Ersin GÖKMEN, Türker ALTUNTAŞ, Abdul Vahap BAKIR, Kaan DERİCİ, Günal ÖZGÜR, Tarık Emre ŞENER
Journal of Urological Surgery - 2026;13(3):212-219
Objective: To evaluate outcomes of mini-percutaneous nephrolithotomy (PCNL) performed with holmium:YAG (Ho:YAG) versus thulium fiber laser (TFL). Materials and Methods: This retrospective study included adult patients who underwent mini-PCNL with either Ho:YAG or TFL between January 2024-2025. Demographic features, stone characteristics, operative parameters, and postoperative outcomes were analysed. All surgeries were performed by a single surgeon using the modified supine position. Residual fragments were assessed on postoperative day 1, and stones >=4 mm were considered significant. Patients were divided into two groups based on the laser system, and outcomes were compared across clinical, perioperative, and postoperative variables. Results: Eighty-six patients underwent mini-PCNL (44 Ho:YAG, 42 TFL). Of the 86 patients included in the study, 64 (74.4%) were male and 22 (25.6%) were female. The median age was 52.5 years (range: 27-76). Baseline and operative parameters were comparable between groups. Stone-free rates were similar (81.4% vs. 88.1%). The thulium group showed lower radiation exposure in stones <3 cm (p=0.028) but a slightly higher postoperative creatinine change (p=0.033). Both lasers demonstrated equivalent efficacy and safety. Conclusion: Ho:YAG and TFL demonstrate comparable safety and efficacy in mini-PCNL. TFL may offer a technical advantage by reducing radiation exposure, particularly in patients with smaller stone burdens, while overall outcomes remain similar. These results support TFL as a reliable, modern alternative to Ho:YAG, with both lasers providing safe and effective energy options for mini-PCNL.
