2020. Available from: https://www.auadailynews.org/ aua-live-thulium-fiber-laser-may-become-the-new-lithotripsy-gold-standard/ [Accessed October 22, 2020]

5. Olympus Launches the Soltive SuperPulsed Thulium Fiber Laser System for Urology; 2020. Available from: https://infomeddnews.com/olympuslaunches- the-soltive-superpulsed-thulium-fiber-laser-system-for-urology/ [Accessed October 21, 2020]

6. BioSpace. Olympus Launches the Soltive SuperPulsed Thulium Fiber Laser System for Urology; 2020. Available from: https://www.biospace.com/article/ releases/olympus-launches-the-soltive-superpulsed-thulium-fiber-laser-system- for-urology/ [Accessed October 21, 2020]

7. Traxer O, Keller EX. Thulium fiber laser: the new player for kidney stone
treatment? A comparison with Holmium:YAG laser. World J Urol 2020;
38:1883–1894. This is one of the first reviews comparing TFL and Ho:YAG laser.

8. Kronenberg P, Traxer O. The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 2019; 8(Suppl 4):S398–S417. This registered systematic review compares all the main features of TFL technology and Ho:YAG in detail, side by side, and is one of the main references in the field.

9. Fried NM. Recent advances in infrared laser lithotripsy invited. Biomed Optic Expr 2018; 9:4552–4568.

10. IPG Photonics. UROLASE SPþ Brochure; 2018.

11. Dymov A, Glybochko P, Alyaev Y, et al. V11-11 thulium lithotripsy: from experiment to clinical practice. J Urol 2017; 197:e1285.

12. Glybochko P, Altshuler G, Vinarov A, et al. 226 - Comparison between the possibilities of holmium and thulium laser in lithotripsy in vitro. Eur Urol Suppl 2017; 16:e391–e392.

13. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6:e1000097.

14. Hardy LA, Vinnichenko V, Fried NM. High power holmium:YAG versus thulium fiber laser treatment of kidney stones in dusting mode: ablation rate and fragment size studies. Lasers Surg Med 2019; 51:522–530. This paper is very good paper ablation efficiency of both technologies. It clearly demonstrates the TFL’s superiority over the Ho:YAG.

15. Carrera R, Randall J, Garcia-Gil M, et al. PD34-04 ureteroscopic performance of thulium fiber laser (soltive premium super pulsed lasertm) for the treatment of urolithiasis. J Urol 2020; 203:e712–e713.

16. Garcia-Gil M, Chew BH, Humphreys MR, et al. PD07-12 thulium fiber laser lithotripsy is safe, efficient and effective in minipcnl. J Urol 2020; 203:e166.

17. Mistry T, Pahwa M, Tyagi V. MP22-05 efficacy of super-pulse thulium fiber laser in endoscopic management of lower ureteric stones in indian population. J Urol 2020; 203:e329.

18. SchembriM, Sahu J, Aboumarzouk O, et al. Thulium fiber laser: The new kid on the block. Turk J Urol 2020; 46:S1–S10.

19. Ventimiglia E, Traxer O. Safety of a novel thulium fibre laser for lithotripsy: an in vitro study on the thermal effect and its impact factor. Eur Urol 2020; 78:111–112.

20. Enikeev D, Shariat SF, Taratkin M, et al. The changing role of lasers in urologic surgery. Curr Opin Urol 2020; 30:24–29.

21. TaratkinM, Laukhtina E, Singla N, et al. How lasers ablate stones: in vitro study of laser lithotripsy (Ho:YAG and Tm-Fiber Lasers) in different environments. J Endourol 2020. 

22. Keller EX, Coninck Vde, Doizi S, et al. Thulium fiber laser: ready to dust all urinary stone composition types? World J Urol 2020. This is a very important paper. It shows how TFL technology can be used to efficiently ablate any kind of urinary stone. It also measured the largest residual fragments resulting during lithotripsy of human urinary stones with the TFL.

23. Olympus. SuperPulsed Laser System SOLTIVE Premium: Sell Sheet; S00316EN 10/20 OEKG; 2020 Available from: https://d3a0ilwurc1bhm.- cloudfront.net/asset/084438885177/c947cc763044fc953bb2253b056edf7b [Accessed October 25, 2020]

24. Jena Surgical. MultiPulse HoPLUS Brochure; J51-2100-000/EN/Rev.02; 2018 Available from: http://www.jenasurgical.com/wordpress/wp-content/ uploads/2018/10/JS_MultiPulse-HoPLUS_EN_REV_02_WEB.pdf [Accessed January 22, 2019]

25. Dornier. Dornier medilas1H 140 specification sheet; DMT340-062018-REV B EN; 2018 [Accessed January 22, 2019]

26. Lumenis. Lumenis PULSE 120H: Operator’s Manual; UM-10012510 Rev. F; 2017. Available from: https://prd medweb-cdn.s3.amazonaws.com/documents/ periopservices/files/UM 10012510_F%20Lumenis%20Pulse% 20120H%20Op%20Manual_English.pdf [Accessed January 22, 2019]

27. Gao B, Bobrowski A, Lee J. A scoping review of the clinical efficacy and safety of the novel thulium fiber laser: the rising star of laser lithotripsy. Can Urol Assoc J 2020. [Epub ahead of print]

28. Panthier F, Doizi S, Berthe L, et al. In vitro comparison of ablation rates between superpulsed thulium fiber laser and ho:Yag laser for endocorporeal lithotripsy. Eur Urol Open Sci 2020; 19:e1884–e1885.

29. Andreeva V, Vinarov A, Yaroslavsky I, et al. Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 2020; 38:497–503.

30. Panthier F, Doizi S, Lapouge P, et al. Comparison of the ablation rates, fissures and fragments produced with 150 mm and 272mm laser fibers with superpulsed thulium fiber laser: an in vitro study. World J Urol 2020.

31. Pattnaik PK, Pattnaik SK, Pattnaik MP. MP21-16 Holmium Laser versus thulium fiber laser for treatment of urinary calculus disease. J Endourol 2019; 33(S1):A237.

32. Paul C, Laurent B, Mattieu H, et al. PD59-06 in vitro comparison of efficiency between superpulsed thulium fiber laser and HO:YAG laser for endocorporeal lithotripsy. J Urol 2019; 201(Supplement 4):e1093–e11093.

33. Dragos L, Somani BK, Etienne XK, et al. PD01-05 high power holmim moses technology versus super-pulse thulium fibre laser. Which is more efficient on stones? J Urol 2019; 201(Supplement 4):e58.

34. Traxer O, De Coninck V, Keller EX, et al. MP17-03 comparing short, long, and moses regimes of HO:YAG laser vs super pulse tm fiber laser in vitro: ablation speed and retropulsion effect. J Urol 2019; 201(Supplement 4):e255 e256.

35. Coninck V, Keller E, Kovalenko A, et al. PT067: Dusting efficiency comparison between Moses technology of Ho: YAG laser and superpulse thulium fiber laser. Eur Urol Suppl 2019; 18:e1757–e1758.

36. Chew Ben H, Knudsen Bodo E, Molina Wilson R. MP79-19 comparison of dusting and fragmenting using the new super pulse thulium fiber laser to a 120W Holmium:YAG Laser. Journal of Urology 2019; 201(Supplement 4):e1159–e1160.

37. Enikeev D, Taratkin M, Klimov R, et al. Superpulsed thulium fiber laser for stone dusting: in search of a perfect ablation regimen-a prospective singlecenter study. J Endourol 2020; 34:1175–1179.

38. Dymov A, Rapoport L, Enikeev D, et al. 383: Prospective clinical study on superpulse thulium fiber laser: Initial analysis of optimal laser settings. Eur Urol Suppl 2019; 18:e500.

39. Enikeev D, Taratkin M, Alyaev Y, et al. Super-pulse thulium-fiber laser for lithotripsy: First clinical experience in percutaneous nephrolithotomy. Eur Urol Open Sci 2020; 19:e350.

40. Enikeev D, Taratkin M, Klimov R, et al. Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy. World J Urol 2020; 38:3069–3074.

41. Dymov A, Rapoport L, Tsarichenko D, et al. PD01-06 prospective clinical study on superpulse thulium fiber laser: initial analysis of optimal laser settings. J Urol 2019; 201(Supplement 4).

42. Ventimiglia E, Doizi S, Kovalenko A, et al. Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium: YAG and super-pulse thulium fibre lasers. BJU Int 2020; 126:159–167.

43. Knudsen B, Chew B, Molina W. MP79-16 super pulse thulium fiber laser compared to 120W Holmium:YAG laser: impact on retropulsion and laser fiber burn back. J Urol 2019; 201(Supplement 4).

44. Enikeev D, Taratkin M, Alyaev Y, et al. MP22-04 super-pulse thulium-fiber laser for lithotripsy. J Urol 2020; 203:e328.

45. Traxer O, Dymov A, Rapoport L, et al. V01-02 comprehensive clinical study of super pulse tm fiber laser for treatment of stone disease. J Urol 2019; 201((Supplement 4).
46. Martov AG, Andronov AS, Dutov SV, et al. V36 Thulium SuperPulse Fiber Laser (TSPFL) for micro-PCNL. Eur Urol Suppl 2019; 18:e2251.

47. Enikeev D, Traxer O, Taratkin M, et al. A review of thulium-fiber laser in stone lithotripsy and soft tissue surgery. Curr Opin Urol 2020; 30:853–860. 48. Knudsen B, Molina W, Chew B. PD30-01 comparison of small core diameter laser fibers used for lithotripsy with a 120W HO. J Urol 2020; 203:e624.

49. Panthier F, Doizi S, Berthe L, et al. Comparison of the fissures and fragments produced with 150mm and 272mm laser fibers with superpulsed thulium fiber laser: An in vitro study. Eur Urol Open Sci 2020; 19:e348–e349.

50.Chiron PH, Doizi S, Coninck Vd, et al. PT066: impact of superpulse thulium fiber laser settings and curve diameter on optical fiber fracture during intracorporeal lithotripsy. Eur Urol Suppl 2019; 18:e1756. This is an excellent abstract that shows how the laser energy beam created by the TFL protects fibers, even laser fibers originally conceived to be used with the Ho:YAG laser.

51. Korolev D, Klimov R, Enikeev D, et al. MP10-17 RIRS for lower pole small renal stones: Novel SuperPulse Thulium (Tm) fiber laser lithotripsy. First clinical results. J Endourol 2019; 33(S1):A122.

52. Hall LA, Gonzalez DA, Fried NM. Thulium fiber laser ablation of kidney stones using an automated, vibrating fiber. J Biomed Opt 2019; 24:1-10-10.

53. Dymov A, Tsarichenko D, Akopyan G, et al. MP30-05 RIRS with SuperPulse Thulium fiber laser for kidney stones larger than 2 cm. J Endourol 2019; 33(S1):A315.

54. Keller EX, Coninck Vde, Vinnichenko V, et al. V01-09 superpulse thulium fiber laser for lithotripsy of large renal stones: initial experience. J Urol 2019; 201(Supplement 4).

55. Martov A, Ergakov D, Baykov N, et al. V04-11 the superpulse thulium fiber laser in the management of giant distal ureter stone. J Urol 2020; 203:e390.

56. Lildal SK, Andreassen KH, Baard J, et al. Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy. World J Urol 2020.

57. Martov A, Andronov A, Moscow SD, et al. V01-11 thulium superpulse fiber
laser (TSPFL) micro-PCNL: how to improve stone-free rate (SFR). J Urol
2019; 201(Supplement 4):e89.

58. Traxer O,MartovA,Ergakov D, et al. V01-01 prospective transurethral lithotripsy study with superpulse TM fiber laser. J Urol 2019; 201(Supplement 4):e85.

59. Secker A, Rassweiler J, Neisius A. Future perspectives of flexible ureteroscopy. Curr Opin Urol 2019; 29:113–117.

60. Peng Y, Liu M, Ming S, et al. Safety of a novel thulium fiber laser for lithotripsy:an in vitro study on the thermal effect and its impact factor. J Endourol 2020;

61. Danilovic A. Editorial comment: safety of a novel thu-lium fiber laser for lithotripsy: an in vitro study on the thermal effect and its impact factor. Int Braz J Urol 2020; 46:849–850.

62. Dragos LB, Somani B, Keller E, et al. 386: Super-pulse thulium fiber versus high power holmium lasers. What about temperature? Eur Urol Suppl 2019; 18:e505–e508. This is one of the main and best studies to show how there isn’t any temperature difference between using one or the other laser technology.

63. Taratkin M, Laukhtina E, Singla N, et al. Temperature changes during laser lithotripsy with Ho:YAG laser and novel Tm-fiber laser: a comparative in-vitro study. World J Urol 2020. This study is so important, because it is one of the few papers that recognizes the current misbeliefs concerning the TFL and really explains why there is no temperature difference in the watery medium while using the TFL or the HO:YAG laser.

64. Keller EX, Traxer O. Laser tulio superpulsado: ?El nuevo esta´ndar en litotricia por la´ser? Arch Espan˜ Urola (Ed impresa) 2020; 73:767–776.

65. Molina W, Chew B, Knudsen B. PD42-05 temperature rise during laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120WHolmium-YAGlaser (HO:YAG). J Urol 2019; 201(Supplement 4):e751.

66. Chiron P, Mande´ S, Doizi S, et al. MP17-04 evaluation of heat generation in an in vitro kidney model: does the superpulsed thulium fiber laser pose a risk? J Urol 2019; 201(Supplement 4):e256. Another abstract that demonstrates and explains the lack of temperature differences between the TFL and the Ho:YAG laser.

67. Rossini FD. Excursion in chemical thermodynamics, from the past into the future. Pure Appl Chem 1964; 8:.

68. Giglio NC, Hutchens TC, Wilson CR, et al. Surfactant enhanced laserinduced vapor bubbles for potential use in thulium fiber laser lithotripsy. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5045–5048.

69. Liu M, Peng Y, Gao X. A new insight into bubble formation and stone ablation of thulium fiber laser. Eur Urol Open Sci 2020; 19:e344.

70. Shah D, Patil A, Reddy N, et al. A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon. World J Urol 2020.

71. Noureldin YA, Kallidonis P, Liatsikos EN. Lasers for stone treatment: how safe are they? Curr Opin Urol 2020; 30:130–134.

72. Meria P. Re: thulium fiber laser: ready to dust all urinary stone composition types? Eur Urol 2020; 78:926.

73. Terry RS, Whelan PS, Lipkin ME. New devices for kidney stone management. Curr Opin Urol 2020; 30:144–148.

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