Thulium fiber laser (TFL) provides high ablation rate, and less stone retropulsion. The goal of
this study was to investigate the safety and efficacy of flexible ureteroscopy (FURS) with TFL
lithotripsy for management of renal staghorn stones.

Thulium fiber laser (TFL) provides high ablation rate, and less stone retropulsion. The goal of
this study was to investigate the safety and efficacy of flexible ureteroscopy (FURS) with TFL
lithotripsy for management of renal staghorn stones.
METHODS: Sixty patients with staghorn renal stones were recruited. Stone width, length,
volume, shape and density were assessedusing preoperative CT scan. A single-use FURS
(OTU) was utilized. Lithotripsy was done using TFL delivered via 200 μm fiber. The primary
outcome was to assess stone free rate (SFR) that was classified into: Grade A (no residual
fragments (RF), Grade B: clinically insignificant RF ≤ 2 mm and Grade C: sizable RF >2mm.
Secondary outcomes included: postoperative complications, hospital stay and TFL efficiency
measures.
RESULTS:
The mean patient age was 41.7±9.3. Four patients were on anticoagulants. Complete staghorn
stones were seen in 15 (25%) patients. The median stone width and volume were 28 (21-32.7)
mm and 11535 (3183-53838) mm3
, respectively. Median operative and lasing time were 140
(70-270) and 120 (50-260) minutes, respectively. The median ablation speed was 1.53 (0.5-4.9)
mm3/sec (Table1).
A total of 17 complications occurred in 12 patients (25%), all were of minor grades. After the first
session, 28 patients (46.7 %) were stone free with no RF while 14 (23%) were Grade B (RF ≤ 2
mm) and 18 (30%) had RF > 2 mm (Grade C) (Figure 1). A second intervention was needed in
10 cases.The overall SFR (zero fragments) after completion of treatment was 63.3%.

CONCLUSIONS: Flexible ureteroscopy with TFL lithotripsy emerges as a highly effective and
reliable alternative for treating staghorn stones, offering stone-free rates comparable to
traditional PCNL. This approach boasts minimal morbidity, reduced blood loss, and a
significantly shorter recovery period, making it a favorable option for patients seeking a less
invasive treatment with excellent outcomes

The mean patient age was 41.7±9.3. Four patients were on anticoagulants. Complete staghorn
stones were seen in 15 (25%) patients. The median stone width and volume were 28 (21-32.7)
mm and 11535 (3183-53838) mm3
, respectively. Median operative and lasing time were 140
(70-270) and 120 (50-260) minutes, respectively. The median ablation speed was 1.53 (0.5-4.9)
mm3/sec (Table1).
A total of 17 complications occurred in 12 patients (25%), all were of minor grades. After the first
session, 28 patients (46.7 %) were stone free with no RF while 14 (23%) were Grade B (RF ≤ 2
mm) and 18 (30%) had RF > 2 mm (Grade C) (Figure 1). A second intervention was needed in
10 cases.The overall SFR (zero fragments) after completion of treatment was 63.3%.

CONCLUSIONS: Flexible ureteroscopy with TFL lithotripsy emerges as a highly effective and
reliable alternative for treating staghorn stones, offering stone-free rates comparable to
traditional PCNL. This approach boasts minimal morbidity, reduced blood loss, and a
significantly shorter recovery period, making it a favorable option for patients seeking a less
invasive treatment with excellent outcom