Thulium fibre laser (TFL) lithotripsy in paediatric urology

We share our early experience with the thulium laser fibre (TFL) for ureterorenoscopic lithotripsy in paediatric renal stone disease. We demonstrate cystoscopic access to the bladder, ureter and upper tract with stone-dusting to achieve a stone-free upper tract, with video-labelling, audio guidance and technical insights.

Our first case involved a 14-year-old girl with bilateral small intra-calyceal calculi causing severe pain. Using TFL endoscopic lithotripsy, nine calculi were disintegrated in under 30 min. The second case was a 5-year-old boy with a single 7 mm lower pole calculus. Access to the ureter was difficult in the first instance, so a JJ stent was left in situ for passive dilatation. On second attempt the calculus was successfully destroyed.

Following the application of TFL, both patients were discharged in under 24 h. In both instances, JJ stents were left in situ. The second patient experienced self-resolving haematuria three days after the procedure. Follow-up ultrasound at 3 months showed that both patients are stone free.

TFL lithotripsy offers a potentially superior stone-free rate to Holmium yttrium–aluminium–garnet (Ho:YAG). Operative time and hospital stay were markedly reduced. In this context, we share insights through guided videos on our experience with this innovative technology. It holds promise in paediatric urology and could enhance modern stone management.