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MP were used at the University Hospital of Geneva, while IP were used at the University Hospital of Zurich. Patient demographics, stone characteristics, and procedural details were collected. Primary outcome was postoperative ureteral stricture (US). Secondary outcome was stone-free rate (SFR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 158 patients were analyzed, 79 in each group. Demographics were similar between the two groups, except for a lower pre-stenting rate in the MP group (56% vs. 91%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and a higher rate of ureteral access sheath use in the MP group (65% vs. 44%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). No significant differences in stone burden (median stone diameter 9\u00a0mm, median stone volume 267 mm\n                      <jats:sup>3<\/jats:sup>\n                      ), nor in the rate of impacted ureteral stones (29% vs. 34%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.49). Mean power, maximal power, frequency settings, and energy consumption were significantly higher in the MP group. US rate was 11% in MP group compared to 1% in IP group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). MP were a significant predictor of US on multivariable analysis (OR 12.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), independently from impacted ureteral stones. No difference in SFR between groups (85% and 84%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.67).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-power, high-frequency laser settings from manufacturer laser presets increase the risk of US, without improving SFR. Future studies shall further evaluate optimal laser settings depending on patient characteristics and intraoperative situation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05553-0","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T03:36:34Z","timestamp":1744947394000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["With great power comes great risk: High ureteral stricture rate after high-power, high-frequency Thulium fiber laser lithotripsy in ureteroscopy"],"prefix":"10.1007","volume":"43","author":[{"given":"Riccardo","family":"Villani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibaut Dominique","family":"Liernur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8963-5445","authenticated-orcid":false,"given":"Olivier Laurent","family":"Windisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1059-2340","authenticated-orcid":false,"given":"Massimo","family":"Valerio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian Thierry","family":"Schoofs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9758-6225","authenticated-orcid":false,"given":"Jia-Lun","family":"Kwok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-7963","authenticated-orcid":false,"given":"Alba","family":"Sierra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8866-8010","authenticated-orcid":false,"given":"Daniel","family":"Eberli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Iselin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-3803","authenticated-orcid":false,"given":"Olivier","family":"Traxer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1667-7609","authenticated-orcid":false,"given":"Etienne Xavier","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"5553_CR1","doi-asserted-by":"publisher","unstructured":"Geraghty RM, Jones P, Somani BK (2017) Worldwide trends of urinary stone disease treatment over the last two decades: A systematic review. 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