Ureteral Stricture Rates after Ho:YAG vs TFL Ureteroscopic Laser Lithotripsy: A Database Analysis

Purpose The goal of our study is to identify the incidence of ureteral strictures after ureteroscopic laser lithotripsy (ULL) with the TFL compared to the Ho:YAG laser. Methods In a nationally representative de-identified aggregate electronic health record database (Truveta Inc.), we studied subjects ≥ 18 years of age who underwent ULL between 2020 and 2024 with at least 3 months of follow up. Subjects were split into a Ho:YAG and TFL cohort. The incidence of ureteral strictures at 6 months was the primary outcome. Results There were 5,922 subjects in the Ho:YAG cohort and 541 in the TFL cohort. 93.2% of the Ho:YAG cohort underwent ULL with a Moses™ fiber. TFL use approximately doubled the rate of stricture formation compared to the Ho:YAG laser at 6 months (5.7% vs 2.8% (p = < 0.001)). Multivariate analysis controlling for relevant variables found that TFL use had an adjusted relative risk of 2.09 (95% CI 1.41, 3.01) for ureteral stricture formation. When a sub-group of Moses Ho:YAG subjects were evaluated against TFL, the adjusted relative risk remained significant at 2.14 (95% CI 1.45, 3.07). Conclusion This large database analysis found approximately double the rate of ureteral strictures with the TFL compared to the Ho:YAG laser on multivariate analysis. Similar findings are seen in a subgroup analysis comparing Moses Ho:YAG to TFL, with the assumption that this compares lasers with similar power and settings.