Holmium and Thulium Laser Fiber Guide for Urology Departments

Core size and what it changes

The core diameter is the thin glass or silica heart of the fiber. Typical urology fibers range from about 150 µm to 550 µm. Small cores, around 150 to 272 µm, bend more easily in a flexible ureteroscope, leave more room for irrigation and suit dusting at lower energies. Larger cores, such as 365 or 550 µm, deliver higher energy and are more robust, which is useful for fragmentation and enucleation.

There is no single best size. Match the core to the procedure, the scope channel and the laser settings. COBRA, for instance, has a 2.4 Fr laser channel suited to fibers up to 365 µm, while enucleation usually uses a thicker fiber through a resectoscope.

• Around 150 to 272 µm: flexible scopes, dusting, better irrigation
• Around 365 µm: general-purpose lithotripsy
• Around 550 µm: enucleation and soft tissue, more robust

Reusable vs single-use laser fiber

A single-use fiber is delivered sterile, which removes reprocessing and risk of damaged tips from earlier cases. A reusable laser fiber is cleaned, inspected, re-cleaved and sterilised between cases, and lowers the cost per case when volumes are high but requires reprocessing capacity and staff training.

The decision depends on case volume, sterile processing capacity and your quality system. Ask for the supplier’s data on the number of reuses allowed and the inspection procedure. The Pulvis 60+ accepts disposable and reusable fibers from 150 to 1,000 µm, while the MegaPulse 70+ detects the sterile fiber and its diameter by RFID.

Stripping and cleaving: preparing the fiber

Before use, the protective coating is stripped from the end so the bare fiber can emit light cleanly, and the end is cleaved with a ceramic or diamond tool to produce a flat face. A poorly cleaved or burnt tip scatters energy, heats up and can damage the scope channel.

Fibers should be inspected for burn-back and cleaved again as needed. Never fire the laser with the tip inside the scope channel. Follow the manufacturer’s instructions for the minimum protrusion beyond the scope tip, and use protective eyewear for the team, as described in our laser safety guide.

Holmium vs thulium fiber and selection by procedure

A holmium laser fiber delivers 2100 nm pulses through a silica fiber. A thulium laser fiber is the delivery fiber for a thulium laser; thulium fiber lasers can use a very small core and are used for dusting and soft tissue. The choice of laser is covered in our thulium vs holmium laser comparison.

By procedure: flexible ureteroscopy favours smaller cores; semi-rigid ureteroscopy allows a wider choice; PCNL and enucleation commonly use thicker fibers. See holmium laser settings for how fiber size interacts with energy and frequency.

Planning fiber inventory and supply

Estimate annual cases, then multiply by fibers per case, allowing for failures and a safety stock of the sizes you use most. Standardise on two or three core sizes to simplify purchasing. Confirm that the fiber connector matches the laser and that the fiber is listed by the laser manufacturer as compatible.

Beckfinity can advise on fiber and consumables for your laser and scope combination. Contact us through the contact page for a quote.