Retrograde intrarenal surgery versus percutaneous nephrolithotomy in larger kidney stones. Could SuperPulsed Thulium-fiber laser change the game?

[...]RIRS itself proved to be an effective modality for managing stones smaller than 2 cm in diameter with a decreased number of complications, blood loss, and shorter hospital stay [2]. [...]previous studies showed that RIRS is also acceptable for larger stones [3], but its efficacy could be limited by suboptimal visualization [4]. In preclinical studies, it was demonstrated that SP TFL produces higher stone ablation rates, three to four-times more dust, smaller stone fragments, when compared to Ho:YAG laser with similar laser parameters [6]. [...]SP TFL can operate within a large range of energy, frequency, and pulse duration settings which leads to wide and more comprehensive parameter combinations [5]. All patients underwent contrast-enhanced computed tomography (CT) of the urinary tract, performed by one experienced radiologist, to assess stone size and location, the number of calyces involved, and stone density (HU). According to local clinical practice, RIRS patients were 'pre-stented' 4-7 days before the surgery for further use of ureteral sheath (10-12 Fr, Cook, USA, and 11-13 Fr, Navigator HD, Boston Scientific, Marlborough, USA).