The holmium:yttrium aluminum garnet (Ho:YAG) laser is the most common type of laser used for lithotripsy and laser enucleation of the prostate and has been used for over ten years and is considered the gold standard. However, with novel developments in laser technology, different laser types for lithotripsy and laser enucleation are now attracting attention.
Study: Preclinical comparison of a novel pulsed solid-state P-Tm:YAG laser versus TFL & Ho:YAG technologies
A novel pulsed thulium:yttrium aluminum garnet laser (p-Tm:YAG) has recently emerged, which is not to be confused with the continuous wave (CW)-Tm: YAG’s and Thulium fiber laser’s (TFL) technology. These laser technologies used in urology offer different emission wavelengths, resulting in different water absorption and thus slightly varying laser-tissue interaction (see Table 1).
The lowest water absorption coefficient among these lasers has the Ho:YAG laser technology, followed by the p-Tm:YAG laser with about twice the absorption and the TFL laser technology with about four times the absorption compared to the Ho:YAG laser technology. This results in a lower penetration depth for p-Tm:YAG of about 0.3 mm and for TFL of about 0.2 mm compared to the gold standard Ho:YAG technology (~0.4 mm).
Overall, the preclinical studies demonstrated that the p-Tm:YAG laser was similar to Ho:YAG fragmentation behavior and TFL dusting performance for urinary stone disintegration. Additionally, the p-Tm:YAG demonstrated better fragmentation performance than TFL technology and better coagulation performance than Ho:YAG technology.