- 2026-03-10
- World journal of urology 44(1)
- Yiwei Zhang
- Lifeng Liu
- Xiaoyu Tang
- Ziqi He
- Zhilong Li
- Du Wang
- Lin Zhang
- Sheng Li
Study Design
- Type
- Meta-Analysis
- Sample size
- n = 441
- Population
- 5 RCTs comprised of 441 patients with ureteral stones
- Methods
- An electronic search of randomized controlled trials (RCTs) of TFL and Ho: YAG under URL for ureteral stones was conducted in PubMed, Embase, Web of Science (WOS), and Cochrane Library to retrieve relevant studies published from inception to March 21, 2025. Meta-analysis was conducted with software RevMan 5.4.1.
Objective/background
To evaluate the safety and efficacy of TFL and Ho: YAG laser in URL for Ureteral Stones.Methods
An electronic search of randomized controlled trials (RCTs) of TFL and Ho: YAG under URL for ureteral stones was conducted in PubMed, Embase, Web of Science (WOS), and Cochrane Library to retrieve relevant studies published from inception to March 21, 2025. Meta-analysis was conducted with software RevMan 5.4.1. The Protocol number is CRD420251021727 ( www.crd.york.ac.uk/PROSPERO ).Results
5 RCTs comprised of 441 patients were included. The TFL group had a higher Stone-free rate (SFR) (RR = 1.03, 95% CI 1.01 to 1.06, P = 0.02, analyzed with fixed-effects model) with acceptable heterogeneity (I2 = 47%), higher laser efficacy (MD=-5.38, 95% CI -5.83 to -4.93, P < 0.00001), shorter lasering time (MD=-5.06, 95% CI -6.53 to -3.59, P < 0.00001), and shorter operation time (MD=-7.16, 95% CI -11.11 to -3.20, P=0.0001) compared to the group of Ho: YAG. No statistical significance was shown regarding the hospital stay, endoscopic view quality, ablation speed, and energy consumption (P > 0.05). Nonetheless, the TFL group had a lower incidence of severe retropulsion (grade 2, Likert scale) (RR = 0.05, 95%CI 0.01 to 0.33, P = 0.002), and a lower risk of mucosal injury (RR = 2.42, 95%CI 1.30 to 4.51, P = 0.006). The incidence of other complications and adverse reactions was insignificant (P ＞0.05).Conclusion
TFL with URL showed significantly higher SFR and shorter operative times than Ho: YAG without increasing complications (Clavien I-III), it also reduced severe retropulsion (grade 2, Likert scale). Nonetheless, these conclusions should be validated through high-quality RCTs with a large sample.