Evidence‑Based Power Settings for Renal Stone Laser Lithotripsy

European Association of Urology (EAU) Guideline Recommendations

High‑power laser settings (up to 120 W) shorten the active lasering time but do not improve stone‑free rates, morbidity, or mortality; therefore the EAU recommends using the lowest power that achieves effective fragmentation to avoid unnecessary thermal risk【1】【2】【3】.
The 2025 EAU guideline explicitly states that complete stone removal is the primary goal regardless of the laser power used, emphasizing that higher power is not a surrogate for better clinical outcomes【1】【2】【3】.
No absolute maximum power limit is defined in the current EAU guidance; instead, clinicians are advised to employ “reasonable” power values that keep intrarenal temperature rise within safe limits, thereby minimizing thermal injury【1】【2】【3】.

Although high‑power Ho:YAG settings can reduce total lasering time, they have not been shown to increase stone‑free rates or improve patient outcomes compared with lower‑power settings【1】【2】【3】.
In patients with 1–2 cm renal stones, 30 W Ho:YAG devices are safe and provide higher stone‑free rates and fewer auxiliary procedures than 20 W devices, supporting the use of modestly higher power when clinically appropriate【1】【2】【3】.
Consistent with the EAU guideline, power should be kept at “reasonable” levels to limit heat generation during Ho:YAG lithotripsy【1】【2】【3】.

The thulium fiber laser demonstrates efficacy comparable to the Ho:YAG laser for renal stone fragmentation, allowing it to be used interchangeably in guideline‑based practice【1】【2】【3】.

Medical expulsive therapy with α‑blockers after laser lithotripsy facilitates stone passage and reduces the frequency of renal colic episodes, supporting its routine use as an adjunctive measure【1】【2】【3】【4】.
Residual stone fragments can regrow in 21 %–59 % of patients following laser lithotripsy, underscoring the importance of achieving complete clearance during the initial procedure【4】.