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Objective: To evaluate the new thulium fiber laser (TFL) from Quanta System (Fiber Dust™) in terms of efficiency, safety, and laser settings in laser lithotripsy during retrograde intrarenal surgery (RIRS)., Methods: A prospective study of the first 50 patients with ureteral and renal stones who underwent RIRS using the new Fiber Dust (TFL from Quanta System, Italy) was performed in a single center. 200 µm and 150 µm laser fibers were used. Stone size, stone density, laser-on time (LOT) and laser settings were recorded. We also assessed the ablation speed (mm 3 /s), Joules/mm 3 and laser power (W) values for each procedure., Results: A total of 50 patients were analyzed. The median (IQR) age was 54.5 (43-65) years old. Median (IQR) stone volume was 347 (147-1800) mm 3 and 1125 (294-4000) mm 3 for ureteral and renal stones, respectively. Median (IQR) stone density was 900 (400-1500) HU for ureteral stones and 950 (725-1125) HU for renal stones. Median (IQR) pulse energy was 0.6 (0.5-1) J and 0.6 (0.5-0.9) J for ureteral and renal stones, respectively. Median (IQR) frequency for ureteral stones was 10 (10-20) Hz and for renal stones, 15 (10-20) Hz. All procedures used short pulse. There were no statistically significant differences in pulse energy, frequency, laser power or LOT in both groups. The median (IQR) J/mm 3 was 8.7 (4.8-65.2) for ureteral stones vs 14.3 (7.8-24.7) for renal stones. The median (IQR) ablation rate was 0.3 (0.2-1.3) mm 3 /s for ureteral stones vs 0.7 (0.4-1.2) mm 3 /s for renal stones. Neither of those results reached the significance threshold. Overall complication rate was low in both groups, and none was related to TFL., Conclusion: According to our results, the new TFL laser is safe and effective for lithotripsy during RIRS, using low pulse energy and low pulse frequency., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Since the construction of the first laser, many companies around the world have contributed to the development of new lasers technologies. To be user-friendly, some companies have developed a pre-setting mode in their laser devices. We aimed to review and compare all laser companies' pre-settings (PS) already established in the market., Materials and Methods: An online search of holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) devices was carried out. Manual and PS mode, pulse width and pulse modulation technology data were collected. The PS parameters were collected directly from the brochure devices or by asking the companies consulting agents., Results: Thirty-nine laser devices were analyzed (33 Ho:YAG and 6 TFL). The power range varies from 15 to 152 W and 35 W to 60 W for Ho:YAG and TFL, respectively. PS are present in 66% of Ho:YAG lasers and the 33% of TFL. Long-pulse modes can be modified in 12 Ho:YAG and 1 TFL lasers. The median (IQR) PS for dusting stones with Ho:YAG laser is 0.4 J (0.2-1), 21.5 Hz (5-120), and 10 W (1.5-28) for energy, frequency and power, respectively; for Ho:YAG fragmentation is 0.8 J (0.3-5), 10 (3-15) Hz and 5 (1.5-50) W for energy, frequency, and power, respectively; and for popcorn is 0.8 J (0.4-1.2), 10 Hz (6-15) and 5 W (4-18) for energy, frequency, and power, respectively. Dusting and fragmentation mode of Rocamed MH01 and EMS LaserClast 35 are programmed according to the stone type. Most of these settings do not depend on the size of the fiber being used nor the location and type of stone. For TFL, the pre-sets are divided in bladder stone, dusting, fine dusting, fragmentation, and ureteral stone., Conclusion: There is a huge variability regarding pre-sets offered by companies because there is no consensus. Pre-sets should provide a range to work efficacy and safety., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)