Laser technology represents one of the most significant advances in endourology over the past three decades. In particular, endoscopic stone management has undergone an important transformation via continuous cutting-edge innovations that have reshaped clinical practice for lithotripsy.

Holmium:YAG (Ho:YAG) has been considered the gold-standard laser for lithotripsy over the past 30 yr thanks to its efficacy and safety profile [1]. In addition to Ho:YAG improvements, other lasers have emerged for endourological lithotripsy, such as thulium fiber laser (TFL) [1] and the latest pulsed thulium:YAG (p-Tm:YAG) [2].

p-Tm:YAG laser seems to represent an excellent middle ground between Ho:YAG laser and TFL as it is suitable for lithotripsy and soft-tissue applications and has the advantages of both technologies.

Currently, two p-Tm:YAG laser machines are commercially available. The RevoLix-HTL (LISA Laser, Katlenburg-Lindau, Germany), which can operate in both pulsed and continuous-wave modes, was the first to be introduced with a peak power of 1.3 kW. A more recent development is, the Thulio system (Dornier MedTech, Weßling, Germany), a purely solid-state pulsed-wave Tm:YAG laser that offers significantly higher peak-power output (3.7 kW) [3].

The aim of this mini review is to summarize the evidence for lithotripsy with this new laser technology.