{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T04:22:24Z","timestamp":1787458944629,"version":"build-2736575974"},"reference-count":43,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Urology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Thulium fiber laser (TFL) and high-power Holmium:Yttrium-Aluminum-Garnet laser (HPHL) are common laser modalities used in flexible ureteroscopy (F-URS). Existing comparisons are imperfect due to lack of randomization, use of obsolete low-power settings, and the recent advent of technologies such as flexible and navigable ureteral access sheaths (FANS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare the safety and efficacy of TFL versus HPHL for F-URS in renal stones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A PRISMA-compliant literature review was conducted on PubMed, EMBASE, Scopus and for randomized trials or propensity score-matched studies comparing TFL to HPHL in renal stones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>Primary outcomes were study-defined stone-free rate (SFR), as well as 100% SFR (zero residual fragments). Secondary outcomes were total operation time, all complications, bleeding complications, postoperative fever, and reintervention. Random-effects meta-analyses were performed to generate risk ratios (RRs) or mean differences (MDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Eight studies (1290 patients) were shortlisted for analysis. Only one utilized FANS; three did not routinely use ureteral access sheaths. Between TFL and HPHL, there was no significant difference in study-reported SFR (RR\u2009=\u20091.17, 95% CI\u2009=\u20090.98\u20131.40,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.07), 100% SFR (RR\u2009=\u20091.16, 95% CI\u2009=\u20090.90\u20131.50,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.19), total operation time (MD \u22121.0\u2009min, 95% CI\u2009=\u2009\u22128.8 to 6.8\u2009min,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.75), all complications (RR\u2009=\u20091.01, 95% CI\u2009=\u20090.54\u20131.87,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.97), bleeding complications (RR\u2009=\u20090.59, 95%CI\u2009=\u20090.01\u201323.3,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.60), postoperative fever (RR\u2009=\u20091.23, 95% CI\u2009=\u20090.68\u20132.24,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.27), and reintervention (RR\u2009=\u20090.72, 95% CI\u2009=\u20090.38\u20131.34,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.15).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This meta-analysis of high-quality studies found no significant differences between HPHL and TFL in the trifecta of outcomes\u2014SFR, complications, and reintervention\u2014in F-URS for renal stones. Continued re-evaluation of this field remains a necessity as technological advancements such as FANS and novel lasers continue to emerge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562872261467267","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:48:50Z","timestamp":1787284130000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Thulium fiber laser versus high-power holmium laser for renal stones: a systematic review and meta-analysis of high-quality studies"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-0800","authenticated-orcid":false,"given":"Khi Yung","family":"Fong","sequence":"first","affiliation":[{"name":"Department of Urology, Singapore General Hospital, Singapore, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jie","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Yeap","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingzeng","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Urology, Singapore General Hospital, Singapore, 31 Third Hospital Avenue, Singapore 168753, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin Wei Xiang","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Urology, Sengkang General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung Wen","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Urology, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palaniappan","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Department of Urology, Sengkang General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2025.03.011"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-016-1881-8"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2017.0253"},{"key":"e_1_3_4_5_2","article-title":"Ureteroscopy is equally efficient and safe in obese and morbidly obese patients: a systematic review and meta-analysis","volume":"9","author":"Wang W","year":"2022","unstructured":"Wang W, Gao X, Peng L, et al. Ureteroscopy is equally efficient and safe in obese and morbidly obese patients: a systematic review and meta-analysis. 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Comparison of thulium fiber laser and holmium:YAG laser lithotripsy in retrograde intrarenal surgery for kidney Stone treatment: a randomized prospective study. Actas Urol Esp (Engl Ed) 2025; 49(8): 501808.","journal-title":"Actas Urol Esp (Engl Ed)"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-023-04651-1"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2022.02.027"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.JU.0001111604.90306.91.10"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2025.0036"},{"issue":"30","key":"e_1_3_4_29_2","first-page":"2307","article-title":"[Comparison of the efficacy of thulium fiber laser and holmium laser lithotripsy in the treatment of upper urinary tract stones]","volume":"103","author":"Xu LW","year":"2023","unstructured":"Xu LW, Yu CH, Hu HY, et al. 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