{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:06:02Z","timestamp":1774951562430,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This meta-analysis aimed to compare the clinical efficacy and safety of the Thulium fiber laser (TFL) and Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) laser for ureteroscopic lithotripsy, considering the distinct technical characteristics of these two systems. Materials and Methods: Following the PRISMA guidelines and PROSPERO registration (CRD42023461573), a systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted through August 2025. We included randomized controlled trials and non-randomized comparative studies comparing TFL and Ho:YAG laser in patients undergoing ureteroscopic management for urolithiasis. The primary outcomes were the stone-free rate (SFR) and complication rates (intraoperative and postoperative). Results: Thirteen studies involving 2217 patients were included. Overall, the TFL group demonstrated a significantly higher SFR compared to the Ho:YAG group (OR = 1.57, 95% CI 1.20\u20132.06, p = 0.001). In subgroup analysis, TFL showed superior SFR compared to Ho:YAG without pulse modulation (OR = 1.69, p = 0.01) and comparable efficacy to Ho:YAG with pulse modulation (OR = 1.52, p = 0.24). Regarding safety, no significant difference was observed in the intraoperative complication rate (OR = 0.77, 95% CI 0.35\u20131.70, p = 0.52) or the postoperative complication rate (OR = 1.02, 95% CI 0.65\u20131.60, p = 0.93) between the two groups. Conclusions: TFL provides a superior SFR compared to the Ho:YAG laser overall, a benefit primarily driven by its significant outperformance of standard Ho:YAG systems without pulse modulation. Importantly, TFL demonstrates comparable efficacy to modern Ho:YAG systems equipped with pulse modulation. The safety profile of TFL, including intraoperative and postoperative complications, is comparable to that of the Ho:YAG laser. Our findings suggest that TFL is a highly effective and safe modality for ureteroscopic lithotripsy, offering distinct advantages over standard Ho:YAG lasers while performing comparably to the latest pulse-modulated systems.<\/jats:p>","DOI":"10.3390\/medicina62040644","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:40:52Z","timestamp":1774878052000},"page":"644","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thulium Fiber Laser Versus Holmium Laser for Ureteroscopic Lithotripsy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1996-6249","authenticated-orcid":false,"given":"Hyun Kyu","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Urology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Yong","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4711-772X","authenticated-orcid":false,"given":"Young Joon","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Urology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-7336","authenticated-orcid":false,"given":"Dong Hyuk","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Urology, Inha University College of Medicine, Incheon 22332, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-585X","authenticated-orcid":false,"given":"Hae Do","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Westmead Hospital, Westmead, NSW 2145, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-5109","authenticated-orcid":false,"given":"Kwang Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3470-1767","authenticated-orcid":false,"given":"Joo Yong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Westmead Hospital, Westmead, NSW 2145, Australia"},{"name":"Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"},{"name":"Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4111\/icu.20230102","article-title":"Korean society of endourology and robotics (kser) recommendation on the diagnosis, treatment, and prevention of urolithiasis","volume":"64","author":"Jung","year":"2023","journal-title":"Investig. 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