This review aims to comprehensively evaluate the impact of solid-state pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser technology in endourology. Special focus is given to its application in laser lithotripsy and endoscopic enucleation of the prostate (EEP), comparing it with established technologies such as holmium:YAG (Ho:YAG) and thulium fiber laser (TFL).
Recent in vitro and clinical studies suggest that p-Tm:YAG offers high ablation efficiency, low retropulsion, and versatility in both stone fragmentation and soft tissue surgery. In laser lithotripsy, p-Tm:YAG has demonstrated comparable or superior dusting and fragmentation outcomes across multiple stone compositions. Clinical studies in ureteroscopy and mini-percutaneous nephrolithotomy (mini-PCNL) have confirmed its safety, high stone-free rates (up to 95%), and reduced lasering time. For prostate enucleation, the technology enables precise tissue dissection with strong hemostatic control, as evidenced by high enucleation speed, low complication rates, and excellent functional outcomes. However, evidence in oncologic applications such as upper tract urothelial carcinoma remains limited to a single case report, with no data on long-term oncological safety.
p-Tm:YAG lasers represent a significant advancement in urological laser surgery, effectively bridging the performance gap between historical Ho:YAG and TFL. While promising results have been observed in stone and prostate surgery, high-quality randomized trials and long-term outcome data are still needed to validate its superiority and expand its clinical indications.
Current opinion in urology. 2025 Oct 30 [Epub ahead of print]
Daniele Robesti, Stefania La Rezza, Olivier Traxer, Ioannis Kartalas Goumas, Eugenio Ventimiglia
Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele., Università degli Studi di Bologna, Medicine and Surgery Graduate Course., Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.