Percutaneous nephrolithotomy (PCNL) remains the gold standard technique to treat kidney stones larger than 2cm of maximum diameter. To reduce its morbidity, miniaturization and downsizing the instruments led to the development of mini-PCNL, which provides comparable success rates with fewer complications, especially when laser lithotripsy is used. The modified Valdivia position allows for a combined approach (i.e. Endoscopic Combined Intra-Renal Surgery [ECIRS]), associating flexible ureteroscopy (FURS), particularly for complex stones. The Holmium:YAG (Ho:YAG) laser is currently the reference technology in mini-PCNL. Its effectiveness is optimal with the use of 500μm fibers and high-power settings (>30W), providing appropriate energy density and promoting fragment mobilization through retropulsion and the Venturi effect. The Thulium Fiber Laser (TFL) is emerging as a promising alternative. It allows the use of smaller diameter fibers (200μm), with better fiber stability and effective energy density, while reducing costs during ECIRS since the same fiber can be used through both approaches. However, the available in the literature regarding its use in mini-PCNL remain limited. Similarly, mini-PNCL with pulsed Thulium:YAG has been reported in a single non-comparative study but could represent a safe and efficient compromise between Ho:YAG and TFL.
The French journal of urology. 2025 Nov [Epub]
Christophe Almeras, Frédéric Panthier, Steeve Doizi, Nadia Abid
URoSud, Clinique la Croix du Sud, Quint-Fonsegrives, France. Electronic address: ., Endolase Lab, GRC n(o) 20, Sorbonne Université, PIMM Lab Arts et Métiers ParisTech, 75020 Paris, France; Service d'Urologie, Assistance publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Endourology Technology Section of European Association of Urology (EAU), Arnhem, The Netherlands; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France., Endolase Lab, GRC n(o) 20, Sorbonne Université, PIMM Lab Arts et Métiers ParisTech, 75020 Paris, France; Service d'Urologie, Assistance publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Endourology Technology Section of European Association of Urology (EAU), Arnhem, The Netherlands., Service d'Urologie, Hôpital Édouard-Herriot, HCL Lyon, Lyon, France.