Table 1.

Summary of the advances or technical aspects of laser lithotripsy, its complications, and their prevention

	Advancement or technical aspect	Benefit	Verdict
Laser lithotripters	Long pulse length (pulse duration or pulse width)	• Less fiber tip degradation • Less stone retropulsion • Smaller residual fragments • Ideal for “dusting”	Gradual rise in its use
	Moses effect (modulated laser pulse)	• More ablative (in vitro) • Less retropulsion	• No significant difference between lasing and procedural time in vivo • Limited availability (one manufacturer) • Costly
	Burst laser lithotripsy	• Greater ablation volume	• Likely to be used more often • Limited availability (one manufacturer)
	Thulium laser (pulsed)	• More ablative than Ho:YAG • Less retropulsion	• New technology • Very limited availability • Lack of clinical studies
Laser fibers	Ball tip fiber	• Easier insertion in deflected scope	• Initial benefit lost after a few seconds with degradation
	Tip cleaving tools	• All were equivalent	• Simple scissors are equally effective
	Leaving fibers coated	• Greater stone ablation • Easier to pass in the scope • Safer than stripped fiber	• More advantageous than stripped fibers in several categories
	Stripping of fibers	• Debatable higher stone ablation	• Significantly less advantages than coated fibers
Laser settings and technique	Fragmentation technique	• Faster ablation of primary stone	• Excellent for bladder or PCNL
	Dusting technique	• No fragments (dust) • No basketing • Decreased ureteral access sheath use	• Ablation itself takes more time, compensated by other time gains • Ultra-high-frequency lithotripters further shorten surgical time
	Pop-corning	• Ideal for multiple smaller stone fragments in an enclosed space Avoids endless chase of fragments	Helpful technique, complementing other lithotripsy methods
	Pop-dusting	• Similar to pop-corning, but creating more dust	• Helpful technique, complementing other lithotripsy methods
	Complication	Prevention
Laser safety and related complications	Fever, subcapsular hematoma	• Reduce operative time • Use low-pressure ureterorenoscopy Confirm negative urine culture
	Local thermal damage	• Never close irrigation • Intermittent laser use • Cooled irrigation if necessary
	Eye damage	• Use eye glasses (simple ones will do) • Avoid laser fibers near eyes
	Collateral instrument damage	• Keep fibers coated for better identification and regularly cleave them • Respect the safety distance between scope and laser fiber tip • Avoid passage of fibers through deflected scopes or else use BT fiber or at least a coated fiber