This kind of studies and papers have gain lots of attention as we need to be careful with the use of new laser technologies. This interesting and practical paper focuses on ways we can make our surgeries safer.

First, the use of small laser fibres allows for lower intra-renal temperature profiles. When using the fiber make sure it is always on the field of view (this is why we also recommend cutting the transparent tip). Ensure constant irrigation and constant flow. Also be aware of keeping avoiding very high-power settings during RIRS, specially at the expense of frequency.

We still need more evidence to suggest which laser is better for each case, but they have to be handled with care. Remember to always use low energy in the ureter. In summary, a must read.

The most recent innovation for laser lithotripsy is the pulsed Thulium YAG laser. As it has a mid-peak power is considered the “in the middle” laser that allows good performances as Holmium and Thulium fiber. This systematic review showed that there are only few papers that have evaluated such technology. The studies, most in-vitro, showed that compared to Ho:YAG it may potentially be equivalent regarding ablated stone weight. Also, an important fact is that temperatures have been equivalent to Holmium in such studies. In terms of coagulation, it also may be greatly effective (maybe better than Holmium) as lower peak power lasers coagulate better. What is clear is that we need more information regarding technical aspects and clinical studies.

We are aware that ureteral stents are related to high rates of bothersome. This study used Bayesian network meta-analysis that stratified the effectiveness of several medical therapies from the available evidence regarding pharmacological management of such symptoms. Although it is a high prevalent problem only 26 studies were adequate for evaluation.

This method that runs simulations revealed that the most effective drugs and dosages for urinary symptoms-combined was silodosin 8 mg+solifenacin 10 mg; for pain-combined silodosin 8 mg+solifenacin 10 mg; for sexual performance-tadalafil 5 mg. Combined silodosin 8 mg+solifenacin 10 mg+tadalafil 5 mg has the best general health scores while solifenacin 10 mg had the best work experience scores. Now you know which combinations are best for your patients.