COMPARATIVE EFFICACY AND SAFETY OF HOLMIUM AND THULIUM LASERS IN UROLOGICAL PROCEDURES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Benign prostatic hyperplasia and urolithiasis are prevalent urological diseases requiring surgical intervention.  This systematic review and meta-analysis aimed to compare the efficacy and safety of holmium versus thulium lasers in urological procedures, focusing on operating time, hemoglobin decrease, postoperative complications, catheterization duration, hospital stay, stone-free rates, and surgical efficiency. Patients and Methods: PubMed, Science Direct, and Cochrane Library were searched systematically.  Inclusion criteria comprised individuals with urological complications requiring surgery, with holmium supplied to the experimental group and thulium to the control group.  The CASP technique assessed study quality.  Random-effects models were applied using R software version 4.4.2. Twenty-two studies were included.  Operative time indicated no significant variation across lasers (SMD 0.18; 95% CI: -0.34 to 0.71).  Thulium lasers were associated with higher stone-free rates for renal stones (92% vs. 67% in Ulvik et al.; 94.9% vs. 90.9% in Mahajan & Mahajan).  Thulium was associated with lower acute urinary retention rates (2.1% vs. 15.2%), reduced intraoperative bleeding (5% vs. 22%), and decreased hemoglobin loss (0.45 g/dL vs. 2.77 g/dL in Bozzini et al.).  Catheterization time and hospital stay were comparable.  Significant heterogeneity (I² > 90%) was detected across various outcomes, while funnel plots revealed no considerable publication bias.  Both lasers are effective and safe for urological procedures.  While thulium may offer advantages in stone-free rates and reduced bleeding, no significant differences were observed in operational time, functional results, or hospital stay.  Laser selection should be driven by clinical conditions rather than overall superiority.