Silent Satisfaction and Improved Laser Ergonomics With TFL: A Prospective Randomized Controlled Trial Comparing SuperPulse Thulium Fiber Laser Versus High-power HoYAG With Moses for Flexible Ureteroscopy

Lucas B Vergamini; Willian Ito; Bristol B Whiles; Jill Smith; Mihaela E Sardiu; Donald Neff; David Duchene; Wilson R Molina

doi:10.1016/j.urology.2026.01.047

Silent Satisfaction and Improved Laser Ergonomics With TFL: A Prospective Randomized Controlled Trial Comparing SuperPulse Thulium Fiber Laser Versus High-power HoYAG With Moses for Flexible Ureteroscopy

Urology. 2026 Feb 4:S0090-4295(26)00084-1. doi: 10.1016/j.urology.2026.01.047. Online ahead of print.

Authors

Lucas B Vergamini¹, Willian Ito², Bristol B Whiles¹, Jill Smith³, Mihaela E Sardiu³, Donald Neff¹, David Duchene¹, Wilson R Molina⁴

Affiliations

¹ Department of Urology, The University of Kansas Health System, Kansas City, KS.
² Department of Urology, University of Texas Southwestern, Dallas, TX.
³ Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS.
⁴ Department of Urology, The University of Kansas Health System, Kansas City, KS. Electronic address: wmolina@kumc.edu.

PMID: 41651229
DOI: 10.1016/j.urology.2026.01.047

Abstract

Objective: To evaluate the clinical performance of the SOLTIVE SuperPulsed thulium fiber laser (TFL) compared to pulse-modulated Holmium:YAG (HoYAG) in flexible ureteroscopy for renal stones <2 cm, with a focus on efficiency, ergonomics, and surgeon experience, given the limited comparative U.S.

Methods: We performed a single-center prospective randomized controlled trial (September, 2022-September, 2024) of patients ≥18 years with stone burden <2 cm undergoing ureteroscopic lithotripsy. Participants were randomized 1:1 to SOLTIVE TFL or pulse-modulated HoYAG (Lumenis Pulse 120 H with MOSES 2.0). The primary endpoint was zero stone-free rate (SFR) on postoperative CT. Secondary endpoints included operative metrics, reintervention, fiber degradation, and surgeon-reported satisfaction and noise encumbrance. Statistical significance was set at P<.05.

Results: Eighty-three patients were analyzed (HoYAG: 47; TFL: 36). Groups were similar in demographics, stone characteristics, and operative time. SFRs were comparable (Zero-SFR: 51.3% vs 53.6%, P = 1.00; <2 mm: 66.7% vs 85.7%, P = .14; <4 mm: 82.1% vs 89.3%, P = .50). Fiber degradation was significantly lower with TFL (2.8% vs 21.3%, P = .02). Surgeon satisfaction favored TFL for handling, maneuverability, and dusting performance (all P<.001). TFL also yielded lower reported noise encumbrance across all measures (P<.001).

Conclusion: While SFR was equivalent, SOLTIVE TFL showed clear benefits in fiber durability, surgeon satisfaction, and intraoperative noise profile compared to high-power pulse-modulated HoYAG. These results support TFL as a preferred flexible ureteroscopy platform. Multicenter trials are needed to confirm generalizability.